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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. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
PVC or Premature atrial contraction (PAC)
Nonulcer dyspepsia
Medication or chemical esophagitis

2. How does CHF present on X-ray?
HIV and syphilis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pleurisy
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

3. Diarrhea from custard filled pastries
HPV testing -Pos=colposcopy -Neg=repeat pap smear
S. Aureus
Peptic ulcer disease or gastritis
Varicella virus

4. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

5. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
100mg; means patient can be trace protein positive and not be detected
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Possibility of Ischemic colitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza

6. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Possibility of Ischemic colitis
Albumin; low molecular weight proteins
ACEi - ARBS - thiazide diuretics

7. Name the skin lesion: honey colored crusts
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Nonulcer dyspepsia
Impetigo
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

8. What does the classic ring worm lesion have?
Furucnle
Kids: Rotavirus Adults: Norwalk Virus
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
A central clear area

9. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
Increase; 200 g/day
Hgb - Electrolytes - and TSH
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

10. What are signs of pulmonary congestion?
Viral infection of the semicircular apparatus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
ACEi - ARBS - thiazide diuretics
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

11. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
MSK - pulmonary - GI - or psychological
Less than 80 ml of blood
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

12. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
S. aureus- beta hemolytic streptococcus
Scabies
ACEi - ARBS - thiazide diuretics
24 hour halter

13. What test done in PE measures instability of shoulder?
Adhesive capsulitis (frozen shoulder): most common in middle age women
100mg; means patient can be trace protein positive and not be detected
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

14. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

15. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

16. patients with herpes zoster may experience what symptom before the rash appear?
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
Pain
High blood pressure - focal neurologic defecit - or papilledema
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

17. Name the skin lesion: pustule in association with a hair follice
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Streptococci
Folliculitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

18. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
100mg; means patient can be trace protein positive and not be detected
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
Loop diuretics (Check serum K+ levels before drug admin)
Echocardiogram

19. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Staphylococcal scalded skin syndrome
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

20. What is afterload?
Medication or chemical esophagitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Bence-Jones

21. What is considered normal blood loss during a menstrual cycle?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Squamocolumnar junction=most common site of cervical cancer
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
Less than 80 ml of blood

22. What are the signs of acute sinusitis?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Fever with frontal or maxillary tenderness
Temporal arteritis-biopsy of the temporal artery

23. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Other brainstem or cranial nerve findings
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

24. What should blood work include for suspected heart failure?
Repeat Pap after infection treated
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Albumin; low molecular weight proteins

25. What are the symptoms of palpitations?
Subarachnoid hemorrhage
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Less than 80 ml of blood
Lightheadedness - dizziness - syncope

26. 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
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
24 hour halter
Excessive bleeding in amount - duration - or both at irregular intervals

27. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Colposcopy - Endocervical curettage - and directed cervical biopsy

28. Discomfort with abducting the arm past 90 degress
Albumin; low molecular weight proteins
Rotator Cuff tendonitis
HPV
Staphylococcal scalded skin syndrome

29. Complete the sentence: pericarditis can cause frictional rub and......
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Serotypes 16 - 18 - 31 -52 -58
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

30. Constipation: What are indications for lab testing?
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Kids: Rotavirus Adults: Norwalk Virus
Less than 80 ml of blood

31. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A 24hr urine protein collection and urine creatinine clearance determination
Kids: Rotavirus Adults: Norwalk Virus
Rotator Cuff problem

32. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
True

33. 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
Warts
Molluscum contagiosum- pox virus
Fever with frontal or maxillary tenderness
Less than 80 ml of blood

34. Initial treatment for Rhinosinusitis
Less than 3 stools per week
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

35. What is the mechanism of action for stimulant agents in treating constipation?
Serotypes 16 - 18 - 31 -52 -58
Common problem that resolves spontaneously and is most often seen in children and young adults
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

36. What should be considered in younger patients with menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
PVC or Premature atrial contraction (PAC)
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.
Coag disorders

37. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC
Presence of proteinuria on at least two separate ocassion

38. Define nephrotic range proteinuria
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
GERD
>3.5g of protein per 24hrs

39. What are the indiciations for neuroimaging?
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
Pancreatitis
RBC casts and old to moderate HTN
S. Aureus

40. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Cholelithiasis
Diuretics -BB -CCB -ACEi

41. At was quantity does urine dipstick test detect elevated protein?
HIV and syphilis
Presence of proteinuria on at least two separate ocassion
Viral gastroenteritis
100mg; means patient can be trace protein positive and not be detected

42. Name the diagnosis of heartburn: severe constant mid abdominal pain
Echocardiogram
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Pancreatitis
Varicella virus

43. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
HIV and syphilis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

44. How are fungal infections diagnosed?
ACEi - ARBS - thiazide diuretics
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
A 24hr urine protein collection and urine creatinine clearance determination
With a KOH wet mount preparation

45. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Analgesic headache
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Irregular bleeding between cycles
Nonulcer dyspepsia

46. Pain in shoulder when throwing - swimming - or serving a tennis ball
Acute headache - ataxia - profuse nausea - and vomiting
Rotator cuff tendonitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Molluscum contagiosum- pox virus

47. 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
Cluster headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
CT
Varicella virus

48. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Acute headache - ataxia - profuse nausea - and vomiting
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
Bence-Jones

49. How does systolic vs. diastolic heart failure present on the echocardiogram?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

50. How do you know if heart palpitations are due to stimulant or medication use?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Squamocolumnar junction=most common site of cervical cancer
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Less abrupt onset and cessation of palpitations