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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. What is a markers of CNS vertigo?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Other brainstem or cranial nerve findings
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

2. Name the diagnosis of heartburn: regurgitation - dysphagia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
GERD
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
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

3. What is the standard tool used for diagnosis of GERD?
Rotator Cuff problem
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
EGD
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

4. What are the most common causes for the common cold?
Dehydration - anemia - cardiac causes
Cluster headache
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

5. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Staphylococcal scalded skin syndrome
Supraspinatus and bicipital tendons
Polymenorrhea

6. What are the most common viral causes of diarrhea in kids and adults?
Streptococci
Colposcopy - Endocervical curettage - and directed cervical biopsy
Medication or chemical esophagitis
Kids: Rotavirus Adults: Norwalk Virus

7. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Nonulcer dyspepsia
Bence-Jones
Generalized Anxiety disorder and panic disorder

8. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Less abrupt onset and cessation of palpitations
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

9. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Squamocolumnar junction=most common site of cervical cancer
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator Cuff tendonitis

10. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
PE - MI - aortic dissection - pneumothorax
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
Possibility of Ischemic colitis

11. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Staphylococcal scalded skin syndrome
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

12. What is the mechanism of action for stimulant agents in treating constipation?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
RBC casts and old to moderate HTN
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

13. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Upper sternal area burning pain - associated with a productive cough
Pleurisy
Polymenorrhea
HPV

14. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less than 80 ml of blood
Cholelithiasis
With a KOH wet mount preparation

15. Diarrhea from custard filled pastries
S. Aureus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Serotypes 16 - 18 - 31 -52 -58

16. How does systolic vs. diastolic heart failure present on the echocardiogram?
Kids: Rotavirus Adults: Norwalk Virus
Polymenorrhea
Acute headache - ataxia - profuse nausea - and vomiting
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

17. Define proteinuria
>3.5g of protein per 24hrs
Irregular bleeding between cycles
Menorrhagia
>150mg per 24hrs

18. What is the role of LH in the menstrual cycle
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
LH surge triggers ovulation
Hgb - Electrolytes - and TSH
Cervical radiculopathy

19. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Pancreatitis
Furucnle
Presence of proteinuria on at least two separate ocassion

20. What are the indiciations for neuroimaging?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
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

21. 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.
Supraspinatus and bicipital tendons
With a KOH wet mount preparation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Upper sternal area burning pain - associated with a productive cough

22. What are the signs of malignant hypertension?
Wolff-Parkinson-White syndrome
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
High blood pressure - focal neurologic defecit - or papilledema
DM - HTN - DVT - seizures - depression - or anxiety

23. 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
Supraspinatus and bicipital tendons
Scabies
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Serotypes 16 - 18 - 31 -52 -58

24. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Non-cardiac causes of palpitations
Regular bleeding at intervals of more than 35 days
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

25. What are the features of glomerular nephritis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
RBC casts and old to moderate HTN

26. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Supraspinatus and bicipital tendons
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Candida albicans

27. Metrorrhagia
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
Irregular bleeding between cycles
A 24hr urine protein collection and urine creatinine clearance determination
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

28. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

29. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Variability in the time for follicle development during the proliferative phase

30. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Bence-Jones
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

31. What test done in PE measures instability of shoulder?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

32. How are fungal infections diagnosed?
Coag disorders
With a KOH wet mount preparation
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

33. 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
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
E. Coli O157:H7
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

34. What does the classic ring worm lesion have?
A central clear area
Generalized Anxiety disorder and panic disorder
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

35. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Coronary artery disease/ angina
Less than 3 stools per week
Presence of proteinuria on at least two separate ocassion
HPV

36. Describe the presentation of pneumonia
Impetigo
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Rotator Cuff tendonitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

37. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Echocardiogram
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
ACEi
Diuretics -BB -CCB -ACEi

38. Pain in shoulder when throwing - swimming - or serving a tennis ball
True
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
Rotator cuff tendonitis
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

39. What are the 2 psych disorders most commonly associated with palpitations?
Regular bleeding at intervals of more than 35 days
Generalized Anxiety disorder and panic disorder
LH surge triggers ovulation
HPV testing -Pos=colposcopy -Neg=repeat pap smear

40. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
E. Coli O157:H7
Adhesive capsulitis (frozen shoulder): most common in middle age women
Repeat Pap after infection treated

41. Describe the presentation of angina?
Impetigo
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
S. Aureus

42. When should a patient get a stress test?
Repeat Pap after infection treated
S. aureus- beta hemolytic streptococcus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

43. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
These patients are associated with low renin states=less likely to respond to medication
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
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

44. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Viral gastroenteritis

45. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Echocardiogram
Warts
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

46. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Varicella virus
Loop diuretics (Check serum K+ levels before drug admin)
Staphylococcal scalded skin syndrome
Furucnle

47. Vaccines that should be updated before planned pregnancy
S. Aureus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Coronary artery disease/ angina

48. 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
True
GERD
Associated with hypotension
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

49. What is the goal of CHF treatment? What drugs should be used?
Coronary artery disease/ angina
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
Bence-Jones
Subarachnoid hemorrhage

50. What are the secondly causes of glomerular disease?
Cellulitis
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve