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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 is the next best step if a patient has two or more positive dipstick tests?
Warts
A 24hr urine protein collection and urine creatinine clearance determination
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

2. What is the Barany maneuver?
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
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
High blood pressure - focal neurologic defecit - or papilledema
A 24hr urine protein collection and urine creatinine clearance determination

3. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults
BB or CCB - catheter ablation of identified bypass tract
A 24hr urine protein collection and urine creatinine clearance determination

4. 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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Warts
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
Slow progression of cervical cancer changes -Availability of effective early treatment

5. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
CT
Lightheadedness - dizziness - syncope
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
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

6. How does systolic vs. diastolic heart failure present on the echocardiogram?
LH surge triggers ovulation
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
Cervical radiculopathy
HPV testing -Pos=colposcopy -Neg=repeat pap smear

7. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Dehydration - anemia - cardiac causes
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
Cluster headache
CT

8. Prenatal visit schedule for low-risk pregnancies
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Hypertension - CAD - valvular heart disease
Loop diuretics (Check serum K+ levels before drug admin)

9. Predictors of cardiac etiology
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
100mg; means patient can be trace protein positive and not be detected
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

10. Natural history of cervical cancer
Wolff-Parkinson-White syndrome
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.
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

11. 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
ACEi - ARBS - thiazide diuretics
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

12. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Pts with palpitations and dizziness - near syncope - or syncope
Furucnle
Associated with hypotension

13. Four muscles of rotator cuff
CBC
Impetigo
Colposcopy - Endocervical curettage - and directed cervical biopsy
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

14. What test done in PE measures instability of shoulder?
Cervical radiculopathy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Folliculitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

15. What is the goal of CHF treatment? What drugs should be used?
Temporal arteritis-biopsy of the temporal artery
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
>3.5g of protein per 24hrs
Impetigo

16. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Generalized Anxiety disorder and panic disorder
Irregular bleeding between cycles
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

17. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
LH surge triggers ovulation
Hgb - Electrolytes - and TSH
S. Aureus

18. 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
Chest pain during pneumonia or PE
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
True
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

19. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Upper sternal area burning pain - associated with a productive cough
Hypertension - CAD - valvular heart disease

20. Define the patient population typically affected by orthostatic or postural proteinuria
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
Anticoag with warfarin to prevent thromboembolism
Diuretics -BB -CCB -ACEi
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

21. Cycle length variabilty is primarily due to what?
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
CBC
Variability in the time for follicle development during the proliferative phase
Pts with palpitations and dizziness - near syncope - or syncope

22. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Candida albicans
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

23. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Furucnle
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

24. What is afterload?
>3.5g of protein per 24hrs
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

25. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Medication or chemical esophagitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

26. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Impetigo
>3.5g of protein per 24hrs
Furucnle
Non-cardiac causes of palpitations

27. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Dehydration - anemia - cardiac causes
PVC or Premature atrial contraction (PAC)

28. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Anticoag with warfarin to prevent thromboembolism
Polymenorrhea
Giardia
Hypertension - CAD - valvular heart disease

29. Uterine bleeding between regular cycles
Intermenstrual bleeding
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
A 24hr urine protein collection and urine creatinine clearance determination
Folliculitis

30. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
A central clear area
Non-cardiac causes of palpitations

31. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
HPV

32. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
S. Aureus
>3.5g of protein per 24hrs
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Loop diuretics (Check serum K+ levels before drug admin)

33. Describe the presentation of myocardial pain?
Pts with palpitations and dizziness - near syncope - or syncope
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

34. When should a patient get a stress test?
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
Chest pain during pneumonia or PE
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure

35. PE for a patient getting an abnormal vaginal bleeding work up
LH surge triggers ovulation
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)
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

36. What does orthostatic positional changes that bring on dizziness suggest?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
MSK - pulmonary - GI - or psychological
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Dehydration - anemia - cardiac causes

37. What are the symptoms of palpitations?
Slow progression of cervical cancer changes -Availability of effective early treatment
Lightheadedness - dizziness - syncope
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Diuretics -BB -CCB -ACEi

38. Shoulder pain with pain radiating to elbow
With a KOH wet mount preparation
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cervical radiculopathy

39. Who should have Xray testing for shoulder pain?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Furucnle

40. What is the difference between a Holter monitor or an event monitor?
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
Infectious esophagitis
Increase; 200 g/day
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.

41. What are the consequences of diastolic dysfunction?
Pleurisy
Streptococci
Adhesive capsulitis (frozen shoulder): most common in middle age women
Higher filling presure - pulmonary congestion - and decreasd cardiac return

42. What are the signs of malignant hypertension?
Scabies
BB or CCB - catheter ablation of identified bypass tract
>3.5g of protein per 24hrs
High blood pressure - focal neurologic defecit - or papilledema

43. Carcinoma in situ is generally referred to a gynecologist and requires ______
Presence of proteinuria on at least two separate ocassion
Warts
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
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

44. What are the features of glomerular nephritis
Other brainstem or cranial nerve findings
Upper sternal area burning pain - associated with a productive cough
RBC casts and old to moderate HTN
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

45. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HPV
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Acute headache - ataxia - profuse nausea - and vomiting

46. 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
PE - MI - aortic dissection - pneumothorax
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
Cluster headache
Intermenstrual bleeding

47. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
CT
CBC

48. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Irregular bleeding between cycles
100mg; means patient can be trace protein positive and not be detected
These patients are associated with low renin states=less likely to respond to medication
Tension headache

49. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
LH surge triggers ovulation
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

50. Clinical Manifestations of HTN
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
Staphylococcal scalded skin syndrome
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool