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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 diagnosis does the 'worse headache of my life' suggest?
Non-cardiac causes of palpitations
Folliculitis
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
Subarachnoid hemorrhage

2. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
These patients are associated with low renin states=less likely to respond to medication
Squamocolumnar junction=most common site of cervical cancer
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

3. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
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.
Increase; 200 g/day
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

4. What is the preload?
A 24hr urine protein collection and urine creatinine clearance determination
Candida albicans
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Viral infection of the semicircular apparatus
Lightheadedness - dizziness - syncope
Squamocolumnar junction=most common site of cervical cancer

6. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
High blood pressure - focal neurologic defecit - or papilledema
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

7. Name the skin lesion: erythema - warmth - edema - pain - fever
Nonulcer dyspepsia
Rotator Cuff tendonitis
Cellulitis
Hgb - Electrolytes - and TSH

8. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Varicella virus
Staphylococcal scalded skin syndrome
Wolff-Parkinson-White syndrome

9. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Varicella virus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pain
S. aureus- beta hemolytic streptococcus

10. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Cholelithiasis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
GERD
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

11. How do you define persistent protein uria?
Squamocolumnar junction=most common site of cervical cancer
MSK - pulmonary - GI - or psychological
Varicella virus
Presence of proteinuria on at least two separate ocassion

12. What are the three types of lice?
Common problem that resolves spontaneously and is most often seen in children and young adults
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

13. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Associated with hypotension
Varicella virus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

14. What does the classic ring worm lesion have?
Furucnle
Viral infection of the semicircular apparatus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
A central clear area

15. Define the patient population typically affected by orthostatic or postural proteinuria
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
Warts
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

16. How do you know if heart palpitations are due to stimulant or medication use?
S. Aureus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Less abrupt onset and cessation of palpitations

17. Treatment for supraventricular tachycardias
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
BB or CCB - catheter ablation of identified bypass tract
A 24hr urine protein collection and urine creatinine clearance determination

18. Define nephrotic range proteinuria
Loop diuretics (Check serum K+ levels before drug admin)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Excessive bleeding in amount - duration - or both at irregular intervals
>3.5g of protein per 24hrs

19. What are signs of pulmonary congestion?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Chest pain during pneumonia or PE

20. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
True
Medication or chemical esophagitis

21. patients with herpes zoster may experience what symptom before the rash appear?
Cellulitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Pain
Influenza - Rhinovirus - Adenovirus - Parainfluenza

22. Describe the history and PE of patient presenting with common cold
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
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
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
Possibility of Ischemic colitis

23. What is the peripheral caUse of vertigo?
Medication or chemical esophagitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

24. 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
Increase; 200 g/day
E. Coli O157:H7
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Scabies

25. What HPV serotypes are most commonly associated with cervical cancer?
Cholelithiasis
Serotypes 16 - 18 - 31 -52 -58
LH surge triggers ovulation
Pain

26. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Varicella virus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

27. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
A central clear area
Associated with hypotension
Cholelithiasis

28. Describe the presentation of pericardial pain
GERD
Adhesive capsulitis (frozen shoulder): most common in middle age 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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

29. 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.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Anticoag with warfarin to prevent thromboembolism
Coronary artery disease/ angina
Tension headache

30. Metrorrhagia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Irregular bleeding between cycles
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.

31. Things that need to be included in history of shoulder pain
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Influenza - Rhinovirus - Adenovirus - Parainfluenza

32. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Temporal arteritis-biopsy of the temporal artery
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

33. Cycle length variabilty is primarily due to what?
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
>3.5g of protein per 24hrs
Variability in the time for follicle development during the proliferative phase
EGD

34. Name types of laxatives
Less than 3 stools per week
Varicella virus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

35. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Variability in the time for follicle development during the proliferative phase
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Paroxysmal atrial fibrillation or supraventricular tachycardia
Increasing fluid (8 - 8oz glasses of water/day) -fiber

36. What is the Epley maneuver?
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
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.
PVC or Premature atrial contraction (PAC)
Slow progression of cervical cancer changes -Availability of effective early treatment

37. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Impetigo
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Non-cardiac causes of palpitations

38. What are the secondly causes of glomerular disease?
True
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

39. Shoulder pain with pain radiating to elbow
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cervical radiculopathy
Analgesic headache
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

40. What is the goal of CHF treatment? What drugs should be used?
Intermenstrual bleeding
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
Infectious esophagitis

41. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

42. Diagnosis of HTN
Pts with palpitations and dizziness - near syncope - or syncope
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Less abrupt onset and cessation of palpitations
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

43. Diarrhea from custard filled pastries
PVC or Premature atrial contraction (PAC)
S. Aureus
Increase; 200 g/day
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

44. When is a lumbar puncture contraindicated?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
LH surge triggers ovulation
Scabies

45. Define proteinuria
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
>150mg per 24hrs
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

46. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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
Cholelithiasis
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

47. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
Rotator Cuff problem
Pts with palpitations and dizziness - near syncope - or syncope

48. Prenatal visit schedule for low-risk pregnancies
MSK - pulmonary - GI - or psychological
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
Viral gastroenteritis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

49. Vaccines that should be updated before planned pregnancy
Regular bleeding at intervals of more than 35 days
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

50. 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
Staphylococcal scalded skin syndrome
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
Warts
Common problem that resolves spontaneously and is most often seen in children and young adults