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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 is the standard tool used for diagnosis of GERD?
Varicella virus
EGD
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

2. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Acute headache - ataxia - profuse nausea - and vomiting
These patients are associated with low renin states=less likely to respond to medication
S. aureus- beta hemolytic streptococcus

3. What drugs do you use to treat H.pylori + PUD?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Presence of proteinuria on at least two separate ocassion
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

4. Shoulder pain with pain radiating to elbow
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Cervical radiculopathy

5. Describe the presentation of myocardial pain?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
RBC casts and old to moderate HTN
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

6. What are the symptoms of palpitations?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Upper sternal area burning pain - associated with a productive cough
Lightheadedness - dizziness - syncope

7. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Impetigo
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
Giardia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

8. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Lightheadedness - dizziness - syncope
Albumin; low molecular weight proteins
Furucnle

9. Diagnosis of HTN
Rotator cuff tendonitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Chest pain during pneumonia or PE

10. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Furucnle
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

11. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
ACEi - ARBS - thiazide diuretics

12. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Generalized Anxiety disorder and panic disorder

13. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Repeat Pap after infection treated
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
CBC
Coag disorders

14. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Presence of proteinuria on at least two separate ocassion
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

15. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
RBC casts and old to moderate HTN
Adhesive capsulitis (frozen shoulder): most common in middle age women

16. Describe the presentation of pneumonia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pleurisy
A central clear area
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

17. What is the difference between a Holter monitor or an event monitor?
Supraspinatus and bicipital tendons
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

18. Name types of laxatives
Less abrupt onset and cessation of palpitations
100mg; means patient can be trace protein positive and not be detected
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

19. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Coronary artery disease/ angina
Higher filling presure - pulmonary congestion - and decreasd cardiac return

20. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
High blood pressure - focal neurologic defecit - or papilledema
35 (exception for postmenopausal women who have recently been started on HRT)

21. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Echocardiogram
Possibility of Ischemic colitis
Temporal arteritis-biopsy of the temporal artery
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

22. Name 4 factors that predispose an individual to develop pneumonia.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
>3.5g of protein per 24hrs
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
ACEi - ARBS - thiazide diuretics

23. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Rotator cuff tendonitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Other brainstem or cranial nerve findings

24. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Giardia
GERD
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

25. Name some medications that can cause proteinuria
Giardia
Other brainstem or cranial nerve findings
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

26. What medications can cause heart palpitations?
Upper sternal area burning pain - associated with a productive cough
Rotator cuff tendonitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

27. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Less than 3 stools per week

28. How to NSAIDs contribute to gastritis and ulcer formation?
HIV and syphilis
DM - HTN - DVT - seizures - depression - or anxiety
Colposcopy - Endocervical curettage - and directed cervical biopsy
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.

29. Name the diagnosis of heartburn: regurgitation - dysphagia
Irregular bleeding between cycles
A central clear area
GERD
Staphylococcal scalded skin syndrome

30. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral infection of the semicircular apparatus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Presence of proteinuria on at least two separate ocassion

31. Diarrhea from custard filled pastries
S. Aureus
Menorrhagia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - 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

32. What are the 2 psych disorders most commonly associated with palpitations?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Generalized Anxiety disorder and panic disorder
Hypertension - CAD - valvular heart disease
Candida albicans

33. What HPV serotypes are most commonly associated with cervical cancer?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Serotypes 16 - 18 - 31 -52 -58
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

34. Describe the presentation of pericardial pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Dehydration - anemia - cardiac causes

35. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Dehydration - anemia - cardiac causes
Chest pain during pneumonia or PE
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Menorrhagia

36. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Slow progression of cervical cancer changes -Availability of effective early treatment

37. Name the diagnosis of heartburn: severe constant mid abdominal pain
Streptococci
ACEi - ARBS - thiazide diuretics
Chest pain during pneumonia or PE
Pancreatitis

38. Diarrhea is defined as an ____ in stool weight to more than ____g per day
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
100mg; means patient can be trace protein positive and not be detected
Increase; 200 g/day
BB or CCB - catheter ablation of identified bypass tract

39. What are the consequences of diastolic dysfunction?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Upper sternal area burning pain - associated with a productive cough
Higher filling presure - pulmonary congestion - and decreasd cardiac return

40. Lab testing for heart palpitation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hgb - Electrolytes - and TSH

41. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Associated with hypotension
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
Excessive bleeding in amount - duration - or both at irregular intervals

42. Cycle length variabilty is primarily due to what?
Supraspinatus and bicipital tendons
Coag disorders
Variability in the time for follicle development during the proliferative phase
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

43. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
With a KOH wet mount preparation
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
Repeat Pap after infection treated

44. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
24 hour halter
Giardia
Rotator cuff tendonitis
Bence-Jones

45. Treatment for supraventricular tachycardias
35 (exception for postmenopausal women who have recently been started on HRT)
HPV
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
BB or CCB - catheter ablation of identified bypass tract

46. What are the signs of cerebral hemorrhage?
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
Acute headache - ataxia - profuse nausea - and vomiting
Hypertension - CAD - valvular heart disease
Hgb - Electrolytes - and TSH

47. What are the features of glomerular nephritis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
S. aureus- beta hemolytic streptococcus
BB or CCB - catheter ablation of identified bypass tract
RBC casts and old to moderate HTN

48. What are the most common causes for the common cold?
Rotator Cuff problem
100mg; means patient can be trace protein positive and not be detected
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

49. What is the goal of CHF treatment? What drugs should be used?
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
Lightheadedness - dizziness - syncope
MSK - pulmonary - GI - or psychological
Streptococci

50. What test done in PE measures instability of shoulder?
Warts
Loop diuretics (Check serum K+ levels before drug admin)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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