Test your basic knowledge |

Family Medicine Shelf

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What is the preload?
Chest pain during pneumonia or PE
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

2. Predictors of cardiac etiology
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Menorrhagia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses -Every 4 wks: up to 28 wks gestational age -Every 2 wks: up to 36 weeks gestational age -Every week: until delivery

3. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Genetic screening - medical assessment for chronic diseases - screening for infectious diseases - and updating of immunizations - advice on proper nutrition and exercise - help with quitting unhealthy habits - and advice on avoiding environmental haz
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
BB or CCB - catheter ablation of identified bypass tract

4. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bence-Jones
CBC
Regular bleeding at intervals of more than 35 days

5. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Peptic ulcer disease or gastritis
Loop diuretics (Check serum K+ levels before drug admin)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Nonulcer dyspepsia

6. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

7. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Early sexuality and multiple pregnancies (immature cells are more common at menarche and ruing the postpartum period) - hx of STDs - smoking - HIV - current or prior history of condyloma - and previously abnormal Pap smears
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pap Smear (unless recent normal pap) -CBC -Pregnancy test -Ultrasound if uterus is enlarged -Cervical culture in patients high risk of infection -Thyroid test and testing for systemic diseases

8. History and PE for Pneumonia
Medication or chemical esophagitis
Hx: High fever - dyspnea - chills - chest pain - develop hypoxia or cardiopulmonary failure - PE: Abnormal Vital signs (fever - tachypnea - tachycardia) - Lungs (localized rales - bronchial breath sounds - wheezing - signs of consolidation-dullness t
CBC
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

9. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Systolic dysfunction- ejection fraction is reduced to less than 45% - diastolic dysfunction- ejection fraction is preserved or high; use doppler techniques- abnormal flow across the mitral valve
Echocardiogram

10. Name types of laxatives
With a KOH wet mount preparation
LH surge triggers ovulation
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

11. How do you know if heart palpitations are due to stimulant or medication use?
Generalized Anxiety disorder and panic disorder
Less abrupt onset and cessation of palpitations
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Adhesive capsulitis (frozen shoulder): most common in middle age women

12. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
These patients are associated with low renin states=less likely to respond to medication
Medication or chemical esophagitis

13. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Influenza - Rhinovirus - Adenovirus - Parainfluenza
HPV
Wolff-Parkinson-White syndrome

14. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Refractory constipation - a new onset of constipation in an older individual - heme-positive stools - and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology
Cluster headache
Chest pain during pneumonia or PE

15. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Chest pain during pneumonia or PE
Pap Smear (unless recent normal pap) -CBC -Pregnancy test -Ultrasound if uterus is enlarged -Cervical culture in patients high risk of infection -Thyroid test and testing for systemic diseases
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

16. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hgb - Electrolytes - and TSH
Analgesic headache
35 (exception for postmenopausal women who have recently been started on HRT)

17. How does CHF present on X-ray?
Giardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Echocardiogram
Scabies

18. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Common problem that resolves spontaneously and is most often seen in children and young adults
Paroxysmal atrial fibrillation or supraventricular tachycardia

19. What is the next best step if a patient has two or more positive dipstick tests?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Scleroderma/polymyositis with secondary gastroesophageal reflux
Coronary artery disease/ angina
A 24hr urine protein collection and urine creatinine clearance determination

20. When should a patient get a stress test?
Other brainstem or cranial nerve findings
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
When the patient has symptoms in association with exercise or who describe chest pain or pressure

21. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Bence-Jones
Bronchitis: Antecedent URI - Cough - No or low-grade fever - clear lungs or coarse rhonchi - Normal CXR Pneumonia: Acute onset of cough - fever - and tachypnea - chest pain - leukocytosis - pulmonary infiltrate on CXR
Peptic ulcer disease or gastritis

22. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
Echocardiogram
Particulate matter or otoliths may form in the semicircular canal. The otoliths become dislodged and stimulate the sensory hair cells in the semicircular canals - leading to vertigo.
Bence-Jones

23. What is the role of FSH in one's menstrual cycle
Streptococci
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Impetigo

24. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Squamocolumnar junction=most common site of cervical cancer

25. What medications can cause heart palpitations?
Conization (or LEEP): removeal of a portion of the cervix and thus patients are at risk of preterm labor - incompetent cervix - or cervical stenosis in future pregnancies
Albumin; low molecular weight proteins
S. aureus- beta hemolytic streptococcus
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

26. PE for a patient getting an abnormal vaginal bleeding work up
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Menorrhagia
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Serotypes 16 - 18 - 31 -52 -58

27. What does orthostatic positional changes that bring on dizziness suggest?
Acute headache - ataxia - profuse nausea - and vomiting
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
Dehydration - anemia - cardiac causes

28. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
A central clear area
Furucnle
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

29. What is the mechanism of action for stimulant agents in treating constipation?
Giardia
Associated with hypotension
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Repeat Pap after infection treated

30. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Warts
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Varicella virus
The patient is seated with the head turned to the right and is quickly lowered to the supine position with the head over the edge of the examination table 30 degrees below horizontal. The test is then repeated with the head turned to the left. The te

31. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Rotator Cuff problem

32. Initial treatment for Rhinosinusitis
Varicella virus
Menorrhagia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

33. What HPV serotypes are most commonly associated with cervical cancer?
CT
Serotypes 16 - 18 - 31 -52 -58
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi - ARBS - thiazide diuretics

34. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Rotator Cuff tendonitis
HIV and syphilis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

35. What is the goal of CHF treatment? What drugs should be used?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
RBC casts and old to moderate HTN
Reduce symptoms - prevent complications - improve survival-diuretics - ACE inhibitors (slow progression of heart failure - decrease the number of hospitalizations and decrease mortality) - beta blockers (decrease mortality and sudden death) - spirono
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

36. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
PE - MI - aortic dissection - pneumothorax
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Furucnle
Nonulcer dyspepsia

37. Prenatal visit schedule for low-risk pregnancies
Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses -Every 4 wks: up to 28 wks gestational age -Every 2 wks: up to 36 weeks gestational age -Every week: until delivery
Infectious esophagitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

38. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Irregular bleeding between cycles
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

39. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Pancreatitis
Pain
Pap Smear (unless recent normal pap) -CBC -Pregnancy test -Ultrasound if uterus is enlarged -Cervical culture in patients high risk of infection -Thyroid test and testing for systemic diseases
1)Promoting Na+retention 2) Promoting hypertrophy and hyperplasia of vascular smooth muscles through its mitogenic properties 3) Modifying ion transport - leading to increase in intracellular Ca2+ 4) Sympathetic activation

40. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow - secretion of mucus - and bicarbonate. Without these protective factors - acid-induced inflammation and ulcers my result.
Tension headache
Rotator Cuff problem

41. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Dehydration - anemia - cardiac causes
Diuretics -BB -CCB -ACEi
Echocardiogram
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

42. What should blood work include for suspected heart failure?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

43. What is the role of LH in the menstrual cycle
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Scleroderma/polymyositis with secondary gastroesophageal reflux
LH surge triggers ovulation
S. Aureus

44. Lab testing for heart palpitation
Headache of recent onset (<6 months) -headache beginning after 50 years of age -worsening headaches -headache that does not fit primary headache pattern -associated seizure -focal neurologic signs or symptoms -personality change-severe headaches unre
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Hgb - Electrolytes - and TSH
Tension headache

45. What diagnosis does the 'worse headache of my life' suggest?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Nonulcer dyspepsia
Subarachnoid hemorrhage
True

46. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Variability in the time for follicle development during the proliferative phase
Cholelithiasis
Medication or chemical esophagitis
Regular bleeding at intervals of more than 35 days

47. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
DM - HTN - DVT - seizures - depression - or anxiety
>150mg per 24hrs
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

48. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Typically brought on exercise - eating - emotional excitement; pain lasts 5 - 15mins - disappears with nitroglycerin or at rest; if the pain lasts <1 or >30mins it should not be considered anginal
A 24hr urine protein collection and urine creatinine clearance determination
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

49. Irregular cycles with excessive flow - duration - or both
The patient is seated with the head turned to the right and is quickly lowered to the supine position with the head over the edge of the examination table 30 degrees below horizontal. The test is then repeated with the head turned to the left. The te
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Menorrhagia
Presence of proteinuria on at least two separate ocassion

50. Define nephrotic range proteinuria
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
>3.5g of protein per 24hrs
HPV
LH surge triggers ovulation