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Family Medicine/ambulatory 2

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. 1st line tx in IBS constipation
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Fiber (e.g. psyllium)
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache

2. Chance of pregnancy after a single act of coitus
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Phenelzine - tranylcypramine
Fasting blood glucose - LFTs - renal function - TSH
8%

3. Cardiac Resynchronization Therapy (CRT) is warranted when ___
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Postpartum fever - uterine tenderness - foul-smelling lochia
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy

4. Sx endometritis
Fiber (e.g. psyllium)
Obesity; increased NE release
Postpartum fever - uterine tenderness - foul-smelling lochia
470ms+ in men - 480ms+ in women

5. Sibutramine
'steeple-sign' (subglottic narrowing)
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Fiber (e.g. psyllium)

6. Sx HoCM
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
8%
'thumb sign' (protrusion of into anterior wall of hypopharynx)

7. Cluster headache acute tx
1st line: TZD
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Obesity; increased NE release
100% O2 6L/min - dihydroergotamine - triptans

8. Stable vtach tx
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Amiodarone/lidocaine
PCP pneumonia
ACEI - B-blocker - diuretic - Ca-blocker

9. Tx HTN + DM
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Bupriopion - amoxipine - trazodone

10. MCA stroke sx
Venlafaxine - duloxetine - mirtazapine
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

11. Sx of pneumococcal pneumonia
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy

12. CXR of CHF
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Eikenella species

13. Organism that causes pneumonia with diarrhea
Legionella
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Postpartum fever - uterine tenderness - foul-smelling lochia

14. Refer to cardiologist post-sports physical if ____
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B

15. Prolonged QT interval (QTc)
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
470ms+ in men - 480ms+ in women
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD

16. Lochia
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Dantrolene IV - antipyretics - O2 - cooling blankets

17. ACA stroke ssx
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Foot/leg deficits - cognitive + personality changes
Furosemide - nitroglycerin - IV morphine sulphate
Digoxin (B-blockers as needed)

18. Dx and Tx of intussception
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
3 hours
1st line: TZD
Barium enema

19. ROME IBS criteria
PCP pneumonia
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance

20. Empiric CAP tx in healthy person
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Dicyclomine - hyoscyamine (antispasmodics)
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide

21. Evaluating limp w/o pain in children
ACEI - B-blocker - spironolactone
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
'thumb sign' (protrusion of into anterior wall of hypopharynx)

22. MCC infxn in closed-fist injuries
Lumbar puncture
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Eikenella species
1st line: TZD

23. Mastitis tx
Cephalexin OR dicloxacillin
TCA's
Obesity; increased NE release
Alzheimer dementia

24. Bronchiolitis sx
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Fever - sore throat - muffled voice - drooling - trismus - neck pain

25. Sx Lewy Body Dementia
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Dementia - incontinence - gait disturbance
Dantrolene IV - antipyretics - O2 - cooling blankets
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)

26. Diethylpropion
Obesity; increased NE release
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
= QT / sqrt(RR interval)
8%

27. Metabolic syndrome
Mass lesion - vascular malformation - stroke - collagen vascular disease
Viral infxn of the subglottis
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
'thumb sign' (protrusion of into anterior wall of hypopharynx)

28. IBS pain tx
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
5-HT blockers: tegasorad - alosetron
Eikenella species
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion

29. 'Alarm' sx for upper GI endoscopy
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Mass lesion - pseudotumor cerebri - meningitis
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity

30. Organism that causes pneumonia post-influenza
Fasting blood glucose - LFTs - renal function - TSH
S. aureus
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Venlafaxine - duloxetine - mirtazapine

31. Tx local - acute rxn to bee sting
Oral prednisone
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Postpartum fever - uterine tenderness - foul-smelling lochia
Digoxin (B-blockers as needed)

32. X-ray epiglottitis

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33. Tx HTN + CKD
Obesity; NE-uptake inhibition
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Cephalexin OR dicloxacillin
ACEI - ARB

34. Headaches increasing in severity + intensity DDx
TCA's
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Cephalexin OR dicloxacillin
Mass lesion - subdural hematoma - medication overuse

35. Papilledema DDx
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Mass lesion - pseudotumor cerebri - meningitis
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Obesity; increased NE release

36. Tx HTN + CVA
ACEI - diuretic
Temporal arteritis - mass lesion
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

37. Statins
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea

38. Baby blues resolves by ______
Obesity; increased NE release
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
10th postpartum day
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test

39. Rivastigmine
Alzheimer dementia
'steeple-sign' (subglottic narrowing)
Barium enema
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance

40. Headache with sx systemic illness DDx
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease

41. GI 'alarm' features
Dantrolene IV - antipyretics - O2 - cooling blankets
Temporal arteritis - mass lesion
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener

42. Cluster headache pflx
Mass lesion - pseudotumor cerebri - meningitis
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Lumbar puncture
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic

43. tx malignant hyperthermia
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
'steeple-sign' (subglottic narrowing)
Fasting blood glucose - LFTs - renal function - TSH
Dantrolene IV - antipyretics - O2 - cooling blankets

44. New-onset headache in patient with HIV/cancer DDx
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Meningitis - brain abscess - metastasis
3 hours
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone

45. Standard workup for dyslipidemia
H. flu - S. pneumo - S. aureus - Strep A/B/C
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Fasting blood glucose - LFTs - renal function - TSH
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

46. most common valvular heart defect in USA
MVP
Foot/leg deficits - cognitive + personality changes
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
= QT / sqrt(RR interval)

47. Dx subarachnoid hemorrhage with negative noncontrast CT
Lumbar puncture
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

48. MAOI
Colonoscopy
Moderate/severe alzheimer dementia
Dicyclomine - hyoscyamine (antispasmodics)
Phenelzine - tranylcypramine

49. Bile acid sequestrants (cholestyramine - colestipol - colesevelam)
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone

50. Tx frequent/severe abd pain

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