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Family Medicine Shelf

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. PE for a patient getting an abnormal vaginal bleeding work up
True
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Diuretics -BB -CCB -ACEi
When the patient has symptoms in association with exercise or who describe chest pain or pressure

2. Name the skin lesion: honey colored crusts
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
Impetigo
Pancreatitis

3. Diarrhea from custard filled pastries
S. Aureus
Other brainstem or cranial nerve findings
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
GERD

4. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Subarachnoid hemorrhage
A central clear area
Non-cardiac causes of palpitations
ACEi - ARBS - thiazide diuretics

5. What should preconception counseling include?
Less than 80 ml of blood
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
A central clear area
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

6. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Menorrhagia
Dehydration - anemia - cardiac causes
Nonulcer dyspepsia

7. What are the most common viral causes of diarrhea in kids and adults?
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Kids: Rotavirus Adults: Norwalk Virus

8. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
HIV and syphilis
Kids: Rotavirus Adults: Norwalk Virus
>3.5g of protein per 24hrs

9. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.

10. What are the two common clinical presentations of acute diarrhea?
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
S. aureus- beta hemolytic streptococcus
>3.5g of protein per 24hrs
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

11. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Less abrupt onset and cessation of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
When the patient has symptoms in association with exercise or who describe chest pain or pressure

12. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Giardia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

13. What is benign transient proteinuria?
Viral gastroenteritis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
24 hour halter
Common problem that resolves spontaneously and is most often seen in children and young adults

14. What are the physical exam signs of CHF?
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
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Supraspinatus and bicipital tendons

15. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
A central clear area
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

16. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Echocardiogram
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Warts

17. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Polymenorrhea
Fever with frontal or maxillary tenderness
Coag disorders

18. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
CBC
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
Chest pain during pneumonia or PE

19. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Temporal arteritis-biopsy of the temporal artery
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Cholelithiasis

20. Clinical Manifestations of HTN
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Pancreatitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
LH surge triggers ovulation

21. What is the caUse of benign positional vertigo?
Serotypes 16 - 18 - 31 -52 -58
Presence of proteinuria on at least two separate ocassion
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.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

22. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Less than 80 ml of blood
Repeat Pap after infection treated
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Variability in the time for follicle development during the proliferative phase

23. Name some medications that can cause proteinuria
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
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
Furucnle
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

24. How to NSAIDs contribute to gastritis and ulcer formation?
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.
>150mg per 24hrs
Impetigo
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

25. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
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
BB or CCB - catheter ablation of identified bypass tract

26. What is the preload?
Rotator cuff tendonitis
Furucnle
Infectious esophagitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

27. When is a lumbar puncture contraindicated?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Upper sternal area burning pain - associated with a productive cough

28. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Supraspinatus and bicipital tendons
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Folliculitis

29. What HPV serotypes are most commonly associated with cervical cancer?
Menorrhagia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Serotypes 16 - 18 - 31 -52 -58
HPV

30. Uterine bleeding between regular cycles
Coronary artery disease/ angina
LH surge triggers ovulation
Intermenstrual bleeding
Supraspinatus and bicipital tendons

31. What test done in PE measures instability of shoulder?
Menorrhagia
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

32. What the consequences of decreased cardiac output?
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
Candida albicans
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
S. aureus- beta hemolytic streptococcus

33. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Streptococci
PE - MI - aortic dissection - pneumothorax
Tension headache

34. What are the three types of lice?
Infectious esophagitis
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

35. 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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Paroxysmal atrial fibrillation or supraventricular tachycardia
Analgesic headache

36. How do you define persistent protein uria?
Cervical radiculopathy
Presence of proteinuria on at least two separate ocassion
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Serotypes 16 - 18 - 31 -52 -58

37. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Presence of proteinuria on at least two separate ocassion
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Echocardiogram

38. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active 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
Irregular bleeding between cycles

39. History and PE for Pneumonia
HIV and syphilis
Supraspinatus and bicipital tendons
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
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

40. What is the Barany maneuver?
These patients are associated with low renin states=less likely to respond to medication
MSK - pulmonary - GI - or psychological
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

41. What are the three major risk factors for heart failure?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Less than 80 ml of blood
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Hypertension - CAD - valvular heart disease

42. Things that need to be included in history of shoulder pain
Cluster headache
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Less than 3 stools per week

43. What does treatment for migrans include?
Generalized Anxiety disorder and panic disorder
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
100mg; means patient can be trace protein positive and not be detected
Tension headache

44. What is the difference between a Holter monitor or an event monitor?
Intermenstrual bleeding
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

45. 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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
PE - MI - aortic dissection - pneumothorax

46. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

47. 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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
>3.5g of protein per 24hrs
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Tension headache

48. 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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
PVC or Premature atrial contraction (PAC)
Cluster headache

49. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Furucnle
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

50. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Cluster headache
Coag disorders
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