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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 diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Common problem that resolves spontaneously and is most often seen in children and young adults
Wolff-Parkinson-White syndrome
Squamocolumnar junction=most common site of cervical cancer
Anticoag with warfarin to prevent thromboembolism

2. 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
Presence of proteinuria on at least two separate ocassion
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
S. aureus- beta hemolytic streptococcus

3. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Associated with hypotension
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

4. 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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Varicella virus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

5. 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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Folliculitis
E. Coli O157:H7

6. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
DM - HTN - DVT - seizures - depression - or anxiety
>3.5g of protein per 24hrs
Cervical radiculopathy

7. What is the Barany maneuver?
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
RBC casts and old to moderate HTN
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

8. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Possibility of Ischemic colitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

9. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Possibility of Ischemic colitis
Cervical radiculopathy
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

10. When is a lumbar puncture contraindicated?
Slow progression of cervical cancer changes -Availability of effective early treatment
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Loop diuretics (Check serum K+ levels before drug admin)
Scleroderma/polymyositis with secondary gastroesophageal reflux

11. What does the classic ring worm lesion have?
Less abrupt onset and cessation of palpitations
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
A central clear area
Less than 80 ml of blood

12. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Coag disorders
Lightheadedness - dizziness - syncope
PE - MI - aortic dissection - pneumothorax
Scleroderma/polymyositis with secondary gastroesophageal reflux

13. Name some medications that can cause proteinuria
CT
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increasing fluid (8 - 8oz glasses of water/day) -fiber

14. What are the most common viral causes of diarrhea in kids and adults?
PE - MI - aortic dissection - pneumothorax
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Kids: Rotavirus Adults: Norwalk Virus
Impetigo

15. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Kids: Rotavirus Adults: Norwalk Virus
Nonulcer dyspepsia

16. What are the symptoms of palpitations?
Albumin; low molecular weight proteins
PVC or Premature atrial contraction (PAC)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Lightheadedness - dizziness - syncope

17. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
35 (exception for postmenopausal women who have recently been started on HRT)
Giardia
Candida albicans

18. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Giardia
High blood pressure - focal neurologic defecit - or papilledema
EGD

19. Define proteinuria
>150mg per 24hrs
Cellulitis
Less abrupt onset and cessation of palpitations
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

20. Describe the presentation of angina?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Cluster headache

21. Metrorrhagia
Loop diuretics (Check serum K+ levels before drug admin)
Temporal arteritis-biopsy of the temporal artery
Hgb - Electrolytes - and TSH
Irregular bleeding between cycles

22. What places women at higher risk of getting cervical cancer?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Rotator Cuff problem
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

23. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Folliculitis
Nonulcer dyspepsia
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

24. MI - pericardial tamponade - PE - GI bleed - are...
Colposcopy - Endocervical curettage - and directed cervical biopsy
Less than 3 stools per week
Associated with hypotension
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

25. Name 4 factors that predispose an individual to develop pneumonia.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Giardia

26. What occurs after ovulation
Associated with hypotension
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
GERD

27. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
A 24hr urine protein collection and urine creatinine clearance determination
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
35 (exception for postmenopausal women who have recently been started on HRT)
S. Aureus

28. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Giardia
Generalized Anxiety disorder and panic disorder

29. What are the primary glomerular diseases?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Molluscum contagiosum- pox virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

30. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Subarachnoid hemorrhage
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
High blood pressure - focal neurologic defecit - or papilledema

31. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Intermenstrual bleeding
Viral gastroenteritis

32. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Viral gastroenteritis
Scabies
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

33. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
LH surge triggers ovulation
PVC or Premature atrial contraction (PAC)

34. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
PE - MI - aortic dissection - pneumothorax
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

35. Constipation: What are indications for lab testing?
Folliculitis
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Acute headache - ataxia - profuse nausea - and vomiting

36. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Viral gastroenteritis
Albumin; low molecular weight proteins
GERD
Bence-Jones

37. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Kids: Rotavirus Adults: Norwalk Virus
Bence-Jones
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Slow progression of cervical cancer changes -Availability of effective early treatment

38. What are the two common clinical presentations of acute diarrhea?
Regular bleeding at intervals of more than 35 days
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

39. What are the indiciations for neuroimaging?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Loop diuretics (Check serum K+ levels before drug admin)
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

40. How do you know if heart palpitations are due to stimulant or medication use?
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Dehydration - anemia - cardiac causes
Less abrupt onset and cessation of palpitations

41. What is the standard tool used for diagnosis of GERD?
CT
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
EGD
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

42. What does orthostatic positional changes that bring on dizziness suggest?
ACEi - ARBS - thiazide diuretics
Dehydration - anemia - cardiac causes
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
24 hour halter

43. What lab tests are recommended for newly diagnosed hypertensive patients?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Intermenstrual bleeding
Analgesic headache
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

44. Vaccines that should be updated before planned pregnancy
Candida albicans
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Medication or chemical esophagitis

45. Describes what occurs during squamous metaplasia of the cervix.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Warts
A central clear area

46. What are the consequences of diastolic dysfunction?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

47. 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)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Possibility of Ischemic colitis

48. 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.
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
Tension headache
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Less than 80 ml of blood

49. What should be considered in younger patients with menorrhagia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Coag disorders

50. Treatment for supraventricular tachycardias
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Anticoag with warfarin to prevent thromboembolism
BB or CCB - catheter ablation of identified bypass tract
Cellulitis