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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. What is an acoustic neuroma?
DM - HTN - DVT - seizures - depression - or anxiety
PE - MI - aortic dissection - pneumothorax
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

2. What HPV serotypes are most commonly associated with cervical cancer?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Serotypes 16 - 18 - 31 -52 -58
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
BB or CCB - catheter ablation of identified bypass tract

3. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
Analgesic headache
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

4. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Infectious esophagitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Staphylococcal scalded skin syndrome

5. Describe the presentation of pneumonia
DM - HTN - DVT - seizures - depression - or anxiety
MSK - pulmonary - GI - or psychological
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

6. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Loop diuretics (Check serum K+ levels before drug admin)
Adhesive capsulitis (frozen shoulder): most common in middle age women

7. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Hgb - Electrolytes - and TSH
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
Rotator Cuff problem
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

8. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Slow progression of cervical cancer changes -Availability of effective early treatment
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

9. What is the next best step if a patient has two or more positive dipstick tests?
DM - HTN - DVT - seizures - depression - or anxiety
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Higher filling presure - pulmonary congestion - and decreasd cardiac return

10. What occurs after ovulation
Hypertension - CAD - valvular heart disease
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

11. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH
Supraspinatus and bicipital tendons

12. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Variability in the time for follicle development during the proliferative phase
Non-cardiac causes of palpitations
Viral infection of the semicircular apparatus
>150mg per 24hrs

13. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
EGD
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

14. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Infectious esophagitis
Giardia
HPV testing -Pos=colposcopy -Neg=repeat pap smear
True

15. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
24 hour halter
Pts with palpitations and dizziness - near syncope - or syncope
Coag disorders

16. What are the secondly causes of glomerular disease?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Temporal arteritis-biopsy of the temporal artery
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

17. Chronic pain and shoulder stiffness with limited motion
Other brainstem or cranial nerve findings
Adhesive capsulitis (frozen shoulder): most common in middle age women
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Nonulcer dyspepsia

18. What is the Epley maneuver?
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.
Loop diuretics (Check serum K+ levels before drug admin)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Regular bleeding at intervals of more than 35 days

19. 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
True
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Viral gastroenteritis
Polymenorrhea

20. History for Acute bronchitis
100mg; means patient can be trace protein positive and not be detected
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

21. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Pleurisy
Pain
Squamocolumnar junction=most common site of cervical cancer

22. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Diuretics -BB -CCB -ACEi
Repeat Pap after infection treated
With a KOH wet mount preparation
Molluscum contagiosum- pox virus

23. Irregular cycles with excessive flow - duration - or both
ACEi - ARBS - thiazide diuretics
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
35 (exception for postmenopausal women who have recently been started on HRT)
Menorrhagia

24. Vaccines that should be updated before planned pregnancy
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Echocardiogram

25. Natural history of cervical cancer
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
ACEi - ARBS - thiazide diuretics
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

26. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Cervical radiculopathy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Hypertension - CAD - valvular heart disease
Diuretics -BB -CCB -ACEi

27. What are the common causes for laryngitis?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
HPV testing -Pos=colposcopy -Neg=repeat pap smear
High blood pressure - focal neurologic defecit - or papilledema

28. Define nephrotic range proteinuria
Cholelithiasis
>3.5g of protein per 24hrs
These patients are associated with low renin states=less likely to respond to medication
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

29. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Albumin; low molecular weight proteins
Menorrhagia
Impetigo

30. Describe the presentation of pericardial pain
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
BB or CCB - catheter ablation of identified bypass tract

31. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Paroxysmal atrial fibrillation or supraventricular tachycardia
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.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

32. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Impetigo
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

33. How does systolic vs. diastolic heart failure present on the echocardiogram?
Acute headache - ataxia - profuse nausea - and vomiting
HPV
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

34. patients with herpes zoster may experience what symptom before the rash appear?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Presence of proteinuria on at least two separate ocassion
Pain
Generalized Anxiety disorder and panic disorder

35. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
Variability in the time for follicle development during the proliferative phase
Albumin; low molecular weight proteins
DM - HTN - DVT - seizures - depression - or anxiety

36. Prenatal visit schedule for low-risk pregnancies
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
Upper sternal area burning pain - associated with a productive cough
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
Analgesic headache

37. History for Sinusitis

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38. What is the standard tool used for diagnosis of GERD?
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
EGD
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

39. 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
RBC casts and old to moderate HTN
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

40. Predictors of cardiac etiology
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cluster headache
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

41. How is constipation clinically defined?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
Less than 3 stools per week

42. Diagnosis of HTN
Less than 3 stools per week
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Furucnle

43. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

44. 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.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Tension headache
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

45. What are the features of glomerular nephritis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
RBC casts and old to moderate HTN
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

46. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Furucnle
A 24hr urine protein collection and urine creatinine clearance determination

47. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Pleurisy
Pain
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.
S. aureus- beta hemolytic streptococcus

48. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Impetigo
Lightheadedness - dizziness - syncope
Scleroderma/polymyositis with secondary gastroesophageal reflux
Chest pain during pneumonia or PE

49. At was quantity does urine dipstick test detect elevated protein?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Hgb - Electrolytes - and TSH
100mg; means patient can be trace protein positive and not be detected

50. What should be considered in younger patients with menorrhagia
Coag disorders
Folliculitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Squamocolumnar junction=most common site of cervical cancer