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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. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Medication or chemical esophagitis
Peptic ulcer disease or gastritis
35 (exception for postmenopausal women who have recently been started on HRT)
MSK - pulmonary - GI - or psychological

2. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Increase; 200 g/day
CBC
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
Subarachnoid hemorrhage

3. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

4. What are symptoms are CHF?
These patients are associated with low renin states=less likely to respond to medication
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
With a KOH wet mount preparation

5. What is the Barany maneuver?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

6. Isolated - extra pounding beats
Cervical radiculopathy
PVC or Premature atrial contraction (PAC)
HPV
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

7. What places women at higher risk of getting cervical cancer?
EGD
Regular bleeding at intervals of more than 35 days
A 24hr urine protein collection and urine creatinine clearance determination
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

8. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
E. Coli O157:H7
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

9. Define proteinuria
>150mg per 24hrs
Serotypes 16 - 18 - 31 -52 -58
Albumin; low molecular weight proteins
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

10. 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
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi - ARBS - thiazide diuretics
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

11. After treatment of dysplasia - women need Pap smears every...
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
PVC or Premature atrial contraction (PAC)
Possibility of Ischemic colitis

12. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Coronary artery disease/ angina
CT
Medication or chemical esophagitis
Candida albicans

13. Name the diagnosis of heartburn: severe constant mid abdominal pain
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Supraspinatus and bicipital tendons
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pancreatitis

14. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

15. Diarrhea from custard filled pastries
S. Aureus
Streptococci
Regular bleeding at intervals of more than 35 days
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

16. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Scabies

17. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Pain

18. Name 4 factors that predispose an individual to develop pneumonia.
Kids: Rotavirus Adults: Norwalk Virus
Dehydration - anemia - cardiac causes
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Variability in the time for follicle development during the proliferative phase

19. What is a markers of CNS vertigo?
Infectious esophagitis
Other brainstem or cranial nerve findings
ACEi - ARBS - thiazide diuretics
Anticoag with warfarin to prevent thromboembolism

20. When should a patient get a stress test?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Wolff-Parkinson-White syndrome
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

21. What are the three major risk factors for heart failure?
Medication or chemical esophagitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Hypertension - CAD - valvular heart disease
Tension headache

22. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Peptic ulcer disease or gastritis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Repeat Pap after infection treated

23. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Lightheadedness - dizziness - syncope
Furucnle
RBC casts and old to moderate HTN

24. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Cluster headache
Varicella virus
Menorrhagia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

25. What should be considered in younger patients with menorrhagia
Paroxysmal atrial fibrillation or supraventricular tachycardia
LH surge triggers ovulation
Echocardiogram
Coag disorders

26. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Excessive bleeding in amount - duration - or both at irregular intervals

27. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cholelithiasis
Analgesic headache
Less than 80 ml of blood

28. What is the Epley maneuver?
GERD
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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.
Repeat Pap after infection treated

29. What is the peripheral caUse of vertigo?
>3.5g of protein per 24hrs
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Temporal arteritis-biopsy of the temporal artery
E. Coli O157:H7

30. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Medication or chemical esophagitis
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

31. What are the most common viral causes of diarrhea in kids and adults?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Kids: Rotavirus Adults: Norwalk Virus
Variability in the time for follicle development during the proliferative phase

32. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Serotypes 16 - 18 - 31 -52 -58
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Chest pain during pneumonia or PE
Kids: Rotavirus Adults: Norwalk Virus

33. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Streptococci
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

34. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
24 hour halter
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Repeat Pap after infection treated

35. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Regular bleeding at intervals of more than 35 days
DM - HTN - DVT - seizures - depression - or anxiety
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
PVC or Premature atrial contraction (PAC)

36. Vaccines that should be updated before planned pregnancy
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Folliculitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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.
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

38. What is the goal of CHF treatment? What drugs should be used?
ACEi
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
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

39. What medications can cause heart palpitations?
Scabies
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
ACEi - ARBS - thiazide diuretics

40. What are the physical exam signs of CHF?
Temporal arteritis-biopsy of the temporal artery
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Echocardiogram

41. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Viral gastroenteritis
Coag disorders

42. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

43. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Serotypes 16 - 18 - 31 -52 -58
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

44. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Temporal arteritis-biopsy of the temporal artery
Pain

45. What is afterload?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Anticoag with warfarin to prevent thromboembolism
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

46. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
24 hour halter

47. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Acute headache - ataxia - profuse nausea - and vomiting
Wolff-Parkinson-White syndrome
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Less than 80 ml of blood

48. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
HPV
Staphylococcal scalded skin syndrome
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
A 24hr urine protein collection and urine creatinine clearance determination

49. What does treatment for migrans include?
EGD
Less than 3 stools per week
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

50. How does systolic vs. diastolic heart failure present on the echocardiogram?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Nonulcer dyspepsia
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
PVC or Premature atrial contraction (PAC)