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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. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Non-cardiac causes of palpitations
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
Less than 3 stools per week

2. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Molluscum contagiosum- pox virus
BB or CCB - catheter ablation of identified bypass tract
Repeat Pap after infection treated
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

3. Describe the presentation of angina?
Intermenstrual bleeding
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Medication or chemical esophagitis

4. Clinical Manifestations of HTN
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
Kids: Rotavirus Adults: Norwalk Virus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
LH surge triggers ovulation

5. What are the two common clinical presentations of acute diarrhea?
RBC casts and old to moderate HTN
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cervical radiculopathy
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

6. What are the primary glomerular diseases?
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pain
Common problem that resolves spontaneously and is most often seen in children and young adults

7. Who should have Xray testing for shoulder pain?
Candida albicans
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Furucnle
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

8. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
ACEi
Staphylococcal scalded skin syndrome
Possibility of Ischemic colitis

9. What is an acoustic neuroma?
Peptic ulcer disease or gastritis
Molluscum contagiosum- pox virus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Loop diuretics (Check serum K+ levels before drug admin)

10. What places women at higher risk of getting cervical cancer?
ACEi - ARBS - thiazide diuretics
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

11. Initial treatment for Rhinosinusitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

12. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cervical radiculopathy
Varicella virus
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

13. Describe the presentation of pericardial pain
Furucnle
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

14. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Giardia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

15. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Kids: Rotavirus Adults: Norwalk Virus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
LH surge triggers ovulation

16. 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
ACEi - ARBS - thiazide diuretics
Cellulitis
E. Coli O157:H7
These patients are associated with low renin states=less likely to respond to medication

17. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
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
Viral infection of the semicircular apparatus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Echocardiogram

18. Cycle length variabilty is primarily due to what?
Paroxysmal atrial fibrillation or supraventricular tachycardia
LH surge triggers ovulation
ACEi - ARBS - thiazide diuretics
Variability in the time for follicle development during the proliferative phase

19. What is the difference between a Holter monitor or an event monitor?
EGD
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
Pts with palpitations and dizziness - near syncope - or syncope
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

20. 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.
Tension headache
Cervical radiculopathy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

21. Name the diagnosis of heartburn: severe constant mid abdominal pain
HPV
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pancreatitis
ACEi

22. Mainstay treatment for soft tissue inflammation (Shoulder)
True
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral infection of the semicircular apparatus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

23. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
S. Aureus
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
Albumin; low molecular weight proteins
Diuretics -BB -CCB -ACEi

24. patients with herpes zoster may experience what symptom before the rash appear?
High blood pressure - focal neurologic defecit - or papilledema
Pain
PVC or Premature atrial contraction (PAC)
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

25. Diarrhea from custard filled pastries
S. Aureus
Irregular bleeding between cycles
Wolff-Parkinson-White syndrome
CBC

26. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fever with frontal or maxillary tenderness

27. Where does the development of abnormal cervical cells begin?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Squamocolumnar junction=most common site of cervical cancer

28. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Viral gastroenteritis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pleurisy
Pts with palpitations and dizziness - near syncope - or syncope

29. History for Sinusitis

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30. 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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Intermenstrual bleeding
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

31. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
E. Coli O157:H7
Rotator Cuff tendonitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Infectious esophagitis

32. History and PE for Pneumonia
A central clear area
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
Pain
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

33. What are the most common viral causes of diarrhea in kids and adults?
E. Coli O157:H7
Kids: Rotavirus Adults: Norwalk Virus
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
Excessive bleeding in amount - duration - or both at irregular intervals

34. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Fever with frontal or maxillary tenderness
ACEi
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

35. What test done in PE measures instability of shoulder?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
These patients are associated with low renin states=less likely to respond to medication
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

36. What are symptoms are CHF?
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
Cellulitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
High blood pressure - focal neurologic defecit - or papilledema

37. Diagnosis of HTN
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Infectious esophagitis
Pts with palpitations and dizziness - near syncope - or syncope

38. What is the peripheral caUse of vertigo?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
A 24hr urine protein collection and urine creatinine clearance determination

39. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Variability in the time for follicle development during the proliferative phase

40. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Hgb - Electrolytes - and TSH
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.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Lightheadedness - dizziness - syncope

41. 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
Peptic ulcer disease or gastritis
Bence-Jones
True
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

42. Pain in shoulder when throwing - swimming - or serving a tennis ball
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Rotator cuff tendonitis
DM - HTN - DVT - seizures - depression - or anxiety
Pts with palpitations and dizziness - near syncope - or syncope

43. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
PE - MI - aortic dissection - pneumothorax
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

44. When does troponin rise following myocardial injury or infarction?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

45. What are the physical exam signs of CHF?
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.
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
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
PVC or Premature atrial contraction (PAC)

46. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Tension headache
Albumin; low molecular weight proteins
Streptococci
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

47. What does orthostatic positional changes that bring on dizziness suggest?
Temporal arteritis-biopsy of the temporal artery
Pain
Dehydration - anemia - cardiac causes
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

48. What is the Barany maneuver?
Subarachnoid hemorrhage
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
Repeat Pap after infection treated
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

49. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Viral gastroenteritis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Loop diuretics (Check serum K+ levels before drug admin)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

50. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pancreatitis
S. aureus- beta hemolytic streptococcus