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Family Medicine Shelf

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. What is afterload?
Tension headache
Peptic ulcer disease or gastritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

2. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Affects 60% of patients with asymptomatic proteinuria; patients are usually <30 - secrete less than 2g protein/day: proteinuria occurs in the upright - but not supine position
Varicella virus
Giardia
HSV1: oral HSV2: genital -primary infection: transmitted by respiratory droplets or by direct contact with an active lesion or infected secretions -secondary phase: reactivation of the latent virus from dorsal root ganglia -grouped vesicles on an ery

3. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cholelithiasis
Lightheadedness - dizziness - syncope
Hypertension - CAD - valvular heart disease

4. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
PVC or Premature atrial contraction (PAC)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Other brainstem or cranial nerve findings

5. Name the skin lesion: honey colored crusts
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Impetigo
ACEi
S. Aureus

6. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase; 200 g/day

7. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Presence of proteinuria on at least two separate ocassion
Triptans - ergotamine - DHE (emergency); prophylaxis- beta blockeres - tricyclic antidepressants - CCBs - anticonvulsants - serotonin antagonists - MAOIs; avoidance of stress - alcohol - caffeine - tyramine (red wine and cheese) - nitrates (cured mea
ACEi - ARBS - thiazide diuretics
Chest pain during pneumonia or PE

8. When should invasive eletrophysiologic study should be considered?
Fever with frontal or maxillary tenderness
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH
Less than 3 stools per week
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

9. Four muscles of rotator cuff
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
With a KOH wet mount preparation
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

10. How does CHF present on X-ray?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

11. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Dysfunctional Uterine bleeding: caused by hormonal imbalances from a functionally abnormal hypothalamic-pitu-ovarian axis resulting in abnormal follicle development and anovulation (metorrhagia) -Corpus luteum does not develop=progesterone-deficient
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
Varicella virus

12. Describe the presentation tracheobronchitis
Medication or chemical esophagitis
Molluscum contagiosum- pox virus
Upper sternal area burning pain - associated with a productive cough
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH

13. What is a markers of CNS vertigo?
Repeat Pap after infection treated
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Other brainstem or cranial nerve findings

14. What are signs of pulmonary congestion?
Pancreatitis
With a KOH wet mount preparation
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

15. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
ACEi - ARBS - thiazide diuretics
With a KOH wet mount preparation

16. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
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
Tension headache
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.

17. What is the goal of CHF treatment? What drugs should be used?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Repeat Pap after infection treated
A 24hr urine protein collection and urine creatinine clearance determination

18. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Serotypes 16 - 18 - 31 -52 -58
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
A 24hr urine protein collection and urine creatinine clearance determination
Colposcopy - Endocervical curettage - and directed cervical biopsy

19. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

20. What is the difference between a Holter monitor or an event monitor?
Holter monitor: 24 hours - detect an arrhythmia; patient keeps a log of symptoms Event monitor: can be carried for 30 days or more and are patient activated at the time of symptoms; event recroding ca nbe transmitted by telephone to a monitoring symp
Cluster headache
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
HSV1: oral HSV2: genital -primary infection: transmitted by respiratory droplets or by direct contact with an active lesion or infected secretions -secondary phase: reactivation of the latent virus from dorsal root ganglia -grouped vesicles on an ery

21. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Upper sternal area burning pain - associated with a productive cough
Serotypes 16 - 18 - 31 -52 -58
Nonulcer dyspepsia

22. Vaccines that should be updated before planned pregnancy
100mg; means patient can be trace protein positive and not be detected
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
BB or CCB - catheter ablation of identified bypass tract
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

23. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Giardia
Molluscum contagiosum- pox virus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
It is a test for BPV. Rotate the patients through a series of positions in an attempt to relocate the debris in the semicircular canal into the vestibule of the labyrinth.

24. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
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
Candida albicans
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

25. Name the diagnosis of heartburn: severe constant mid abdominal pain
GERD
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
Pancreatitis
Diuretics -BB -CCB -ACEi

26. What are the primary glomerular diseases?
Activation of the RAAS - increased levels of catecholamines - secretion of atrial natriuretic hormone -This leads to vasoconstriction - fluid retention - increased afterload - which further inhibits cardiac output -late changes are mycoardial and vas
Temporal arteritis-biopsy of the temporal artery
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Kids: Rotavirus Adults: Norwalk Virus

27. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Variability in the time for follicle development during the proliferative phase
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Pancreatitis
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH

28. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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
Hypertension - CAD - valvular heart disease
35 (exception for postmenopausal women who have recently been started on HRT)
Coronary artery disease/ angina

29. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Common problem that resolves spontaneously and is most often seen in children and young adults
EGD
Adhesive capsulitis (frozen shoulder): most common in middle age women

30. What is an acoustic neuroma?
HSV1: oral HSV2: genital -primary infection: transmitted by respiratory droplets or by direct contact with an active lesion or infected secretions -secondary phase: reactivation of the latent virus from dorsal root ganglia -grouped vesicles on an ery
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

31. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Folliculitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

32. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
High blood pressure - focal neurologic defecit - or papilledema
True
HPV testing -Pos=colposcopy -Neg=repeat pap smear

33. Prenatal visit schedule for low-risk pregnancies
HIV and syphilis
Albumin; low molecular weight proteins
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

34. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
ACEi
Analgesic headache
Pancreatitis
Folliculitis

35. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Acute headache - ataxia - profuse nausea - and vomiting
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

36. What is the caUse of benign positional vertigo?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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.
Rotator Cuff problem
Nonulcer dyspepsia

37. How is constipation clinically defined?
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Less than 3 stools per week
LH surge triggers ovulation

38. What does the classic ring worm lesion have?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
35 (exception for postmenopausal women who have recently been started on HRT)
A central clear area
100mg; means patient can be trace protein positive and not be detected

39. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Varicella virus
Nonulcer dyspepsia
Affects 60% of patients with asymptomatic proteinuria; patients are usually <30 - secrete less than 2g protein/day: proteinuria occurs in the upright - but not supine position

40. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
ACEi - ARBS - thiazide diuretics
Muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures
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
Echocardiogram

41. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Rotator cuff tendonitis
Warts
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
ACEi

42. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
HPV

43. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pain
Coag disorders

44. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Regular bleeding at intervals of more than 35 days
Less than 80 ml of blood
W/in 4hrs and peaks 24hrs; it is important to obtain serial markers since the first set of cardiac markers are negative in 25 - 50% of patients with an acute MI
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

45. What is the role of LH in the menstrual cycle
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
LH surge triggers ovulation
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
Hypertension - CAD - valvular heart disease

46. 1+ protein level on urine dipstick usually represents how much protein in the urine?
HPV
Cholelithiasis
Peptic ulcer disease or gastritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

47. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Holter monitor: 24 hours - detect an arrhythmia; patient keeps a log of symptoms Event monitor: can be carried for 30 days or more and are patient activated at the time of symptoms; event recroding ca nbe transmitted by telephone to a monitoring symp
Wolff-Parkinson-White syndrome

48. What should blood work include for suspected heart failure?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
MSK - pulmonary - GI - or psychological
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

49. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
It is a test for BPV. Rotate the patients through a series of positions in an attempt to relocate the debris in the semicircular canal into the vestibule of the labyrinth.
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
Excessive bleeding in amount - duration - or both at irregular intervals

50. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Increase; 200 g/day
Scabies
Infectious esophagitis