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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.
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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. Tx HTN + CHF
Mass lesion - subdural hematoma - medication overuse
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
ACEI - ARB - B-blocker - diuretic - Spironolactone
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement

2. Tx migraine
Digoxin (B-blockers as needed)
470ms+ in men - 480ms+ in women
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Barium enema

3. Phentermine
Obesity; NE-uptake inhibition
Quinolone + metronidazole
High K - high Ca - low Na
Lumbar puncture

4. CXR of CHF
Cephalexin OR dicloxacillin
MVP
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
ACEI - B-blocker - spironolactone

5. malignant hyperthermia
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
10th postpartum day
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity

6. Tx local - acute rxn to bee sting
Bacterial infxn of supraglottic tissue and surrounding areas
Oral prednisone
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
'thumb sign' (protrusion of into anterior wall of hypopharynx)

7. Lochia
10th postpartum day
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Quinolone + metronidazole

8. Causes of diverticular bleeding
Mass lesion - subdural hematoma - medication overuse
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Obesity; increased NE release
'steeple-sign' (subglottic narrowing)

9. Empiric CAP tx in hospitalized patient
Oral prednisone
3 hours
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone

10. 1st line tx in IBS constipation
TCA's
Fiber (e.g. psyllium)
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
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD

11. Afib - Aflutter tx
Digoxin (B-blockers as needed)
PCP pneumonia
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
MVP

12. Pyloric stenosis sx

13. Phendimetrazine
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Barium enema
Oral prednisone
Obesity; increased NE release

14. Focal neurologic sx (other than aura) DDx
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Mass lesion - vascular malformation - stroke - collagen vascular disease
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

15. Croup
Viral infxn of the subglottis
Amitriptyline - propanolol - timolol - divalproex sodium
Quinolone + metronidazole
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity

16. Tx acute pulmonary edema 2ndary to CHF
Meningitis - brain abscess - metastasis
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Furosemide - nitroglycerin - IV morphine sulphate

17. Tx HTN + CKD
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
ACEI - ARB
Alzheimer dementia
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

18. Dx subarachnoid hemorrhage with negative noncontrast CT
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Lumbar puncture
Mass lesion - subdural hematoma - medication overuse
Viral infxn of the subglottis

19. Croup X-ray

20. Sudden-onset headache DDx
S. aureus
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
1st line: TZD

21. Test to best determine source of lower GI bleed
Halothane - succinylcholine
Obesity; NE-uptake inhibition
Colonoscopy
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

22. Donepezil use/sfx
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Mass lesion - pseudotumor cerebri - meningitis
Cephalexin OR dicloxacillin
H. flu - S. pneumo - S. aureus - Strep A/B/C

23. TCA
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Dementia - incontinence - gait disturbance

24. Evaluating limp w/o pain in children
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
Mass lesion - pseudotumor cerebri - meningitis
Venlafaxine - duloxetine - mirtazapine

25. Croup sx
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
8%
'steeple-sign' (subglottic narrowing)
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

26. DDx limp in infant/toddler
PCP pneumonia
Septic arthritis - fractures - congenital hip dysplasia
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Renal parenchymal disease

27. DDx Limp w/o pain in children - orthopedic
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing

28. Sx HoCM
ACEI - ARB - diuretic - Ca-blocker - B-blocker
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Eikenella species

29. 'Alarm' sx for upper GI endoscopy
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
MVP
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer

30. Cholesterol absorption blocker (ezetimibe)
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease

31. Empiric CAP tx in healthy person
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Dantrolene IV - antipyretics - O2 - cooling blankets
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.

32. SSRI's
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD

33. Cluster headache acute tx
100% O2 6L/min - dihydroergotamine - triptans
Legionella
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Moderate/severe alzheimer dementia

34. Mastitis tx
Cephalexin OR dicloxacillin
Septic arthritis - fractures - congenital hip dysplasia
ACEI - ARB - B-blocker - diuretic - Spironolactone
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy

35. Retropharyngeal abscess Sx
Alzheimer dementia
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
470ms+ in men - 480ms+ in women
Renal parenchymal disease

36. Outpatient tx CHF
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Neonate - infants - bilious vomiting - abdominal pain
Mass lesion - subdural hematoma - medication overuse
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)

37. Organism that causes pneumonia with diarrhea
Legionella
'steeple-sign' (subglottic narrowing)
8%
100% O2 6L/min - dihydroergotamine - triptans

38. CAGE questionnaire
3 hours
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
Venlafaxine - duloxetine - mirtazapine

39. DDx dementia
S. aureus
Eikenella species
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease

40. Prolonged QT interval (QTc)
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Obesity; increased NE release
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
470ms+ in men - 480ms+ in women

41. Malrotation sx
Bupriopion - amoxipine - trazodone
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Digoxin (B-blockers as needed)
Neonate - infants - bilious vomiting - abdominal pain

42. Bronchiolitis sx
ACEI - diuretic
8%
Mass lesion - vascular malformation - stroke - collagen vascular disease
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

43. Headaches increasing in severity + intensity DDx
Obesity; increased NE release
Bacterial infxn of supraglottic tissue and surrounding areas
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Mass lesion - subdural hematoma - medication overuse

44. ACA stroke ssx
100% O2 6L/min - dihydroergotamine - triptans
Moderate/severe alzheimer dementia
Legionella
Foot/leg deficits - cognitive + personality changes

45. Galantamine use/sfx
8%
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Flat disk - button - batteries
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools

46. SNRI
Postpartum fever - uterine tenderness - foul-smelling lochia
ACEI - ARB - diuretic - Ca-blocker - B-blocker
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Venlafaxine - duloxetine - mirtazapine

47. Tx HTN + DM
SCFE (slipped capital femoral epiphysis)
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion

48. epiglottitis
Bacterial infxn of supraglottic tissue and surrounding areas
Quinolone + metronidazole
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Amiodarone/lidocaine

49. Commonly ingested foreign bodies
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Flat disk - button - batteries
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Halothane - succinylcholine

50. Tx HTN + CAD
Renal parenchymal disease
Eikenella species
ACEI - B-blocker - diuretic - Ca-blocker
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine