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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 afterload?
Rotator cuff tendonitis
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

2. How can GERD (or esophageal motility disorders) lead to chest pain?
EGD
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
Other brainstem or cranial nerve findings
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

3. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Cluster headache
CT

4. What treatments are the cornerstone for treating cases of functional constipation?
Repeat Pap after infection treated
Serotypes 16 - 18 - 31 -52 -58
Increasing fluid (8 - 8oz glasses of water/day) -fiber
MSK - pulmonary - GI - or psychological

5. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Menorrhagia
Giardia

6. What does the classic ring worm lesion have?
Coag disorders
A central clear area
Increase; 200 g/day
S. aureus- beta hemolytic streptococcus

7. Why don't ACEi work well for the elderly and African Americans when treating HTN?
True
These patients are associated with low renin states=less likely to respond to medication
Less than 3 stools per week
Upper sternal area burning pain - associated with a productive cough

8. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Nonulcer dyspepsia
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

9. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Variability in the time for follicle development during the proliferative phase
Analgesic headache

10. Tx of chronic or intermittent afibs
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Bulk forming: Psyllium - Methycellulose - Polycarbophil
35 (exception for postmenopausal women who have recently been started on HRT)
Anticoag with warfarin to prevent thromboembolism

11. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Presence of proteinuria on at least two separate ocassion
High blood pressure - focal neurologic defecit - or papilledema
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

12. What are the signs of malignant hypertension?
Loop diuretics (Check serum K+ levels before drug admin)
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
High blood pressure - focal neurologic defecit - or papilledema
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

13. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
100mg; means patient can be trace protein positive and not be detected
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Possibility of Ischemic colitis
Higher filling presure - pulmonary congestion - and decreasd cardiac return

14. 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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Hgb - Electrolytes - and TSH
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

15. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
DM - HTN - DVT - seizures - depression - or anxiety
Serotypes 16 - 18 - 31 -52 -58
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.

16. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Repeat Pap after infection treated
Irregular bleeding between cycles
Temporal arteritis-biopsy of the temporal artery
E. Coli O157:H7

17. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Viral infection of the semicircular apparatus
24 hour halter
Cellulitis
Less than 3 stools per week

18. Menometrorrhagia
Bence-Jones
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Excessive bleeding in amount - duration - or both at irregular intervals
Loop diuretics (Check serum K+ levels before drug admin)

19. How are fungal infections diagnosed?
Coronary artery disease/ angina
Rotator cuff tendonitis
With a KOH wet mount preparation
>150mg per 24hrs

20. Isolated - extra pounding beats
Anticoag with warfarin to prevent thromboembolism
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
PVC or Premature atrial contraction (PAC)
Varicella virus

21. What test done in PE measures instability of shoulder?
S. aureus- beta hemolytic streptococcus
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.
Impetigo
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

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

23. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cervical radiculopathy
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

24. How do you know if heart palpitations are due to stimulant or medication use?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Less abrupt onset and cessation of palpitations
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

25. 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
Infectious esophagitis
Wolff-Parkinson-White syndrome
Intermenstrual bleeding

26. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
>150mg per 24hrs
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Fever with frontal or maxillary tenderness
Nonulcer dyspepsia

27. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Possibility of Ischemic colitis
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Infectious esophagitis

28. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Nonulcer dyspepsia
Peptic ulcer disease or gastritis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

29. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Folliculitis
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
Infectious esophagitis
ACEi - ARBS - thiazide diuretics

30. Pneumonia tx: suitable for healthy adults less than 60
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Slow progression of cervical cancer changes -Availability of effective early treatment
Excessive bleeding in amount - duration - or both at irregular intervals
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

31. Describe the history and PE of patient presenting with common cold
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pancreatitis
RBC casts and old to moderate HTN

32. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi
Repeat Pap after infection treated

33. What is the Epley maneuver?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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.
Cervical radiculopathy

34. Natural history of cervical cancer
Loop diuretics (Check serum K+ levels before drug admin)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Intermenstrual bleeding

35. Prenatal visit schedule for low-risk pregnancies
Serotypes 16 - 18 - 31 -52 -58
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

36. 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
Coronary artery disease/ angina
Squamocolumnar junction=most common site of cervical cancer
Impetigo

37. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
S. aureus- beta hemolytic streptococcus
Furucnle
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
Squamocolumnar junction=most common site of cervical cancer

38. name the 4 emergent causes of chest pain
Viral infection of the semicircular apparatus
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
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
PE - MI - aortic dissection - pneumothorax

39. Chronic pain and shoulder stiffness with limited motion
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Viral gastroenteritis
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cluster headache

40. What occurs after ovulation
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Rotator Cuff problem
DM - HTN - DVT - seizures - depression - or anxiety

41. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

42. Define the patient population typically affected by orthostatic or postural proteinuria
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Chest pain during pneumonia or PE
Non-cardiac causes of palpitations

43. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
True
Warts
Streptococci

44. What is the standard tool used for diagnosis of GERD?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
S. Aureus
Peptic ulcer disease or gastritis
EGD

45. Predictors of cardiac etiology
When the patient has symptoms in association with exercise or who describe chest pain or pressure
These patients are associated with low renin states=less likely to respond to medication
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Repeat Pap after infection treated

46. What is the role of FSH in one's menstrual cycle
Infectious esophagitis
CT
LH surge triggers ovulation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

47. What should be considered in younger patients with menorrhagia
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Molluscum contagiosum- pox virus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Coag disorders

48. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Anticoag with warfarin to prevent thromboembolism
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

49. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cellulitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Cholelithiasis

50. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Viral gastroenteritis
Acute headache - ataxia - profuse nausea - and vomiting
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp