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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. CXR of CHF
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
1st line: TZD
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools

2. Empiric CAP tx in hospitalized patient
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
= QT / sqrt(RR interval)

3. NMDA-R antagonist (memantine)
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Amitriptyline - propanolol - timolol - divalproex sodium
3rd month postpartum
Moderate/severe alzheimer dementia

4. epiglottitis
Neonate - infants - bilious vomiting - abdominal pain
Amiodarone/lidocaine
Bacterial infxn of supraglottic tissue and surrounding areas
Foot/leg deficits - cognitive + personality changes

5. Metabolic syndrome
Digoxin (B-blockers as needed)
Quinolone + metronidazole
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD

6. Galantamine use/sfx
10th postpartum day
Mass lesion - subdural hematoma - medication overuse
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
S. aureus

7. Cluster headache pflx
MVP
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Amitriptyline - propanolol - timolol - divalproex sodium
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

8. Croup
Viral infxn of the subglottis
Uterine atony
MVP
IV labetalol - nicardipine - sodium nitroprusside

9. Lochia
8%
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

10. If not breast-feeding - when does menstruation restart?
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
3rd month postpartum
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Fever - sore throat - muffled voice - drooling - trismus - neck pain

11. Chance of pregnancy after a single act of coitus
8%
Dicyclomine - hyoscyamine (antispasmodics)
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Flat disk - button - batteries

12. Tx HTN + post-MI
ACEI - B-blocker - spironolactone
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Temporal arteritis - mass lesion
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity

13. QTc
= QT / sqrt(RR interval)
Moderate/severe alzheimer dementia
Mass lesion - subdural hematoma - medication overuse
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

14. vertebrobasilar stroke sx
PCP pneumonia
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Colonoscopy

15. malignant hyperthermia
Alzheimer dementia
Viral infxn of the subglottis
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram

16. Cardiac Resynchronization Therapy (CRT) is warranted when ___
TCA's
Dantrolene IV - antipyretics - O2 - cooling blankets
ACEI - B-blocker - spironolactone
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy

17. Sx Lewy Body Dementia
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Foot/leg deficits - cognitive + personality changes
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

18. Sx HoCM
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Bacterial infxn of supraglottic tissue and surrounding areas
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.

19. TCA
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Amiodarone/lidocaine

20. Orlistat
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Furosemide - nitroglycerin - IV morphine sulphate

21. Tx HTN + CKD
Foot/leg deficits - cognitive + personality changes
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
ACEI - ARB

22. Statins
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

23. DDx Limp w/o pain in children - orthopedic
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
B-blocker - Ca-channel blocker
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
MVP

24. SNRI
Venlafaxine - duloxetine - mirtazapine
S. aureus
SCFE (slipped capital femoral epiphysis)
H. flu - S. pneumo - S. aureus - Strep A/B/C

25. IBS pain tx
'steeple-sign' (subglottic narrowing)
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Halothane - succinylcholine
5-HT blockers: tegasorad - alosetron

26. Pyloric stenosis sx

27. X-ray epiglottitis

28. MCC non-traumatic hip pathology in adolescents
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
SCFE (slipped capital femoral epiphysis)
'thumb sign' (protrusion of into anterior wall of hypopharynx)

29. Mastitis tx
Obesity; NE-uptake inhibition
Furosemide - nitroglycerin - IV morphine sulphate
Cephalexin OR dicloxacillin
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

30. Croup sx
Mass lesion - subdural hematoma - medication overuse
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Lumbar puncture

31. Retropharyngeal abscess Sx
Obesity; increased NE release
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Barium enema
Amoxicillin-clavulanate (augmentin) p.o 7-14 days

32. DDx postoperative fever
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
100% O2 6L/min - dihydroergotamine - triptans
Quinolone + metronidazole

33. Evaluating limp w/o pain in children
High K - high Ca - low Na
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Furosemide - nitroglycerin - IV morphine sulphate
Legionella

34. Tx HTN + DM
ACEI - ARB - B-blocker - diuretic - Spironolactone
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Venlafaxine - duloxetine - mirtazapine
ACEI - ARB - diuretic - Ca-blocker - B-blocker

35. 4 T's of postpartum hemorrhage
10th postpartum day
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Mass lesion - vascular malformation - stroke - collagen vascular disease
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)

36. Bite injury pflx
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Obesity; increased NE release
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Amoxicillin-clavulanate (augmentin) p.o 7-14 days

37. Intussusception sx
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
5-HT blockers: tegasorad - alosetron
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

38. SSRI's
Fiber (e.g. psyllium)
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Septic arthritis - fractures - congenital hip dysplasia

39. Pflx migraine
Dementia - incontinence - gait disturbance
Amitriptyline - propanolol - timolol - divalproex sodium
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)

40. atypical
Phenelzine - tranylcypramine
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Bupriopion - amoxipine - trazodone

41. Epiglottitis pathogens
H. flu - S. pneumo - S. aureus - Strep A/B/C
Halothane - succinylcholine
ACEI - B-blocker - spironolactone
8%

42. Sudden-onset headache DDx
Dementia - incontinence - gait disturbance
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
8%
Neonate - infants - bilious vomiting - abdominal pain

43. Tx HTN
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
1st line: TZD
TCA's
S. aureus

44. Tx HTN + CAD
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
ACEI - B-blocker - diuretic - Ca-blocker
Renal parenchymal disease
Lumbar puncture

45. Cholesterol absorption blocker (ezetimibe)
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
= QT / sqrt(RR interval)
Renal parenchymal disease

46. contraindications to thrombolytic therapy
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Colonoscopy
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy

47. Sx of pneumococcal pneumonia
Furosemide - nitroglycerin - IV morphine sulphate
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Bacterial infxn of supraglottic tissue and surrounding areas
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR

48. Malrotation sx
Dementia - incontinence - gait disturbance
8%
Eikenella species
Neonate - infants - bilious vomiting - abdominal pain

49. Bronchiolitis sx
Amitriptyline - propanolol - timolol - divalproex sodium
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Venlafaxine - duloxetine - mirtazapine
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

50. Headache with sx systemic illness DDx
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
ACEI - ARB - B-blocker - diuretic - Spironolactone
Obesity; increased NE release