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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. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Folliculitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

2. Diarrhea from custard filled pastries
Irregular bleeding between cycles
S. Aureus
Folliculitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

3. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
HIV and syphilis
Lightheadedness - dizziness - syncope
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

4. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Possibility of Ischemic colitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

5. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Hgb - Electrolytes - and TSH

6. What are signs of pulmonary congestion?
EGD
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

7. Initial treatment for Rhinosinusitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
100mg; means patient can be trace protein positive and not be detected
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Wolff-Parkinson-White syndrome

8. Where does the development of abnormal cervical cells begin?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Irregular bleeding between cycles
Squamocolumnar junction=most common site of cervical cancer

9. What are the signs of acute sinusitis?
Presence of proteinuria on at least two separate ocassion
Associated with hypotension
Fever with frontal or maxillary tenderness
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

10. 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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
True

11. Pain in shoulder when throwing - swimming - or serving a tennis ball
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Loop diuretics (Check serum K+ levels before drug admin)
Acute headache - ataxia - profuse nausea - and vomiting
Rotator cuff tendonitis

12. HIgh risk pregnant patients should be evaluated for ____ and ____
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HIV and syphilis
Nonulcer dyspepsia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

13. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Subarachnoid hemorrhage
LH surge triggers ovulation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Albumin; low molecular weight proteins

14. What is the peripheral caUse of vertigo?
Diuretics -BB -CCB -ACEi
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Adhesive capsulitis (frozen shoulder): most common in middle age women
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

15. Describe the presentation of pneumonia
Molluscum contagiosum- pox virus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

16. 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
True
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

17. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
RBC casts and old to moderate HTN
Wolff-Parkinson-White syndrome
Less abrupt onset and cessation of palpitations

18. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Dehydration - anemia - cardiac causes
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pleurisy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

19. Clinical Manifestations of HTN
Molluscum contagiosum- pox virus
ACEi - ARBS - thiazide diuretics
Intermenstrual bleeding
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

20. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Less than 3 stools per week
MSK - pulmonary - GI - or psychological
Bence-Jones
Pain

21. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
EGD

22. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
ACEi - ARBS - thiazide diuretics
Increase; 200 g/day

23. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Adhesive capsulitis (frozen shoulder): most common in middle age women
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Cellulitis
Peptic ulcer disease or gastritis

24. Diagnostic Evaluation of Abnoraml vaginal bleeding
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Menorrhagia
HPV

25. Constipation: What are indications for lab testing?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
HIV and syphilis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

26. Irregular cycles with excessive flow - duration - or both
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Menorrhagia
Rotator Cuff tendonitis

27. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

28. What is a markers of CNS vertigo?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral gastroenteritis
Other brainstem or cranial nerve findings

29. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Furucnle
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Bence-Jones

30. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Cluster headache
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less abrupt onset and cessation of palpitations
Adhesive capsulitis (frozen shoulder): most common in middle age women

31. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

32. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Molluscum contagiosum- pox virus
Cervical radiculopathy

33. What should blood work include for suspected heart failure?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Albumin; low molecular weight proteins
Kids: Rotavirus Adults: Norwalk Virus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

34. What are the features of nephrotic syndrome?
Rotator Cuff problem
True
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

35. What are the primary glomerular diseases?
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
Chest pain during pneumonia or PE
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Cellulitis

36. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Irregular bleeding between cycles
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Paroxysmal atrial fibrillation or supraventricular tachycardia

37. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Presence of proteinuria on at least two separate ocassion

38. What does the classic ring worm lesion have?
E. Coli O157:H7
A central clear area
Folliculitis
Intermenstrual bleeding

39. 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
High blood pressure - focal neurologic defecit - or papilledema
E. Coli O157:H7
ACEi - ARBS - thiazide diuretics
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

40. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Upper sternal area burning pain - associated with a productive cough
Pancreatitis
Lightheadedness - dizziness - syncope

41. Describe the presentation of pericardial pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Warts
24 hour halter
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

42. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
A 24hr urine protein collection and urine creatinine clearance determination
Paroxysmal atrial fibrillation or supraventricular tachycardia
Viral infection of the semicircular apparatus

43. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Impetigo
Cholelithiasis
S. Aureus
Echocardiogram

44. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Upper sternal area burning pain - associated with a productive cough
Medication or chemical esophagitis
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

45. Natural history of cervical cancer
Fever with frontal or maxillary tenderness
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
100mg; means patient can be trace protein positive and not be detected

46. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
Pancreatitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A 24hr urine protein collection and urine creatinine clearance determination

47. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
Candida albicans
Infectious esophagitis
Non-cardiac causes of palpitations

48. Cycle length variabilty is primarily due to what?
Furucnle
Variability in the time for follicle development during the proliferative phase
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
With a KOH wet mount preparation

49. How is constipation clinically defined?
GERD
Common problem that resolves spontaneously and is most often seen in children and young adults
Less than 3 stools per week
Medication or chemical esophagitis

50. What is the Epley maneuver?
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.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Scleroderma/polymyositis with secondary gastroesophageal reflux
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