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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. Pneumonia tx: suitable for healthy adults less than 60
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

2. What are the physical exam signs of CHF?
Regular bleeding at intervals of more than 35 days
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
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
Squamocolumnar junction=most common site of cervical cancer

3. 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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

4. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Cholelithiasis
Cervical radiculopathy
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Furucnle

5. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Folliculitis
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.
Rotator Cuff problem

6. How are fungal infections diagnosed?
Molluscum contagiosum- pox virus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
With a KOH wet mount preparation

7. 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
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
Possibility of Ischemic colitis
True
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

8. Tx of chronic or intermittent afibs
Pleurisy
Anticoag with warfarin to prevent thromboembolism
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Tension headache

9. 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
Peptic ulcer disease or gastritis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
ACEi

10. What is the standard tool used for diagnosis of GERD?
EGD
Infectious esophagitis
Scabies
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

11. 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.
Repeat Pap after infection treated
Adhesive capsulitis (frozen shoulder): most common in middle age women
A 24hr urine protein collection and urine creatinine clearance determination
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

12. Describe the presentation of angina?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Streptococci
Pancreatitis

13. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
High blood pressure - focal neurologic defecit - or papilledema
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Less than 3 stools per week

14. Diagnosis of HTN
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Furucnle
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

15. Constipation: What are indications for lab testing?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Candida albicans
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
Less than 80 ml of blood
LH surge triggers ovulation

17. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
>150mg per 24hrs
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

18. What are the features of glomerular nephritis
Cluster headache
Peptic ulcer disease or gastritis
RBC casts and old to moderate HTN
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

19. Predictors of cardiac etiology
Fever with frontal or maxillary tenderness
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Influenza - Rhinovirus - Adenovirus - Parainfluenza

20. What are the most common viral causes of diarrhea in kids and adults?
Pleurisy
Kids: Rotavirus Adults: Norwalk Virus
Presence of proteinuria on at least two separate ocassion
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

21. How is constipation clinically defined?
Rotator Cuff tendonitis
Less than 3 stools per week
Common problem that resolves spontaneously and is most often seen in children and young adults
Slow progression of cervical cancer changes -Availability of effective early treatment

22. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Peptic ulcer disease or gastritis
Nonulcer dyspepsia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

23. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Repeat Pap after infection treated
Temporal arteritis-biopsy of the temporal artery

24. History and PE for Pneumonia
Upper sternal area burning pain - associated with a productive cough
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

25. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Less than 80 ml of blood
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

26. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Diuretics -BB -CCB -ACEi
Coag disorders
CT

27. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Rotator Cuff problem
Molluscum contagiosum- pox virus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
RBC casts and old to moderate HTN

28. Describe the presentation of pericardial 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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A 24hr urine protein collection and urine creatinine clearance determination
HIV and syphilis

29. What drugs do you use to treat H.pylori + PUD?
Increase; 200 g/day
Non-cardiac causes of palpitations
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
>3.5g of protein per 24hrs

30. Name 4 factors that predispose an individual to develop pneumonia.
Scabies
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

31. What is a markers of CNS vertigo?
PVC or Premature atrial contraction (PAC)
Other brainstem or cranial nerve findings
Slow progression of cervical cancer changes -Availability of effective early treatment
When the patient has symptoms in association with exercise or who describe chest pain or pressure

32. What are the indiciations for neuroimaging?
PE - MI - aortic dissection - pneumothorax
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
HIV and syphilis
Coag disorders

33. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Coronary artery disease/ angina
Coag disorders
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

34. What are the common causes for laryngitis?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pts with palpitations and dizziness - near syncope - or syncope

35. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
100mg; means patient can be trace protein positive and not be detected
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
PVC or Premature atrial contraction (PAC)

36. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Squamocolumnar junction=most common site of cervical cancer
Repeat Pap after infection treated
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bence-Jones

37. Things that need to be included in history of shoulder pain
Warts
Excessive bleeding in amount - duration - or both at irregular intervals
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Streptococci

38. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Folliculitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cholelithiasis
24 hour halter

39. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Polymenorrhea
Excessive bleeding in amount - duration - or both at irregular intervals

40. What are the signs of cerebral hemorrhage?
LH surge triggers ovulation
Acute headache - ataxia - profuse nausea - and vomiting
Pancreatitis
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

41. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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.
Influenza - Rhinovirus - Adenovirus - Parainfluenza

42. What are the two common clinical presentations of acute diarrhea?
A 24hr urine protein collection and urine creatinine clearance determination
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

43. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Cellulitis

44. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Pleurisy
Varicella virus
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

45. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Subarachnoid hemorrhage
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
35 (exception for postmenopausal women who have recently been started on HRT)

46. Complete the sentence: pericarditis can cause frictional rub and......
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Analgesic headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

47. Define proteinuria
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
>150mg per 24hrs
Varicella virus

48. Prenatal visit schedule for low-risk pregnancies
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Molluscum contagiosum- pox virus
Scleroderma/polymyositis with secondary gastroesophageal reflux

49. 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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cluster headache
Coag disorders
When the patient has symptoms in association with exercise or who describe chest pain or pressure

50. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema