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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. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
High blood pressure - focal neurologic defecit - or papilledema
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
24 hour halter
Hgb - Electrolytes - and TSH

2. What is the goal of CHF treatment? What drugs should be used?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less than 80 ml of blood
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
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

3. How do you define persistent protein uria?
Associated with hypotension
HPV
Presence of proteinuria on at least two separate ocassion
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

4. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Slow progression of cervical cancer changes -Availability of effective early treatment
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Cholelithiasis
Loop diuretics (Check serum K+ levels before drug admin)

5. What are the common causes for laryngitis?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Variability in the time for follicle development during the proliferative phase
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

6. Carcinoma in situ is generally referred to a gynecologist and requires ______
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.
Cluster headache
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
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

7. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Medication or chemical esophagitis
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
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

8. Describe the presentation of pneumonia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
With a KOH wet mount preparation
These patients are associated with low renin states=less likely to respond to medication

9. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
Coronary artery disease/ angina
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
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

10. What is an acoustic neuroma?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
PE - MI - aortic dissection - pneumothorax
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
CBC
Scleroderma/polymyositis with secondary gastroesophageal reflux
Medication or chemical esophagitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

12. Menometrorrhagia
Peptic ulcer disease or gastritis
Excessive bleeding in amount - duration - or both at irregular intervals
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
Folliculitis

13. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bence-Jones

14. What are the primary glomerular diseases?
Bence-Jones
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Kids: Rotavirus Adults: Norwalk Virus

15. What is the Epley maneuver?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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.
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Increase; 200 g/day

16. Name the diagnosis of heartburn: regurgitation - dysphagia
Hx: Scratchy throat - runny nose - nasal congestion - rhinorrhea - malaise - fever - hoarsenss - cough - low grade fever - headache PE: Swollen red nasal mucosa - fever - purulent discharge - facial tenderness
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Tension headache
GERD

17. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Temporal arteritis-biopsy of the temporal artery
These patients are associated with low renin states=less likely to respond to medication
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

18. What type of imaging is need for chronic sinusitis?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Non-cardiac causes of palpitations
CT
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

19. Pain in shoulder when throwing - swimming - or serving a tennis ball
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
RBC casts and old to moderate HTN
Giardia
Rotator cuff tendonitis

20. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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 (exception for postmenopausal women who have recently been started on HRT)

21. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Streptococci
Impetigo
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

22. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Intermenstrual bleeding
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Medication or chemical esophagitis

23. 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
Varicella virus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

24. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Medication or chemical esophagitis
With a KOH wet mount preparation
Paroxysmal atrial fibrillation or supraventricular tachycardia
Squamocolumnar junction=most common site of cervical cancer

25. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Subarachnoid hemorrhage
Anticoag with warfarin to prevent thromboembolism
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

26. What is the difference between a Holter monitor or an event monitor?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

27. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

28. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
PE - MI - aortic dissection - pneumothorax
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

29. HIgh risk pregnant patients should be evaluated for ____ and ____
LH surge triggers ovulation
HIV and syphilis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Menorrhagia

30. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Viral infection of the semicircular apparatus
Increase; 200 g/day
Folliculitis

31. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Hypertension - CAD - valvular heart disease
Cellulitis

32. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Repeat Pap after infection treated
Infectious esophagitis
CT
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

33. What are the most common viral causes of diarrhea in kids and adults?
HPV
Kids: Rotavirus Adults: Norwalk Virus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

34. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
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.
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

35. 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.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Repeat Pap after infection treated
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

36. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Folliculitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Furucnle
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

37. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Generalized Anxiety disorder and panic disorder
Chest pain during pneumonia or PE
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Associated with hypotension

38. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Tension headache
Nonulcer dyspepsia
Rotator Cuff tendonitis
Molluscum contagiosum- pox virus

39. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

40. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Warts
CBC
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

41. Define proteinuria
Pancreatitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
>150mg per 24hrs
Anticoag with warfarin to prevent thromboembolism

42. Name the diagnosis of heartburn: severe constant mid abdominal pain
Menorrhagia
Molluscum contagiosum- pox virus
Pancreatitis
Hx: Scratchy throat - runny nose - nasal congestion - rhinorrhea - malaise - fever - hoarsenss - cough - low grade fever - headache PE: Swollen red nasal mucosa - fever - purulent discharge - facial tenderness

43. Name 4 factors that predispose an individual to develop pneumonia.
Peptic ulcer disease or gastritis
35 (exception for postmenopausal women who have recently been started on HRT)
Chest pain during pneumonia or PE
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

44. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Fever with frontal or maxillary tenderness

45. 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
HIV and syphilis
Warts
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Rotator cuff tendonitis

46. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
HIV and syphilis
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
Possibility of Ischemic colitis
Pancreatitis

47. What should be considered in younger patients with menorrhagia
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Pts with palpitations and dizziness - near syncope - or syncope
Coag disorders

48. What diagnosis does the 'worse headache of my life' suggest?
Pts with palpitations and dizziness - near syncope - or syncope
S. Aureus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Subarachnoid hemorrhage

49. What medications can cause heart palpitations?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
A 24hr urine protein collection and urine creatinine clearance determination
Bence-Jones

50. What does treatment for migrans include?
Repeat Pap after infection treated
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
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
Intermenstrual bleeding