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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. What are the two common clinical presentations of acute diarrhea?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
HPV testing -Pos=colposcopy -Neg=repeat pap smear
True
24 hour halter

3. Name the skin lesion: erythema - warmth - edema - pain - fever
Infectious esophagitis
Cellulitis
24 hour halter
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

4. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Less abrupt onset and cessation of palpitations
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
Menorrhagia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

5. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Folliculitis

6. Natural history of cervical cancer
Increase; 200 g/day
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Presence of proteinuria on at least two separate ocassion
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

7. What are the most common causes for the common cold?
Increase; 200 g/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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hgb - Electrolytes - and TSH

8. Describe the presentation tracheobronchitis
Furucnle
MSK - pulmonary - GI - or psychological
Upper sternal area burning pain - associated with a productive cough
DM - HTN - DVT - seizures - depression - or anxiety

9. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
These patients are associated with low renin states=less likely to respond to medication
CT

10. What should preconception counseling include?
Variability in the time for follicle development during the proliferative phase
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
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

11. Describe the history and PE of patient presenting with common cold
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
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
Tension headache
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

12. How do you know if heart palpitations are due to stimulant or medication use?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Less abrupt onset and cessation of palpitations
Slow progression of cervical cancer changes -Availability of effective early treatment
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

13. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Non-cardiac causes of palpitations
Common problem that resolves spontaneously and is most often seen in children and young adults
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

14. Oligomenorrhea
Pancreatitis
Regular bleeding at intervals of more than 35 days
Dehydration - anemia - cardiac causes
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

15. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
True
DM - HTN - DVT - seizures - depression - or anxiety
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

16. What drugs do you use to treat H.pylori + PUD?
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Serotypes 16 - 18 - 31 -52 -58
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

17. Pneumonia tx: suitable for healthy adults older than 60
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
ACEi - ARBS - thiazide diuretics
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

18. 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
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cluster headache
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

19. What are the 2 psych disorders most commonly associated with palpitations?
Nonulcer dyspepsia
Generalized Anxiety disorder and panic disorder
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Hgb - Electrolytes - and TSH

20. Define nephrotic range proteinuria
Nonulcer dyspepsia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Increase; 200 g/day
>3.5g of protein per 24hrs

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - 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
Rotator cuff tendonitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Coronary artery disease/ angina

22. Describe the presentation of angina?
Pts with palpitations and dizziness - near syncope - or syncope
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
DM - HTN - DVT - seizures - depression - or anxiety
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

23. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Analgesic headache
>150mg per 24hrs

24. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
E. Coli O157:H7
Increase; 200 g/day
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

25. What are the features of nephrotic syndrome?
Slow progression of cervical cancer changes -Availability of effective early treatment
Serotypes 16 - 18 - 31 -52 -58
High blood pressure - focal neurologic defecit - or papilledema
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

26. What is benign transient proteinuria?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Common problem that resolves spontaneously and is most often seen in children and young adults
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

27. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
GERD
Peptic ulcer disease or gastritis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

28. Treatment for supraventricular tachycardias
Colposcopy - Endocervical curettage - and directed cervical biopsy
These patients are associated with low renin states=less likely to respond to medication
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
BB or CCB - catheter ablation of identified bypass tract

29. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
Cervical radiculopathy
Streptococci
Increase; 200 g/day

30. Describes what occurs during squamous metaplasia of the cervix.
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.
Nonulcer dyspepsia
Paroxysmal atrial fibrillation or supraventricular tachycardia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

31. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
With a KOH wet mount preparation
Diuretics -BB -CCB -ACEi
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

32. Name the skin lesion: pustule in association with a hair follice
Pain
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
Folliculitis
Rotator Cuff tendonitis

33. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

34. What does orthostatic positional changes that bring on dizziness suggest?
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
Rotator Cuff problem
Dehydration - anemia - cardiac causes
Coag disorders

35. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Intermenstrual bleeding

36. Uterine bleeding between regular cycles
Medication or chemical esophagitis
Intermenstrual bleeding
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

37. How does CHF present on X-ray?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Less than 80 ml of blood
Warts

38. Where does the development of abnormal cervical cells begin?
Other brainstem or cranial nerve findings
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Squamocolumnar junction=most common site of cervical cancer
Dehydration - anemia - cardiac causes

39. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
True
Menorrhagia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

40. How can GERD (or esophageal motility disorders) lead to chest pain?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pancreatitis
Hgb - Electrolytes - and TSH
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

41. How to NSAIDs contribute to gastritis and ulcer formation?
Kids: Rotavirus Adults: Norwalk Virus
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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Pain

42. Chronic pain and shoulder stiffness with limited motion
With a KOH wet mount preparation
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cellulitis
ACEi

43. SE Of Beta blockers?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
A 24hr urine protein collection and urine creatinine clearance determination
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

44. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
GERD
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
MSK - pulmonary - GI - or psychological

45. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Intermenstrual bleeding

46. Menometrorrhagia
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Excessive bleeding in amount - duration - or both at irregular intervals
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
Impetigo

47. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cervical radiculopathy
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

48. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Streptococci
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

49. What are the indiciations for neuroimaging?
ACEi - ARBS - thiazide diuretics
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
Albumin; low molecular weight proteins
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

50. patients with herpes zoster may experience what symptom before the rash appear?
Viral gastroenteritis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pain
Regular bleeding at intervals of more than 35 days