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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. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
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
Fever with frontal or maxillary tenderness
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

2. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Repeat Pap after infection treated

3. What are the features of nephrotic syndrome?
Presence of proteinuria on at least two separate ocassion
Slow progression of cervical cancer changes -Availability of effective early treatment
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Subarachnoid hemorrhage

4. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pleurisy
Polymenorrhea
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. Complete the sentence: pericarditis can cause frictional rub and......
>3.5g of protein per 24hrs
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
EGD

6. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
HPV
Cellulitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

7. How do you know if heart palpitations are due to stimulant or medication use?
Pancreatitis
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
Less abrupt onset and cessation of palpitations

8. MI - pericardial tamponade - PE - GI bleed - are...
Acute headache - ataxia - profuse nausea - and vomiting
Associated with hypotension
Colposcopy - Endocervical curettage - and directed cervical biopsy
Increasing fluid (8 - 8oz glasses of water/day) -fiber

9. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Generalized Anxiety disorder and panic disorder
Analgesic headache
Rotator Cuff tendonitis
Scleroderma/polymyositis with secondary gastroesophageal reflux

10. When does troponin rise following myocardial injury or infarction?
Supraspinatus and bicipital tendons
Increase; 200 g/day
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Staphylococcal scalded skin syndrome

11. After treatment of dysplasia - women need Pap smears every...
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

12. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Peptic ulcer disease or gastritis
S. aureus- beta hemolytic streptococcus
When the patient has symptoms in association with exercise or who describe chest pain or pressure

13. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Anticoag with warfarin to prevent thromboembolism
Chest pain during pneumonia or PE
Regular bleeding at intervals of more than 35 days
DM - HTN - DVT - seizures - depression - or anxiety

14. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Anticoag with warfarin to prevent thromboembolism
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less abrupt onset and cessation of palpitations
Pleurisy

15. What treatments are the cornerstone for treating cases of functional constipation?
S. Aureus
Giardia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Adhesive capsulitis (frozen shoulder): most common in middle age women

16. Name the skin lesion: honey colored crusts
Impetigo
Anticoag with warfarin to prevent thromboembolism
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

17. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Generalized Anxiety disorder and panic disorder
Hgb - Electrolytes - and TSH
Increase; 200 g/day
Infectious esophagitis

18. Four muscles of rotator cuff
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

19. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Cervical radiculopathy
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
S. aureus- beta hemolytic streptococcus

20. What are the secondly causes of glomerular disease?
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
LH surge triggers ovulation
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

21. Oligomenorrhea
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Folliculitis
Regular bleeding at intervals of more than 35 days

22. What are the symptoms of palpitations?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Supraspinatus and bicipital tendons
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
Lightheadedness - dizziness - syncope

23. 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.
24 hour halter
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
Supraspinatus and bicipital tendons
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

24. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Common problem that resolves spontaneously and is most often seen in children and young adults
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cluster headache

25. What are the primary glomerular diseases?
DM - HTN - DVT - seizures - depression - or anxiety
Intermenstrual bleeding
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

26. 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
Acute headache - ataxia - profuse nausea - and vomiting
Warts
High blood pressure - focal neurologic defecit - or papilledema
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

27. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
>3.5g of protein per 24hrs
Irregular bleeding between cycles
Echocardiogram

28. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Hgb - Electrolytes - and TSH
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

29. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
RBC casts and old to moderate HTN
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
A 24hr urine protein collection and urine creatinine clearance determination
Colposcopy - Endocervical curettage - and directed cervical biopsy

30. 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
Pain
E. Coli O157:H7
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.
>150mg per 24hrs

31. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Tension headache
Less than 3 stools per week
Less abrupt onset and cessation of palpitations

32. Name some medications that can cause proteinuria
Higher filling presure - pulmonary congestion - and decreasd cardiac return
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Wolff-Parkinson-White syndrome
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

33. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Hgb - Electrolytes - and TSH
Cellulitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC

34. Regular bleeding at intervals of less than 21 days
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
HPV
Polymenorrhea
Wolff-Parkinson-White syndrome

35. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

36. SE Of Beta blockers?
Diuretics -BB -CCB -ACEi
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Lightheadedness - dizziness - syncope
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

37. What is the mechanism of action for stimulant agents in treating constipation?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
These patients are associated with low renin states=less likely to respond to medication
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Viral gastroenteritis

38. 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
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
Analgesic headache
>150mg per 24hrs

39. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
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
Repeat Pap after infection treated
Generalized Anxiety disorder and panic disorder

40. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Upper sternal area burning pain - associated with a productive cough
PE - MI - aortic dissection - pneumothorax
Anticoag with warfarin to prevent thromboembolism

41. What does the classic ring worm lesion have?
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
A central clear area
S. aureus- beta hemolytic streptococcus
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

42. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
HPV
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Intermenstrual bleeding
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

43. Isolated - extra pounding beats
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
PVC or Premature atrial contraction (PAC)
Subarachnoid hemorrhage
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

44. Describe the presentation tracheobronchitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Non-cardiac causes of palpitations
Cholelithiasis
Upper sternal area burning pain - associated with a productive cough

45. What lab tests are recommended for newly diagnosed hypertensive patients?
HPV
Slow progression of cervical cancer changes -Availability of effective early treatment
Polymenorrhea
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

46. 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
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
HIV and syphilis
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

47. What is the preload?
Bence-Jones
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

48. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
MSK - pulmonary - GI - or psychological
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Hgb - Electrolytes - and TSH

49. What is the goal of CHF treatment? What drugs should be used?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

50. How do you define persistent protein uria?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Presence of proteinuria on at least two separate ocassion
Folliculitis
Paroxysmal atrial fibrillation or supraventricular tachycardia