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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. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Peptic ulcer disease or gastritis
Temporal arteritis-biopsy of the temporal artery

2. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Generalized Anxiety disorder and panic disorder
Furucnle
S. Aureus
Cellulitis

3. What is the role of FSH in one's menstrual cycle
Less abrupt onset and cessation of palpitations
Chest pain during pneumonia or PE
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Anticoag with warfarin to prevent thromboembolism

4. Difference between Pneumonia and Bronchitis
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
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
HPV

5. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Warts
Rotator Cuff tendonitis
Medication or chemical esophagitis
Diuretics -BB -CCB -ACEi

6. Carcinoma in situ is generally referred to a gynecologist and requires ______
CT
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
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

7. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cholelithiasis
ACEi
Serotypes 16 - 18 - 31 -52 -58

8. When does troponin rise following myocardial injury or infarction?
Molluscum contagiosum- pox virus
Cervical radiculopathy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

9. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
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
Tension headache
Less abrupt onset and cessation of palpitations
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

10. Name the diagnosis of heartburn: severe constant mid abdominal pain
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HIV and syphilis
Pancreatitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

11. patients with herpes zoster may experience what symptom before the rash appear?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Repeat Pap after infection treated
Pain
Kids: Rotavirus Adults: Norwalk Virus

12. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
High blood pressure - focal neurologic defecit - or papilledema
Staphylococcal scalded skin syndrome
Diuretics -BB -CCB -ACEi
Bence-Jones

13. Pneumonia tx: suitable for healthy adults less than 60
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
Impetigo
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
PVC or Premature atrial contraction (PAC)

14. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Regular bleeding at intervals of more than 35 days
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Higher filling presure - pulmonary congestion - and decreasd cardiac return

15. What are the two common clinical presentations of acute diarrhea?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
E. Coli O157:H7
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

16. name the 4 emergent causes of chest pain
24 hour halter
PE - MI - aortic dissection - pneumothorax
Menorrhagia
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

17. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Generalized Anxiety disorder and panic disorder
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

18. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Furucnle
E. Coli O157:H7

19. Describe the presentation of pericardial pain
Coronary artery disease/ angina
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

20. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Hgb - Electrolytes - and TSH
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

21. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Loop diuretics (Check serum K+ levels before drug admin)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pain

22. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
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
High blood pressure - focal neurologic defecit - or papilledema
E. Coli O157:H7

23. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Hgb - Electrolytes - and TSH
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
High blood pressure - focal neurologic defecit - or papilledema

24. Define proteinuria
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
>150mg per 24hrs
ACEi - ARBS - thiazide diuretics
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

25. What is the next best step if a patient has two or more positive dipstick tests?
Dehydration - anemia - cardiac causes
Scabies
A 24hr urine protein collection and urine creatinine clearance determination
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

26. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Loop diuretics (Check serum K+ levels before drug admin)
Viral infection of the semicircular apparatus

27. HIgh risk pregnant patients should be evaluated for ____ and ____
CT
Presence of proteinuria on at least two separate ocassion
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
HIV and syphilis

28. When should invasive eletrophysiologic study should be considered?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
EGD
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

29. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Colposcopy - Endocervical curettage - and directed cervical biopsy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
CT

30. What the consequences of decreased cardiac output?
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
Associated with hypotension
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
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

31. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Possibility of Ischemic colitis
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

32. What are the consequences of diastolic dysfunction?
Medication or chemical esophagitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

33. What are the three major risk factors for heart failure?
Other brainstem or cranial nerve findings
High blood pressure - focal neurologic defecit - or papilledema
Hypertension - CAD - valvular heart disease
CBC

34. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
S. aureus- beta hemolytic streptococcus
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
Nonulcer dyspepsia
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

35. Uterine bleeding between regular cycles
Intermenstrual bleeding
Excessive bleeding in amount - duration - or both at irregular intervals
Squamocolumnar junction=most common site of cervical cancer
Anticoag with warfarin to prevent thromboembolism

36. What are the signs of malignant hypertension?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
S. Aureus
Infectious esophagitis
High blood pressure - focal neurologic defecit - or papilledema

37. What is a markers of CNS vertigo?
Cervical radiculopathy
Other brainstem or cranial nerve findings
Common problem that resolves spontaneously and is most often seen in children and young adults
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

38. Pain in shoulder when throwing - swimming - or serving a tennis ball
Impetigo
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Rotator cuff tendonitis
Cellulitis

39. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
EGD
Dehydration - anemia - cardiac causes
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

40. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Irregular bleeding between cycles
Less than 3 stools per week

41. What is an acoustic neuroma?
Bence-Jones
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

42. When should a patient get a stress test?
Wolff-Parkinson-White syndrome
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

43. How do you know if heart palpitations are due to stimulant or medication use?
Hgb - Electrolytes - and TSH
Less abrupt onset and cessation of palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

44. How does CHF present on X-ray?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
With a KOH wet mount preparation
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

45. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Possibility of Ischemic colitis
Slow progression of cervical cancer changes -Availability of effective early treatment
Diuretics -BB -CCB -ACEi

46. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Generalized Anxiety disorder and panic disorder
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Infectious esophagitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

47. Discomfort with abducting the arm past 90 degress
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
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
Rotator Cuff tendonitis
Less than 80 ml of blood

48. Prenatal visit schedule for low-risk pregnancies
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

49. What does the classic ring worm lesion have?
High blood pressure - focal neurologic defecit - or papilledema
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
A central clear area

50. At was quantity does urine dipstick test detect elevated protein?
Rotator Cuff problem
100mg; means patient can be trace protein positive and not be detected
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule