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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 are signs of pulmonary congestion?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Tension headache
S. aureus- beta hemolytic streptococcus

2. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
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

3. 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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

4. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
CBC
Furucnle
Coag disorders
Bence-Jones

5. 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
Tension headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Varicella virus
Viral infection of the semicircular apparatus

6. Initial treatment for Rhinosinusitis
High blood pressure - focal neurologic defecit - or papilledema
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

7. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Medication or chemical esophagitis

8. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Colposcopy - Endocervical curettage - and directed cervical biopsy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Loop diuretics (Check serum K+ levels before drug admin)

9. Name the skin lesion: pustule in association with a hair follice
Folliculitis
True
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
Chest pain during pneumonia or PE

10. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Upper sternal area burning pain - associated with a productive cough
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

11. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
Pts with palpitations and dizziness - near syncope - or syncope
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Wolff-Parkinson-White syndrome

12. When should invasive eletrophysiologic study should be considered?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Echocardiogram
HIV and syphilis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

13. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
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
Infectious esophagitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

14. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Loop diuretics (Check serum K+ levels before drug admin)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

15. What should preconception counseling include?
A 24hr urine protein collection and urine creatinine clearance determination
Varicella virus
LH surge triggers ovulation
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

16. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Coag disorders
Pleurisy
Peptic ulcer disease or gastritis

17. Treatment for supraventricular tachycardias
DM - HTN - DVT - seizures - depression - or anxiety
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
BB or CCB - catheter ablation of identified bypass tract
Less than 80 ml of blood

18. What are the three types of lice?
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

19. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Staphylococcal scalded skin syndrome
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

20. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
LH surge triggers ovulation
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Cluster headache
Hypertension - CAD - valvular heart disease

21. At was quantity does urine dipstick test detect elevated protein?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
100mg; means patient can be trace protein positive and not be detected

22. What is the peripheral caUse of vertigo?
A 24hr urine protein collection and urine creatinine clearance determination
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Less abrupt onset and cessation of palpitations
Nonulcer dyspepsia

23. What is the caUse of Meniere disease? What are the cardinal symptoms?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Serotypes 16 - 18 - 31 -52 -58

24. Difference between Pneumonia and Bronchitis
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
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
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

25. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
ACEi
HPV
Staphylococcal scalded skin syndrome

26. After treatment of dysplasia - women need Pap smears every...
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Generalized Anxiety disorder and panic disorder
Anticoag with warfarin to prevent thromboembolism

27. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Regular bleeding at intervals of more than 35 days
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

28. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Bulk forming: Psyllium - Methycellulose - Polycarbophil
35 (exception for postmenopausal women who have recently been started on HRT)
MSK - pulmonary - GI - or psychological

29. Describe the presentation of angina?
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
Medication or chemical esophagitis
DM - HTN - DVT - seizures - depression - or anxiety
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

30. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Presence of proteinuria on at least two separate ocassion
Viral infection of the semicircular apparatus
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

31. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Cholelithiasis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

32. 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
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
Viral infection of the semicircular apparatus
GERD

33. Oligomenorrhea
Coronary artery disease/ angina
Peptic ulcer disease or gastritis
Regular bleeding at intervals of more than 35 days
Streptococci

34. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Lightheadedness - dizziness - syncope
Adhesive capsulitis (frozen shoulder): most common in middle age women
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

35. Tx of chronic or intermittent afibs
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
Anticoag with warfarin to prevent thromboembolism
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Giardia

36. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Viral gastroenteritis
Upper sternal area burning pain - associated with a productive cough
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided

37. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
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
Squamocolumnar junction=most common site of cervical cancer
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

38. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Coronary artery disease/ angina
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Menorrhagia

39. Four muscles of rotator cuff
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pancreatitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

40. What are symptoms are CHF?
Peptic ulcer disease or gastritis
Fever with frontal or maxillary tenderness
Kids: Rotavirus Adults: Norwalk Virus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

41. What is an acoustic neuroma?
Other brainstem or cranial nerve findings
ACEi - ARBS - thiazide diuretics
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

42. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
LH surge triggers ovulation
Non-cardiac causes of palpitations
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

43. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Nonulcer dyspepsia
Non-cardiac causes of palpitations
Lightheadedness - dizziness - syncope

44. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
DM - HTN - DVT - seizures - depression - or anxiety
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

45. Clinical Manifestations of HTN
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
PVC or Premature atrial contraction (PAC)
Viral infection of the semicircular apparatus

46. 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
Associated with hypotension
Rotator cuff tendonitis
>3.5g of protein per 24hrs
Scabies

47. What is the difference between a Holter monitor or an event monitor?
Scabies
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Coag disorders
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

48. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Pleurisy

49. 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
Staphylococcal scalded skin syndrome
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

50. MI - pericardial tamponade - PE - GI bleed - are...
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Associated with hypotension
True
BB or CCB - catheter ablation of identified bypass tract