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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. After treatment of dysplasia - women need Pap smears every...
Irregular bleeding between cycles
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Analgesic headache
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

2. What are the signs of cerebral hemorrhage?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Acute headache - ataxia - profuse nausea - and vomiting
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.

3. What are the most common viral causes of diarrhea in kids and adults?
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
Generalized Anxiety disorder and panic disorder
Kids: Rotavirus Adults: Norwalk Virus
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

4. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Echocardiogram
Pleurisy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

5. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
MSK - pulmonary - GI - or psychological
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Molluscum contagiosum- pox virus

6. Define nephrotic range proteinuria
E. Coli O157:H7
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
>3.5g of protein per 24hrs

7. What should be considered in younger patients with menorrhagia
Coag disorders
ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

8. How do you know if heart palpitations are due to stimulant or medication use?
Molluscum contagiosum- pox virus
Less abrupt onset and cessation of palpitations
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
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.

9. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Cluster headache
Nonulcer dyspepsia
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
S. aureus- beta hemolytic streptococcus

10. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Rotator cuff tendonitis
Fever with frontal or maxillary tenderness

11. What are the three major risk factors for heart failure?
Temporal arteritis-biopsy of the temporal artery
Supraspinatus and bicipital tendons
Hypertension - CAD - valvular heart disease
HIV and syphilis

12. 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
Cluster headache
Cervical radiculopathy
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Hypertension - CAD - valvular heart disease

13. What the consequences of decreased cardiac output?
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
CT
Paroxysmal atrial fibrillation or supraventricular tachycardia
BB or CCB - catheter ablation of identified bypass tract

14. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

15. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Folliculitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Diuretics -BB -CCB -ACEi

16. What should preconception counseling include?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Fever with frontal or maxillary tenderness
CT

17. Pneumonia tx: suitable for healthy adults less than 60
Tension headache
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
MSK - pulmonary - GI - or psychological

18. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Molluscum contagiosum- pox virus
PVC or Premature atrial contraction (PAC)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

19. What is the goal of CHF treatment? What drugs should be used?
Increase; 200 g/day
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

20. What are the signs of acute sinusitis?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Increase; 200 g/day
Fever with frontal or maxillary tenderness

21. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Colposcopy - Endocervical curettage - and directed cervical biopsy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
CT

22. Describe the presentation tracheobronchitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
>150mg per 24hrs
24 hour halter
Upper sternal area burning pain - associated with a productive cough

23. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Less abrupt onset and cessation of palpitations
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
DM - HTN - DVT - seizures - depression - or anxiety

24. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Non-cardiac causes of palpitations
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

25. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Subarachnoid hemorrhage
E. Coli O157:H7
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

26. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
>3.5g of protein per 24hrs
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

27. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Acute headache - ataxia - profuse nausea - and vomiting
Generalized Anxiety disorder and panic disorder
Rotator Cuff tendonitis
Non-cardiac causes of palpitations

28. Name the skin lesion: honey colored crusts
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
Associated with hypotension
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Impetigo

29. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Impetigo
LH surge triggers ovulation
DM - HTN - DVT - seizures - depression - or anxiety
Colposcopy - Endocervical curettage - and directed cervical biopsy

30. How to NSAIDs contribute to gastritis and ulcer formation?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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.
Rotator Cuff tendonitis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

31. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
ACEi
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Albumin; low molecular weight proteins

32. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Pts with palpitations and dizziness - near syncope - or syncope
Albumin; low molecular weight proteins
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
S. aureus- beta hemolytic streptococcus

33. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Intermenstrual bleeding
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Loop diuretics (Check serum K+ levels before drug admin)
HPV

34. What are the 2 psych disorders most commonly associated with palpitations?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pts with palpitations and dizziness - near syncope - or syncope
Non-cardiac causes of palpitations
Generalized Anxiety disorder and panic disorder

35. How does systolic vs. diastolic heart failure present on the echocardiogram?
Generalized Anxiety disorder and panic disorder
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
Pain
Coag disorders

36. Name 4 factors that predispose an individual to develop pneumonia.
Medication or chemical esophagitis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

37. What is benign transient proteinuria?
Less abrupt onset and cessation of palpitations
Common problem that resolves spontaneously and is most often seen in children and young adults
E. Coli O157:H7
Associated with hypotension

38. What are signs of pulmonary congestion?
Coag disorders
Cholelithiasis
Impetigo
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

39. What are the common causes for laryngitis?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Rotator cuff tendonitis
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

40. How do you define persistent protein uria?
RBC casts and old to moderate HTN
Lightheadedness - dizziness - syncope
Presence of proteinuria on at least two separate ocassion
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

41. When is a lumbar puncture contraindicated?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Loop diuretics (Check serum K+ levels before drug admin)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

42. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Coronary artery disease/ angina
Intermenstrual bleeding
Less abrupt onset and cessation of palpitations

43. Describe the presentation of myocardial pain?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral infection of the semicircular apparatus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

44. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
DM - HTN - DVT - seizures - depression - or anxiety
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
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

45. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Bence-Jones
A 24hr urine protein collection and urine creatinine clearance determination
GERD

46. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
A central clear area
When the patient has symptoms in association with exercise or who describe chest pain or pressure

47. Who should have Xray testing for shoulder pain?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Infectious esophagitis
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

48. Define proteinuria
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Associated with hypotension
Non-cardiac causes of palpitations
>150mg per 24hrs

49. What medications can cause heart palpitations?
Non-cardiac causes of palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Irregular bleeding between cycles
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

50. Pneumonia tx: suitable for healthy adults older than 60
A 24hr urine protein collection and urine creatinine clearance determination
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Rotator cuff tendonitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma