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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. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
24 hour halter

2. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Tension headache

3. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Coronary artery disease/ angina
Generalized Anxiety disorder and panic disorder
With a KOH wet mount preparation
Bulk forming: Psyllium - Methycellulose - Polycarbophil

4. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Less than 80 ml of blood

5. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Infectious esophagitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
ACEi

6. Describes what occurs during squamous metaplasia of the cervix.
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

7. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
>150mg per 24hrs
Variability in the time for follicle development during the proliferative phase
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

8. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
35 (exception for postmenopausal women who have recently been started on HRT)
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
Cervical radiculopathy

9. What are the signs of cerebral hemorrhage?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Acute headache - ataxia - profuse nausea - and vomiting

10. What is benign transient proteinuria?
Associated with hypotension
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

11. 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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CT

12. When is a lumbar puncture contraindicated?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

13. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Rotator cuff tendonitis
Impetigo
When the patient has symptoms in association with exercise or who describe chest pain or pressure

14. Clinical Manifestations of HTN
Viral gastroenteritis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Candida albicans

15. What should be considered in younger patients with menorrhagia
Coag disorders
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Viral gastroenteritis

16. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi - ARBS - thiazide diuretics
GERD
Rotator cuff tendonitis

17. How can GERD (or esophageal motility disorders) lead to chest pain?
Wolff-Parkinson-White syndrome
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

18. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

19. What are signs of pulmonary congestion?
Diuretics -BB -CCB -ACEi
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Staphylococcal scalded skin syndrome

20. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dehydration - anemia - cardiac causes
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

21. How does systolic vs. diastolic heart failure present on the echocardiogram?
Wolff-Parkinson-White syndrome
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Associated with hypotension
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

22. How is constipation clinically defined?
Coag disorders
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Temporal arteritis-biopsy of the temporal artery
Less than 3 stools per week

23. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Coag disorders
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
HPV

24. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
Coronary artery disease/ angina
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

25. Who should have Xray testing for shoulder pain?
Temporal arteritis-biopsy of the temporal artery
Coag disorders
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

26. What is the role of LH in the menstrual cycle
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
LH surge triggers ovulation

27. Diarrhea from custard filled pastries
>3.5g of protein per 24hrs
>150mg per 24hrs
S. Aureus
Acute headache - ataxia - profuse nausea - and vomiting

28. Describe the presentation of angina?
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
Coag disorders
Variability in the time for follicle development during the proliferative phase
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

29. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Diuretics -BB -CCB -ACEi
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

30. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
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
Staphylococcal scalded skin syndrome
When the patient has symptoms in association with exercise or who describe chest pain or pressure

31. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
DM - HTN - DVT - seizures - depression - or anxiety
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

32. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Diuretics -BB -CCB -ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

33. After treatment of dysplasia - women need Pap smears every...
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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

34. Describe the presentation of pericardial pain
Peptic ulcer disease or gastritis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Cervical radiculopathy

35. Diagnostic Evaluation of Abnoraml vaginal bleeding
Lightheadedness - dizziness - syncope
Cervical radiculopathy
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

36. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
EGD
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Furucnle
Staphylococcal scalded skin syndrome

37. What is the goal of CHF treatment? What drugs should be used?
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
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
Pancreatitis
Pts with palpitations and dizziness - near syncope - or syncope

38. Metrorrhagia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Nonulcer dyspepsia
Irregular bleeding between cycles

39. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Pts with palpitations and dizziness - near syncope - or syncope
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
LH surge triggers ovulation
Colposcopy - Endocervical curettage - and directed cervical biopsy

40. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Increase; 200 g/day
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

41. Uterine bleeding between regular cycles
ACEi
Intermenstrual bleeding
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

42. What is the standard tool used for diagnosis of GERD?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
EGD
CT

43. What lab tests are recommended for newly diagnosed hypertensive patients?
Cervical radiculopathy
Generalized Anxiety disorder and panic disorder
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Furucnle

44. 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
Fever with frontal or maxillary tenderness
Warts
Colposcopy - Endocervical curettage - and directed cervical biopsy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

45. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Less than 3 stools per week
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
Polymenorrhea

46. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Cluster headache
Cellulitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

47. What does treatment for migrans include?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
GERD
Scabies
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

48. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cervical radiculopathy
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

49. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Cholelithiasis
Excessive bleeding in amount - duration - or both at irregular intervals
Non-cardiac causes of palpitations
Supraspinatus and bicipital tendons

50. Pneumonia tx: suitable for healthy adults older than 60
Diuretics -BB -CCB -ACEi
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain