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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. What type of imaging is need for chronic sinusitis?
CT
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.
Rotator Cuff tendonitis
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

2. Prenatal visit schedule for low-risk pregnancies
Infectious esophagitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

3. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

4. Name some medications that can cause proteinuria
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Viral infection of the semicircular apparatus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

5. What are the most common causes for the common cold?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Associated with hypotension
Slow progression of cervical cancer changes -Availability of effective early treatment
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

6. patients with herpes zoster may experience what symptom before the rash appear?
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.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pain

7. Describe the presentation tracheobronchitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Upper sternal area burning pain - associated with a productive cough
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Furucnle

8. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Echocardiogram
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

9. What are the three major risk factors for heart failure?
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
DM - HTN - DVT - seizures - depression - or anxiety
Hypertension - CAD - valvular heart disease

10. Describe the presentation of pericardial pain
Menorrhagia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

11. Menometrorrhagia
Tension headache
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
Excessive bleeding in amount - duration - or both at irregular intervals
Kids: Rotavirus Adults: Norwalk Virus

12. What does treatment for migrans include?
HIV and syphilis
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
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
Associated with hypotension

13. Pain in shoulder when throwing - swimming - or serving a tennis ball
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Rotator cuff tendonitis
High blood pressure - focal neurologic defecit - or papilledema
A 24hr urine protein collection and urine creatinine clearance determination

14. When should a patient get a stress test?
True
LH surge triggers ovulation
When the patient has symptoms in association with exercise or who describe chest pain or pressure
24 hour halter

15. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Fever with frontal or maxillary tenderness
Squamocolumnar junction=most common site of cervical cancer
Non-cardiac causes of palpitations
Giardia

16. What should be considered in younger patients with menorrhagia
Non-cardiac causes of palpitations
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Coag disorders

17. Describe the presentation of angina?
CBC
A 24hr urine protein collection and urine creatinine clearance determination
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
E. Coli O157:H7

18. What is benign transient proteinuria?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator Cuff tendonitis

19. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Variability in the time for follicle development during the proliferative phase
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

20. Four muscles of rotator cuff
Tension headache
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Coronary artery disease/ angina
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

21. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Folliculitis
35 (exception for postmenopausal women who have recently been started on HRT)
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
Supraspinatus and bicipital tendons

22. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
High blood pressure - focal neurologic defecit - or papilledema

23. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
MSK - pulmonary - GI - or psychological
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

24. How is constipation clinically defined?
Less than 3 stools per week
Anticoag with warfarin to prevent thromboembolism
Diuretics -BB -CCB -ACEi
Folliculitis

25. What is the difference between a Holter monitor or an event monitor?
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
RBC casts and old to moderate HTN
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

26. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Serotypes 16 - 18 - 31 -52 -58
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Viral infection of the semicircular apparatus

27. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Polymenorrhea
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

28. What are the most common viral causes of diarrhea in kids and adults?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Kids: Rotavirus Adults: Norwalk Virus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

29. Who should have Xray testing for shoulder pain?
Lightheadedness - dizziness - syncope
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Repeat Pap after infection treated

30. Complete the sentence: pericarditis can cause frictional rub and......
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
DM - HTN - DVT - seizures - depression - or anxiety
Nonulcer dyspepsia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

31. MI - pericardial tamponade - PE - GI bleed - are...
Subarachnoid hemorrhage
Hgb - Electrolytes - and TSH
Associated with hypotension
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

32. What is the next best step if a patient has two or more positive dipstick tests?
BB or CCB - catheter ablation of identified bypass tract
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Staphylococcal scalded skin syndrome
A 24hr urine protein collection and urine creatinine clearance determination

33. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
E. Coli O157:H7
RBC casts and old to moderate HTN
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

34. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

35. Name 4 factors that predispose an individual to develop pneumonia.
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
Echocardiogram
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

36. 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.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
S. aureus- beta hemolytic streptococcus
Anticoag with warfarin to prevent thromboembolism
Supraspinatus and bicipital tendons

37. History for Sinusitis

38. What are the signs of acute sinusitis?
CBC
Cholelithiasis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Fever with frontal or maxillary tenderness

39. What test done in PE measures instability of shoulder?
Chest pain during pneumonia or PE
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

40. Irregular cycles with excessive flow - duration - or both
Menorrhagia
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
With a KOH wet mount preparation
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

41. Name the diagnosis of heartburn: regurgitation - dysphagia
Cellulitis
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)
GERD

42. 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
Echocardiogram
ACEi
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Scabies

43. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

44. What are symptoms are CHF?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Non-cardiac causes of palpitations
CT

45. Constipation: What are indications for lab testing?
Coag disorders
High blood pressure - focal neurologic defecit - or papilledema
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
Rotator cuff tendonitis

46. Tx of chronic or intermittent afibs
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
A 24hr urine protein collection and urine creatinine clearance determination
Anticoag with warfarin to prevent thromboembolism
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

47. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Candida albicans
When the patient has symptoms in association with exercise or who describe chest pain or pressure

48. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cellulitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
RBC casts and old to moderate HTN

49. What places women at higher risk of getting cervical cancer?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
MSK - pulmonary - GI - or psychological
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

50. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Diuretics -BB -CCB -ACEi
100mg; means patient can be trace protein positive and not be detected
Candida albicans