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. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pts with palpitations and dizziness - near syncope - or syncope
Rotator Cuff tendonitis
Upper sternal area burning pain - associated with a productive cough

2. Isolated - extra pounding beats
MSK - pulmonary - GI - or psychological
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
PVC or Premature atrial contraction (PAC)
Pts with palpitations and dizziness - near syncope - or syncope

3. How do you define persistent protein uria?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Presence of proteinuria on at least two separate ocassion
Less than 80 ml of blood
HPV testing -Pos=colposcopy -Neg=repeat pap smear

4. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
These patients are associated with low renin states=less likely to respond to medication
Less abrupt onset and cessation of palpitations
Presence of proteinuria on at least two separate ocassion
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

5. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Impetigo
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Coag disorders

6. Describe the presentation tracheobronchitis
S. Aureus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Upper sternal area burning pain - associated with a productive cough
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

7. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cholelithiasis
True
CT

8. Treatment for supraventricular tachycardias
HIV and syphilis
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
BB or CCB - catheter ablation of identified bypass tract

9. After treatment of dysplasia - women need Pap smears every...
PE - MI - aortic dissection - pneumothorax
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pleurisy
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

10. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Excessive bleeding in amount - duration - or both at irregular intervals
Streptococci
Pancreatitis

11. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Chest pain during pneumonia or PE
Infectious esophagitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

12. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
Dehydration - anemia - cardiac causes
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

13. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
A 24hr urine protein collection and urine creatinine clearance determination
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

14. Where does the development of abnormal cervical cells begin?
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
Squamocolumnar junction=most common site of cervical cancer
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

15. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Medication or chemical esophagitis
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
Anticoag with warfarin to prevent thromboembolism

16. MI - pericardial tamponade - PE - GI bleed - are...
Generalized Anxiety disorder and panic disorder
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Staphylococcal scalded skin syndrome
Associated with hypotension

17. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Giardia
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
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

18. Vaccines that should be updated before planned pregnancy
CT
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

19. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Hypertension - CAD - valvular heart disease
Hgb - Electrolytes - and TSH
Rotator Cuff tendonitis

20. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
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
Rotator Cuff problem

21. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Varicella virus
Less than 3 stools per week
HPV testing -Pos=colposcopy -Neg=repeat pap smear

22. What are the 2 psych disorders most commonly associated with palpitations?
A 24hr urine protein collection and urine creatinine clearance determination
ACEi
Generalized Anxiety disorder and panic disorder
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

23. History and PE for Pneumonia
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
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
DM - HTN - DVT - seizures - depression - or anxiety
Less abrupt onset and cessation of palpitations

24. Who should have Xray testing for shoulder pain?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

25. Natural history of cervical cancer
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

26. What is benign transient proteinuria?
DM - HTN - DVT - seizures - depression - or anxiety
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
Common problem that resolves spontaneously and is most often seen in children and young adults
LH surge triggers ovulation

27. What should preconception counseling include?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Cellulitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

28. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Lightheadedness - dizziness - syncope
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Hgb - Electrolytes - and TSH
Viral gastroenteritis

29. What are the three major risk factors for heart failure?
Serotypes 16 - 18 - 31 -52 -58
Tension headache
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
Hypertension - CAD - valvular heart disease

30. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Folliculitis
Warts
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

31. PE for a patient getting an abnormal vaginal bleeding work up
Wolff-Parkinson-White syndrome
Medication or chemical esophagitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

32. Regular bleeding at intervals of less than 21 days
100mg; means patient can be trace protein positive and not be detected
Polymenorrhea
Coronary artery disease/ angina
Tension headache

33. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Cervical radiculopathy
Irregular bleeding between cycles
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

34. How are fungal infections diagnosed?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Dehydration - anemia - cardiac causes
With a KOH wet mount preparation
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

35. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Less than 3 stools per week

36. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Supraspinatus and bicipital tendons
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

37. What is the Epley maneuver?
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.
Rotator Cuff problem
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

38. What is afterload?
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.
Intermenstrual bleeding
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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

39. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Dehydration - anemia - cardiac causes
Tension headache
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
CT

40. Uterine bleeding between regular cycles
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Kids: Rotavirus Adults: Norwalk Virus
Intermenstrual bleeding
Echocardiogram

41. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

42. What diagnosis does the 'worse headache of my life' suggest?
Chest pain during pneumonia or PE
Intermenstrual bleeding
Subarachnoid hemorrhage
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

43. How do you know if heart palpitations are due to stimulant or medication use?
PE - MI - aortic dissection - pneumothorax
Less abrupt onset and cessation of palpitations
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Warts

44. What is the next best step if a patient has two or more positive dipstick tests?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A 24hr urine protein collection and urine creatinine clearance determination
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

45. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
ACEi
True
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

46. What places women at higher risk of getting cervical cancer?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Staphylococcal scalded skin syndrome

47. Irregular cycles with excessive flow - duration - or both
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Menorrhagia
LH surge triggers ovulation

48. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Paroxysmal atrial fibrillation or supraventricular tachycardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

49. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
100mg; means patient can be trace protein positive and not be detected

50. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Nonulcer dyspepsia
Regular bleeding at intervals of more than 35 days
Scabies