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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. What is the caUse of benign positional vertigo?
MSK - pulmonary - GI - or psychological
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Menorrhagia
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.

2. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
PE - MI - aortic dissection - pneumothorax
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral infection of the semicircular apparatus
A 24hr urine protein collection and urine creatinine clearance determination

3. HIgh risk pregnant patients should be evaluated for ____ and ____
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
HIV and syphilis
Cellulitis
E. Coli O157:H7

4. Mainstay treatment for soft tissue inflammation (Shoulder)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

5. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Temporal arteritis-biopsy of the temporal artery
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Staphylococcal scalded skin syndrome
Candida albicans

6. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
Supraspinatus and bicipital tendons
Serotypes 16 - 18 - 31 -52 -58
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

7. What is the role of FSH in one's menstrual cycle
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Acute headache - ataxia - profuse nausea - and vomiting

8. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

9. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Hgb - Electrolytes - and TSH
These patients are associated with low renin states=less likely to respond to medication
Bence-Jones

10. 1+ protein level on urine dipstick usually represents how much protein in the urine?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Analgesic headache
Rotator Cuff problem

11. 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.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Supraspinatus and bicipital tendons
Pain

12. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
>150mg per 24hrs
Tension headache
Associated with hypotension

13. What is benign transient proteinuria?
Colposcopy - Endocervical curettage - and directed cervical biopsy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Common problem that resolves spontaneously and is most often seen in children and young adults
Associated with hypotension

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

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

16. SE Of Beta blockers?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

17. What is the preload?
E. Coli O157:H7
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
Dehydration - anemia - cardiac causes
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

18. History and PE for Pneumonia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

19. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
ACEi
With a KOH wet mount preparation
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
35 (exception for postmenopausal women who have recently been started on HRT)

20. Name types of laxatives
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
Generalized Anxiety disorder and panic disorder
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
A 24hr urine protein collection and urine creatinine clearance determination

21. Diarrhea from custard filled pastries
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
S. Aureus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

22. What is an acoustic neuroma?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Varicella virus

23. Cycle length variabilty is primarily due to what?
Cellulitis
S. aureus- beta hemolytic streptococcus
Pancreatitis
Variability in the time for follicle development during the proliferative phase

24. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pleurisy
100mg; means patient can be trace protein positive and not be detected
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

25. Tx of chronic or intermittent afibs
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Anticoag with warfarin to prevent thromboembolism
HIV and syphilis

26. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
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
Fever with frontal or maxillary tenderness
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

27. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Impetigo
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
MSK - pulmonary - GI - or psychological
Diuretics -BB -CCB -ACEi

28. How do you know if heart palpitations are due to stimulant or medication use?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Less abrupt onset and cessation of palpitations
Dehydration - anemia - cardiac causes

29. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Intermenstrual bleeding
Bence-Jones
ACEi - ARBS - thiazide diuretics
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

30. When does troponin rise following myocardial injury or infarction?
24 hour halter
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

31. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Paroxysmal atrial fibrillation or supraventricular tachycardia
EGD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

32. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Dehydration - anemia - cardiac causes
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
These patients are associated with low renin states=less likely to respond to medication
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

33. Name 4 factors that predispose an individual to develop pneumonia.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Echocardiogram
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

34. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Presence of proteinuria on at least two separate ocassion
Cellulitis
Scleroderma/polymyositis with secondary gastroesophageal reflux
24 hour halter

35. What does orthostatic positional changes that bring on dizziness suggest?
With a KOH wet mount preparation
Medication or chemical esophagitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dehydration - anemia - cardiac causes

36. What are signs of pulmonary congestion?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
HIV and syphilis
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

37. What should be considered in younger patients with menorrhagia
Less than 3 stools per week
Loop diuretics (Check serum K+ levels before drug admin)
Echocardiogram
Coag disorders

38. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Peptic ulcer disease or gastritis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

39. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Viral infection of the semicircular apparatus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

40. Prenatal visit schedule for low-risk pregnancies
35 (exception for postmenopausal women who have recently been started on HRT)
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
Rotator Cuff problem
Kids: Rotavirus Adults: Norwalk Virus

41. When should a patient get a stress test?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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.
Scabies
When the patient has symptoms in association with exercise or who describe chest pain or pressure

42. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

43. Pneumonia tx: suitable for healthy adults less than 60
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Generalized Anxiety disorder and panic disorder
CT
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

44. Who should have Xray testing for shoulder pain?
Nonulcer dyspepsia
BB or CCB - catheter ablation of identified bypass tract
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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. 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.
Loop diuretics (Check serum K+ levels before drug admin)
Associated with hypotension
Tension headache
Less than 80 ml of blood

46. Name the diagnosis of heartburn: regurgitation - dysphagia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Varicella virus
GERD

47. 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
24 hour halter
Acute headache - ataxia - profuse nausea - and vomiting
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

48. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Streptococci
Cholelithiasis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

49. Complete the sentence: pericarditis can cause frictional rub and......
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HIV and syphilis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

50. What does treatment for migrans include?
Candida albicans
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
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
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