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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 treatments are the cornerstone for treating cases of functional constipation?
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Increase; 200 g/day
Increasing fluid (8 - 8oz glasses of water/day) -fiber

2. Describe the presentation of myocardial pain?
Rotator Cuff tendonitis
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

3. What does orthostatic positional changes that bring on dizziness suggest?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Chest pain during pneumonia or PE
Dehydration - anemia - cardiac causes
Acute headache - ataxia - profuse nausea - and vomiting

4. What drugs do you use to treat H.pylori + PUD?
Repeat Pap after infection treated
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Varicella virus
Possibility of Ischemic colitis

5. What the consequences of decreased cardiac output?
Variability in the time for follicle development during the proliferative phase
Echocardiogram
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

6. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Rotator Cuff tendonitis
Viral infection of the semicircular apparatus
Cholelithiasis

7. 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
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
E. Coli O157:H7
Rotator Cuff tendonitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

8. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
HPV
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

9. Constipation: What are indications for lab testing?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
S. aureus- beta hemolytic streptococcus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

10. How does CHF present on X-ray?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Varicella virus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Acute headache - ataxia - profuse nausea - and vomiting

11. 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
Rotator Cuff problem
>150mg per 24hrs
Menorrhagia

12. What places women at higher risk of getting cervical cancer?
Cellulitis
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
Increase; 200 g/day
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

13. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Cellulitis
Coronary artery disease/ angina
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

14. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Viral gastroenteritis

15. Describe the presentation of angina?
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
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.
Chest pain during pneumonia or PE
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

16. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Hypertension - CAD - valvular heart disease

17. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Variability in the time for follicle development during the proliferative phase
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Presence of proteinuria on at least two separate ocassion

18. How are fungal infections diagnosed?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
With a KOH wet mount preparation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

19. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When the patient has symptoms in association with exercise or who describe chest pain or pressure
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

20. Pneumonia tx: suitable for healthy adults less than 60
Generalized Anxiety disorder and panic disorder
These patients are associated with low renin states=less likely to respond to medication
Cellulitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

21. What is the caUse of benign positional vertigo?
>150mg per 24hrs
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

22. What is a markers of CNS vertigo?
Folliculitis
Less abrupt onset and cessation of palpitations
Other brainstem or cranial nerve findings
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

23. Name the skin lesion: honey colored crusts
Impetigo
Polymenorrhea
Irregular bleeding between cycles
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

24. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

25. When does troponin rise following myocardial injury or infarction?
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.
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Wolff-Parkinson-White syndrome
Coag disorders

26. What are the 2 psych disorders most commonly associated with palpitations?
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Generalized Anxiety disorder and panic disorder
Irregular bleeding between cycles

27. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Less abrupt onset and cessation of palpitations
Echocardiogram

28. Difference between Pneumonia and Bronchitis
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
With a KOH wet mount preparation
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

29. 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
Albumin; low molecular weight proteins
True
ACEi - ARBS - thiazide diuretics
Giardia

30. What is benign transient proteinuria?
DM - HTN - DVT - seizures - depression - or anxiety
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

31. How do you define persistent protein uria?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Presence of proteinuria on at least two separate ocassion

32. What HPV serotypes are most commonly associated with cervical cancer?
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

33. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
A 24hr urine protein collection and urine creatinine clearance determination
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Higher filling presure - pulmonary congestion - and decreasd cardiac return

34. What is the next best step if a patient has two or more positive dipstick tests?
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
Bence-Jones
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
A 24hr urine protein collection and urine creatinine clearance determination

35. Where does the development of abnormal cervical cells begin?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Squamocolumnar junction=most common site of cervical cancer
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
>3.5g of protein per 24hrs

36. What is the peripheral caUse of vertigo?
Menorrhagia
>150mg per 24hrs
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
24 hour halter

37. What are the features of glomerular nephritis
Scleroderma/polymyositis with secondary gastroesophageal reflux
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
ACEi
RBC casts and old to moderate HTN

38. What does the classic ring worm lesion have?
MSK - pulmonary - GI - or psychological
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
Coronary artery disease/ angina
A central clear area

39. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Less abrupt onset and cessation of palpitations
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Temporal arteritis-biopsy of the temporal artery

40. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Peptic ulcer disease or gastritis
HPV
When the patient has symptoms in association with exercise or who describe chest pain or pressure

41. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Associated with hypotension
E. Coli O157:H7
Common problem that resolves spontaneously and is most often seen in children and young adults
ACEi - ARBS - thiazide diuretics

42. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Hypertension - CAD - valvular heart disease
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Medication or chemical esophagitis
Candida albicans

43. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
A central clear area

44. What is the standard tool used for diagnosis of GERD?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
EGD
CBC
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.

45. What should blood work include for suspected heart failure?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

46. Irregular cycles with excessive flow - duration - or both
Candida albicans
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Menorrhagia
Anticoag with warfarin to prevent thromboembolism

47. How does systolic vs. diastolic heart failure present on the echocardiogram?
Cervical radiculopathy
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

48. What are symptoms are CHF?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

49. Clinical Manifestations of HTN
These patients are associated with low renin states=less likely to respond to medication
Echocardiogram
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

50. Uterine bleeding between regular cycles
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
Intermenstrual bleeding
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Non-cardiac causes of palpitations