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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. Complete the sentence: pericarditis can cause frictional rub and......
100mg; means patient can be trace protein positive and not be detected
Menorrhagia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

2. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
HIV and syphilis

3. Diarrhea from custard filled pastries
S. Aureus
Non-cardiac causes of palpitations
E. Coli O157:H7
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

4. HIgh risk pregnant patients should be evaluated for ____ and ____
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
HIV and syphilis
Possibility of Ischemic colitis
Associated with hypotension

5. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Varicella virus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
PE - MI - aortic dissection - pneumothorax

6. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
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
Upper sternal area burning pain - associated with a productive cough

7. Prenatal visit schedule for low-risk pregnancies
MSK - pulmonary - GI - or psychological
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

8. When should invasive eletrophysiologic study should be considered?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

9. 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
Rotator Cuff problem
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

10. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Infectious esophagitis

11. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
A central clear area
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Cholelithiasis

12. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Serotypes 16 - 18 - 31 -52 -58
Nonulcer dyspepsia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

13. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Common problem that resolves spontaneously and is most often seen in children and young adults
CBC
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
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.

14. Name 4 factors that predispose an individual to develop pneumonia.
Temporal arteritis-biopsy of the temporal artery
S. Aureus
These patients are associated with low renin states=less likely to respond to medication
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

15. Natural history of cervical cancer
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Anticoag with warfarin to prevent thromboembolism

16. Isolated - extra pounding beats
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Fever with frontal or maxillary tenderness
PVC or Premature atrial contraction (PAC)
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

17. How are fungal infections diagnosed?
Less than 3 stools per week
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
With a KOH wet mount preparation
Pleurisy

18. SE Of Beta blockers?
CBC
CT
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Supraspinatus and bicipital tendons

19. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Less than 80 ml of blood
100mg; means patient can be trace protein positive and not be detected
Tension headache
Cholelithiasis

20. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Cellulitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

21. Four muscles of rotator cuff
Less than 80 ml of blood
Rotator Cuff problem
>3.5g of protein per 24hrs
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

22. name the 4 emergent causes of chest pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
PE - MI - aortic dissection - pneumothorax
Subarachnoid hemorrhage
Variability in the time for follicle development during the proliferative phase

23. At was quantity does urine dipstick test detect elevated protein?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
BB or CCB - catheter ablation of identified bypass tract
100mg; means patient can be trace protein positive and not be detected
A central clear area

24. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
Squamocolumnar junction=most common site of cervical cancer
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

25. What is the preload?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Tension headache
S. Aureus

26. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Albumin; low molecular weight proteins
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

27. Menometrorrhagia
>3.5g of protein per 24hrs
RBC casts and old to moderate HTN
Excessive bleeding in amount - duration - or both at irregular intervals
Influenza - Rhinovirus - Adenovirus - Parainfluenza

28. When does troponin rise following myocardial injury or infarction?
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
E. Coli O157:H7
High blood pressure - focal neurologic defecit - or papilledema

29. 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.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
HPV

30. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
>150mg per 24hrs
Furucnle
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
Supraspinatus and bicipital tendons

31. Describe the presentation of myocardial pain?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Echocardiogram
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

32. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
EGD

33. Cycle length variabilty is primarily due to what?
ACEi
Variability in the time for follicle development during the proliferative phase
Colposcopy - Endocervical curettage - and directed cervical biopsy
Folliculitis

34. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Possibility of Ischemic colitis
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
Supraspinatus and bicipital tendons
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

35. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Non-cardiac causes of palpitations
Paroxysmal atrial fibrillation or supraventricular tachycardia
MSK - pulmonary - GI - or psychological
Albumin; low molecular weight proteins

36. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Rotator Cuff problem
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

37. Describes what occurs during squamous metaplasia of the cervix.
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
Anticoag with warfarin to prevent thromboembolism
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

38. What should blood work include for suspected heart failure?
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
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

39. What HPV serotypes are most commonly associated with cervical cancer?
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Serotypes 16 - 18 - 31 -52 -58

40. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Peptic ulcer disease or gastritis
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
Chest pain during pneumonia or PE
Bence-Jones

41. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
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
Albumin; low molecular weight proteins
Other brainstem or cranial nerve findings

42. What is the Barany maneuver?
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
Rotator Cuff tendonitis
E. Coli O157:H7
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

43. When should a patient get a stress test?
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
Intermenstrual bleeding
Folliculitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

44. 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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pain
Colposcopy - Endocervical curettage - and directed cervical biopsy
Varicella virus

45. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
>3.5g of protein per 24hrs
Scleroderma/polymyositis with secondary gastroesophageal reflux
Molluscum contagiosum- pox virus

46. What are the two common clinical presentations of acute diarrhea?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

47. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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.
Infectious esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

48. What places women at higher risk of getting cervical cancer?
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
LH surge triggers ovulation

49. 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
Warts
High blood pressure - focal neurologic defecit - or papilledema
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Scabies

50. Diagnosis of HTN
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
>3.5g of protein per 24hrs
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart