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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. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Less than 80 ml of blood
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

2. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Increase; 200 g/day
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

3. Describe the presentation tracheobronchitis
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.
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Upper sternal area burning pain - associated with a productive cough

4. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
MSK - pulmonary - GI - or psychological
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

5. 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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Anticoag with warfarin to prevent thromboembolism
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

6. Diagnosis of HTN
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Excessive bleeding in amount - duration - or both at irregular intervals
Hypertension - CAD - valvular heart disease

7. Regular bleeding at intervals of less than 21 days
Common problem that resolves spontaneously and is most often seen in children and young adults
Polymenorrhea
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Giardia

8. What is the mechanism of action for stimulant agents in treating constipation?
True
100mg; means patient can be trace protein positive and not be detected
Temporal arteritis-biopsy of the temporal artery
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

9. Name 4 factors that predispose an individual to develop pneumonia.
Impetigo
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pts with palpitations and dizziness - near syncope - or syncope

10. Who should have Xray testing for shoulder pain?
Furucnle
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
BB or CCB - catheter ablation of identified bypass tract
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

11. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
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.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Giardia

12. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Peptic ulcer disease or gastritis
S. Aureus
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

13. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
MSK - pulmonary - GI - or psychological
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

14. After treatment of dysplasia - women need Pap smears every...
When the patient has symptoms in association with exercise or who describe chest pain or pressure
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Diuretics -BB -CCB -ACEi

15. What are the three types of lice?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Presence of proteinuria on at least two separate ocassion
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

16. Carcinoma in situ is generally referred to a gynecologist and requires ______
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
CBC
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

17. What is the peripheral caUse of vertigo?
HIV and syphilis
35 (exception for postmenopausal women who have recently been started on HRT)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Coronary artery disease/ angina

18. What are the most common causes for the common cold?
Squamocolumnar junction=most common site of cervical cancer
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Other brainstem or cranial nerve findings
CBC

19. What is the goal of CHF treatment? What drugs should be used?
Streptococci
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
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

20. What is considered normal blood loss during a menstrual cycle?
Pancreatitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Viral gastroenteritis
Less than 80 ml of blood

21. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
BB or CCB - catheter ablation of identified bypass tract
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
True

22. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Intermenstrual bleeding
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
Giardia
These patients are associated with low renin states=less likely to respond to medication

23. MI - pericardial tamponade - PE - GI bleed - are...
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Squamocolumnar junction=most common site of cervical cancer
Coronary artery disease/ angina
Associated with hypotension

24. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Generalized Anxiety disorder and panic disorder
Acute headache - ataxia - profuse nausea - and vomiting
Coronary artery disease/ angina

25. What treatments are the cornerstone for treating cases of functional constipation?
100mg; means patient can be trace protein positive and not be detected
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Non-cardiac causes of palpitations
35 (exception for postmenopausal women who have recently been started on HRT)

26. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Chest pain during pneumonia or PE
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

27. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Staphylococcal scalded skin syndrome
Cholelithiasis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

28. What are the signs of malignant hypertension?
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
High blood pressure - focal neurologic defecit - or papilledema
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Chest pain during pneumonia or PE

29. 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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Higher filling presure - pulmonary congestion - and decreasd cardiac return
ACEi
Warts

30. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Viral gastroenteritis
Subarachnoid hemorrhage
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

31. Mainstay treatment for soft tissue inflammation (Shoulder)
LH surge triggers ovulation
When the patient has symptoms in association with exercise or who describe chest pain or pressure
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

32. What are the common causes for laryngitis?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Viral infection of the semicircular apparatus

33. How is constipation clinically defined?
>3.5g of protein per 24hrs
Less than 3 stools per week
Pleurisy
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

34. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Peptic ulcer disease or gastritis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Viral gastroenteritis

35. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Squamocolumnar junction=most common site of cervical cancer
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Streptococci

36. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Cholelithiasis
Loop diuretics (Check serum K+ levels before drug admin)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
LH surge triggers ovulation

37. What are signs of pulmonary congestion?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Variability in the time for follicle development during the proliferative phase
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

38. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Cholelithiasis

39. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Molluscum contagiosum- pox virus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Cervical radiculopathy

40. When does troponin rise following myocardial injury or infarction?
Nonulcer dyspepsia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Wolff-Parkinson-White syndrome
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

41. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Diuretics -BB -CCB -ACEi
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

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
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
Excessive bleeding in amount - duration - or both at irregular intervals
Varicella virus
Scabies

43. What is the role of LH in the menstrual cycle
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Associated with hypotension
Hgb - Electrolytes - and TSH
LH surge triggers ovulation

44. Diagnostic Evaluation of Abnoraml vaginal bleeding
Cholelithiasis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Folliculitis
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

45. Four muscles of rotator cuff
Coag disorders
Other brainstem or cranial nerve findings
Irregular bleeding between cycles
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

46. What is the Barany maneuver?
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

47. Why don't ACEi work well for the elderly and African Americans when treating HTN?
CBC
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
These patients are associated with low renin states=less likely to respond to medication
Squamocolumnar junction=most common site of cervical cancer

48. 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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
PE - MI - aortic dissection - pneumothorax
Varicella virus
With a KOH wet mount preparation

49. What medications can cause heart palpitations?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
>150mg per 24hrs
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

50. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Staphylococcal scalded skin syndrome
DM - HTN - DVT - seizures - depression - or anxiety
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