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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. Define nephrotic range proteinuria
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
>3.5g of protein per 24hrs
Medication or chemical esophagitis

2. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Lightheadedness - dizziness - syncope

3. Difference between Pneumonia and Bronchitis
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
Dehydration - anemia - cardiac causes
Paroxysmal atrial fibrillation or supraventricular tachycardia
Staphylococcal scalded skin syndrome

4. PE for a patient getting an abnormal vaginal bleeding work up
HIV and syphilis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Slow progression of cervical cancer changes -Availability of effective early treatment

5. What are the three types of lice?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Menorrhagia

6. What test done in PE measures instability of shoulder?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Viral gastroenteritis

7. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Fever with frontal or maxillary tenderness
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

8. What are the most common causes for the common cold?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Candida albicans
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

9. What is an acoustic neuroma?
Chest pain during pneumonia or PE
Candida albicans
Temporal arteritis-biopsy of the temporal artery
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

10. Name the skin lesion: pustule in association with a hair follice
S. aureus- beta hemolytic streptococcus
Less abrupt onset and cessation of palpitations
Folliculitis
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

11. What is the next best step if a patient has two or more positive dipstick tests?
Generalized Anxiety disorder and panic disorder
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
A 24hr urine protein collection and urine creatinine clearance determination
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

12. Define proteinuria
LH surge triggers ovulation
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
Viral infection of the semicircular apparatus
>150mg per 24hrs

13. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH
Furucnle

14. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Temporal arteritis-biopsy of the temporal artery
24 hour halter

15. What is the mechanism of action for stimulant agents in treating constipation?
BB or CCB - catheter ablation of identified bypass tract
PVC or Premature atrial contraction (PAC)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

16. Treatment for supraventricular tachycardias
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
BB or CCB - catheter ablation of identified bypass tract
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
Temporal arteritis-biopsy of the temporal artery

17. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

18. What is the goal of CHF treatment? What drugs should be used?
Variability in the time for follicle development during the proliferative phase
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
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
Anticoag with warfarin to prevent thromboembolism

19. Metrorrhagia
CT
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
Irregular bleeding between cycles
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

20. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

21. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Giardia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

22. Discomfort with abducting the arm past 90 degress
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Rotator Cuff tendonitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV

23. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Influenza - Rhinovirus - Adenovirus - Parainfluenza
GERD
PE - MI - aortic dissection - pneumothorax
Wolff-Parkinson-White syndrome

24. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Scleroderma/polymyositis with secondary gastroesophageal reflux
Upper sternal area burning pain - associated with a productive cough
Intermenstrual bleeding

25. What are the common causes for laryngitis?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Influenza - Rhinovirus - Adenovirus - Parainfluenza

26. What occurs after ovulation
Polymenorrhea
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
ACEi
Less abrupt onset and cessation of palpitations

27. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Molluscum contagiosum- pox virus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Infectious esophagitis

28. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Tension headache
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

29. Pneumonia tx: suitable for healthy adults older than 60
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Colposcopy - Endocervical curettage - and directed cervical biopsy

30. When should a patient get a stress test?
PE - MI - aortic dissection - pneumothorax
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
When the patient has symptoms in association with exercise or who describe chest pain or pressure

31. Tx of chronic or intermittent afibs
Supraspinatus and bicipital tendons
Infectious esophagitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Anticoag with warfarin to prevent thromboembolism

32. What are the signs of acute sinusitis?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Fever with frontal or maxillary tenderness

33. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Wolff-Parkinson-White syndrome
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pleurisy

34. What are symptoms are CHF?
Subarachnoid hemorrhage
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

35. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pain
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
Variability in the time for follicle development during the proliferative phase

36. When is a lumbar puncture contraindicated?
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
Peptic ulcer disease or gastritis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

37. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Diuretics -BB -CCB -ACEi
High blood pressure - focal neurologic defecit - or papilledema
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 are the indiciations for neuroimaging?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
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

39. What is the standard tool used for diagnosis of GERD?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
EGD
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Other brainstem or cranial nerve findings

40. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
Varicella virus

41. What is the preload?
Peptic ulcer disease or gastritis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

42. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Staphylococcal scalded skin syndrome
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

43. What are the primary glomerular diseases?
Peptic ulcer disease or gastritis
Nonulcer dyspepsia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Scleroderma/polymyositis with secondary gastroesophageal reflux

44. Name the skin lesion: erythema - warmth - edema - pain - fever
Nonulcer dyspepsia
A 24hr urine protein collection and urine creatinine clearance determination
Molluscum contagiosum- pox virus
Cellulitis

45. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH
Staphylococcal scalded skin syndrome
With a KOH wet mount preparation

46. Describe the presentation of angina?
100mg; means patient can be trace protein positive and not be detected
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
Menorrhagia
Chest pain during pneumonia or PE

47. Describe the presentation of myocardial pain?
Staphylococcal scalded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

48. How do you know if heart palpitations are due to stimulant or medication use?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Repeat Pap after infection treated
Less abrupt onset and cessation of palpitations
Polymenorrhea

49. Chronic pain and shoulder stiffness with limited motion
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Adhesive capsulitis (frozen shoulder): most common in middle age women

50. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise