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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. Name the skin lesion: honey colored crusts
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
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
Coag disorders
Impetigo

2. What are the indiciations for neuroimaging?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
S. Aureus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Possibility of Ischemic colitis
Bence-Jones
PE - MI - aortic dissection - pneumothorax

4. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
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
Coag disorders
Wolff-Parkinson-White syndrome
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

5. 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.
Supraspinatus and bicipital tendons
24 hour halter
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

6. PE for a patient getting an abnormal vaginal bleeding work up
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

7. What lab tests are recommended for newly diagnosed hypertensive patients?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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.

8. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Diuretics -BB -CCB -ACEi
Other brainstem or cranial nerve findings
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.

9. Treatment for supraventricular tachycardias
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.
Viral gastroenteritis
BB or CCB - catheter ablation of identified bypass tract
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

10. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Cellulitis
Pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
GERD
Less than 3 stools per week
Possibility of Ischemic colitis

12. What are the physical exam signs of CHF?
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
Anticoag with warfarin to prevent thromboembolism
Pain
S. Aureus

13. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
>150mg per 24hrs
Paroxysmal atrial fibrillation or supraventricular tachycardia
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.

14. What should preconception counseling include?
Serotypes 16 - 18 - 31 -52 -58
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
S. aureus- beta hemolytic streptococcus
DM - HTN - DVT - seizures - depression - or anxiety

15. Oligomenorrhea
>3.5g of protein per 24hrs
Anticoag with warfarin to prevent thromboembolism
Cervical radiculopathy
Regular bleeding at intervals of more than 35 days

16. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

17. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

18. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Impetigo

19. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Cellulitis
ACEi - ARBS - thiazide diuretics
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

20. Constipation: What are indications for lab testing?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Less than 3 stools per week
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

21. Shoulder pain with pain radiating to elbow
Streptococci
Molluscum contagiosum- pox virus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Cervical radiculopathy

22. Difference between Pneumonia and Bronchitis
Lightheadedness - dizziness - syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Upper sternal area burning pain - associated with a productive cough

23. What are the signs of acute sinusitis?
Cervical radiculopathy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fever with frontal or maxillary tenderness
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

24. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Generalized Anxiety disorder and panic disorder
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

25. What are the three types of lice?
Loop diuretics (Check serum K+ levels before drug admin)
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Warts

26. MI - pericardial tamponade - PE - GI bleed - are...
MSK - pulmonary - GI - or psychological
Associated with hypotension
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

27. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Tension headache
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
GERD
Hypertension - CAD - valvular heart disease

28. What is the preload?
Other brainstem or cranial nerve findings
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

29. Initial treatment for Rhinosinusitis
Scabies
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

30. Vaccines that should be updated before planned pregnancy
Polymenorrhea
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

31. What is the caUse of Meniere disease? What are the cardinal symptoms?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
24 hour halter

32. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Possibility of Ischemic colitis
Rotator Cuff problem
Nonulcer dyspepsia

33. When is a lumbar puncture contraindicated?
Non-cardiac causes of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

34. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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)
Regular bleeding at intervals of more than 35 days
Candida albicans

35. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Associated with hypotension
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

36. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
HIV and syphilis
Anticoag with warfarin to prevent thromboembolism
Loop diuretics (Check serum K+ levels before drug admin)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

37. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
True
Paroxysmal atrial fibrillation or supraventricular tachycardia

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Coronary artery disease/ angina

39. What drugs do you use to treat H.pylori + PUD?
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 abrupt onset and cessation of palpitations
Viral infection of the semicircular apparatus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

40. Describe the presentation of pneumonia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
ACEi - ARBS - thiazide diuretics

41. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Viral infection of the semicircular apparatus
Peptic ulcer disease or gastritis
Analgesic headache
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.

42. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Streptococci
Diuretics -BB -CCB -ACEi
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

43. History for Acute bronchitis
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.
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Supraspinatus and bicipital tendons
Paroxysmal atrial fibrillation or supraventricular tachycardia

44. Define the patient population typically affected by orthostatic or postural proteinuria
Cholelithiasis
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
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

45. What does orthostatic positional changes that bring on dizziness suggest?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Dehydration - anemia - cardiac causes
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

46. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Less than 3 stools per week
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Viral infection of the semicircular apparatus

47. Discomfort with abducting the arm past 90 degress
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator Cuff tendonitis
>150mg per 24hrs
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

48. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Wolff-Parkinson-White syndrome
ACEi - ARBS - thiazide diuretics
24 hour halter

49. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Bulk forming: Psyllium - Methycellulose - Polycarbophil

50. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Echocardiogram
Scleroderma/polymyositis with secondary gastroesophageal reflux