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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. Cluster headache acute tx
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Viral infxn of the subglottis
Cephalexin OR dicloxacillin
100% O2 6L/min - dihydroergotamine - triptans

2. Croup
Viral infxn of the subglottis
Fasting blood glucose - LFTs - renal function - TSH
Quinolone + metronidazole
Obesity; increased NE release

3. 'Alarm' sx for upper GI endoscopy
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
10th postpartum day

4. Peritonsillar abscess Sx
Cephalexin OR dicloxacillin
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
Mass lesion - vascular malformation - stroke - collagen vascular disease
Fever - sore throat - muffled voice - drooling - trismus - neck pain

5. Bronchiolitis sx
Dementia - incontinence - gait disturbance
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
3 hours
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

6. Donepezil use/sfx
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

7. Primary SVT tx
3 hours
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
3rd month postpartum
B-blocker - Ca-channel blocker

8. Tx HTN + CAD
ACEI - B-blocker - diuretic - Ca-blocker
Amitriptyline - propanolol - timolol - divalproex sodium
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
TCA's

9. DDx Limp w/o pain in children - orthopedic
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
= QT / sqrt(RR interval)

10. New-onset headache in patient with HIV/cancer DDx
Meningitis - brain abscess - metastasis
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Foot/leg deficits - cognitive + personality changes

11. Sudden-onset headache DDx
H. flu - S. pneumo - S. aureus - Strep A/B/C
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Obesity; increased NE release

12. Malrotation sx
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Neonate - infants - bilious vomiting - abdominal pain

13. Bile acid sequestrants (cholestyramine - colestipol - colesevelam)
Phenelzine - tranylcypramine
Venlafaxine - duloxetine - mirtazapine
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400

14. Pflx migraine
Venlafaxine - duloxetine - mirtazapine
H. flu - S. pneumo - S. aureus - Strep A/B/C
Amitriptyline - propanolol - timolol - divalproex sodium
ACEI - diuretic

15. Sibutramine
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Moderate/severe alzheimer dementia
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Postpartum fever - uterine tenderness - foul-smelling lochia

16. Tx HTN + post-MI
Digoxin (B-blockers as needed)
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
High K - high Ca - low Na
ACEI - B-blocker - spironolactone

17. tx malignant hyperthermia
Dantrolene IV - antipyretics - O2 - cooling blankets
ACEI - diuretic
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Temporal arteritis - mass lesion

18. Lubiprostone
ACEI - ARB
Obesity; increased NE release
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea

19. GI 'alarm' features
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Bacterial infxn of supraglottic tissue and surrounding areas

20. X-ray epiglottitis

21. Headache after 50 YO DDx
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Mass lesion - subdural hematoma - medication overuse
Temporal arteritis - mass lesion
ACEI - ARB - B-blocker - diuretic - Spironolactone

22. atypical
Fasting blood glucose - LFTs - renal function - TSH
Cephalexin OR dicloxacillin
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Bupriopion - amoxipine - trazodone

23. Papilledema DDx
Mass lesion - subdural hematoma - medication overuse
ACEI - ARB
Mass lesion - pseudotumor cerebri - meningitis
Dicyclomine - hyoscyamine (antispasmodics)

24. Afib - Aflutter tx
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Digoxin (B-blockers as needed)
Meningitis - brain abscess - metastasis
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing

25. 1st line tx in IBS constipation
Fiber (e.g. psyllium)
Mass lesion - pseudotumor cerebri - meningitis
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

26. Empiric CAP tx in healthy person
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Cephalexin OR dicloxacillin
Amiodarone/lidocaine
Amoxicillin-clavulanate (augmentin) p.o 7-14 days

27. malignant hyperthermia
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Fiber (e.g. psyllium)
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.

28. Nicotinic acids
Furosemide - nitroglycerin - IV morphine sulphate
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.

29. Sx normal-pressure hydrocephalus
Fiber (e.g. psyllium)
Dementia - incontinence - gait disturbance
Obesity; increased NE release
1st line: IV oxytocin - bimanual uterine massage - 2nd line: methylergonovine IM (CI in HTN) - 3rd line: PGF2a (Hemabate) IM (CI in asthma) - 4th line: Misoprostol

30. CXR of CHF
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
B-blocker - Ca-channel blocker
PCP pneumonia
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea

31. Tx HTN + CHF
ACEI - ARB - B-blocker - diuretic - Spironolactone
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Obesity; NE-uptake inhibition

32. Tx HTN + CVA
ACEI - diuretic
8%
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

33. Sx endometritis
Postpartum fever - uterine tenderness - foul-smelling lochia
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia

34. DDx dementia
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Septic arthritis - fractures - congenital hip dysplasia

35. Headaches increasing in severity + intensity DDx
Mass lesion - subdural hematoma - medication overuse
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Lumbar puncture
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo

36. DDx pediatric intestinal obsutrction
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion

37. Retropharyngeal abscess Sx
Postpartum fever - uterine tenderness - foul-smelling lochia
1st line: TZD
ACEI - ARB - B-blocker - diuretic - Spironolactone
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress

38. Chance of pregnancy after a single act of coitus
S. aureus
8%
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
MVP

39. Sx Lewy Body Dementia
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Septic arthritis - fractures - congenital hip dysplasia
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
3rd month postpartum

40. most common valvular heart defect in USA
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
MVP
Colonoscopy

41. causes of malignant hyperthernia
B-blocker - Ca-channel blocker
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Halothane - succinylcholine
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement

42. Organism that causes pneumonia post-influenza
Obesity; increased NE release
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
S. aureus
Flat disk - button - batteries

43. MCC infxn in closed-fist injuries
Fasting blood glucose - LFTs - renal function - TSH
Eikenella species
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Septic arthritis - fractures - congenital hip dysplasia

44. Dx and Tx of intussception
Lumbar puncture
High K - high Ca - low Na
Barium enema
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

45. Tx local - acute rxn to bee sting
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Oral prednisone
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

46. 4 T's of postpartum hemorrhage
Quinolone + metronidazole
IV labetalol - nicardipine - sodium nitroprusside
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Obesity; increased NE release

47. NMDA-R antagonist (memantine)
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
= QT / sqrt(RR interval)
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Moderate/severe alzheimer dementia

48. Cholesterol absorption blocker (ezetimibe)
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
S. aureus
Postpartum fever - uterine tenderness - foul-smelling lochia

49. MCC postpartum hemorrhage
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Venlafaxine - duloxetine - mirtazapine
Uterine atony
Bacterial infxn of supraglottic tissue and surrounding areas

50. TCA
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Furosemide - nitroglycerin - IV morphine sulphate
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Amiodarone/lidocaine