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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. 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
Irregular bleeding between cycles
GERD
Cluster headache
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

2. What are the most common viral causes of diarrhea in kids and adults?
With a KOH wet mount preparation
Kids: Rotavirus Adults: Norwalk Virus
Dehydration - anemia - cardiac causes
Menorrhagia

3. When does troponin rise following myocardial injury or infarction?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
E. Coli O157:H7
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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.

4. What type of imaging is need for chronic sinusitis?
High blood pressure - focal neurologic defecit - or papilledema
CT
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

5. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Colposcopy - Endocervical curettage - and directed cervical biopsy
Albumin; low molecular weight proteins
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
EGD

6. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Candida albicans
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
High blood pressure - focal neurologic defecit - or papilledema

7. What are symptoms are CHF?
High blood pressure - focal neurologic defecit - or papilledema
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

8. Name the skin lesion: honey colored crusts
Wolff-Parkinson-White syndrome
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
Impetigo
Analgesic headache

9. What medications can cause heart palpitations?
Scabies
These patients are associated with low renin states=less likely to respond to medication
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

10. What is a markers of CNS vertigo?
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
Other brainstem or cranial nerve findings
Menorrhagia
Possibility of Ischemic colitis

11. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Pancreatitis
Coronary artery disease/ angina
Acute headache - ataxia - profuse nausea - and vomiting

12. What does the classic ring worm lesion have?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
A central clear area
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
Coag disorders

13. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Irregular bleeding between cycles
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

14. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
S. Aureus
Colposcopy - Endocervical curettage - and directed cervical biopsy
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.
Pts with palpitations and dizziness - near syncope - or syncope

15. What are the three major risk factors for heart failure?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Hypertension - CAD - valvular heart disease
Candida albicans
35 (exception for postmenopausal women who have recently been started on HRT)

16. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Colposcopy - Endocervical curettage - and directed cervical biopsy

17. name the 4 emergent causes of chest pain
Warts
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Impetigo
PE - MI - aortic dissection - pneumothorax

18. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Rotator Cuff problem
Viral infection of the semicircular apparatus
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

19. After treatment of dysplasia - women need Pap smears every...
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
EGD
Echocardiogram
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

20. What is the role of FSH in one's menstrual cycle
Pancreatitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
>150mg per 24hrs
Less than 3 stools per week

21. What should be considered in younger patients with menorrhagia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Coag disorders
True
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

22. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

23. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Scabies
Coronary artery disease/ angina
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Upper sternal area burning pain - associated with a productive cough

24. Treatment for supraventricular tachycardias
Increasing fluid (8 - 8oz glasses of water/day) -fiber
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
BB or CCB - catheter ablation of identified bypass tract

25. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fever with frontal or maxillary tenderness
PVC or Premature atrial contraction (PAC)

26. Name the diagnosis of heartburn: severe constant mid abdominal pain
Candida albicans
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
HPV
Pancreatitis

27. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Serotypes 16 - 18 - 31 -52 -58
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
Viral infection of the semicircular apparatus

28. Discomfort with abducting the arm past 90 degress
Medication or chemical esophagitis
>150mg per 24hrs
Rotator Cuff tendonitis
Tension headache

29. Describe the presentation of myocardial pain?
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

30. 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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Common problem that resolves spontaneously and is most often seen in children and young adults
Varicella virus

31. What is the next best step if a patient has two or more positive dipstick tests?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A 24hr urine protein collection and urine creatinine clearance determination
Less than 3 stools per week
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

32. What is the Barany maneuver?
Scabies
Irregular bleeding between cycles
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

33. Clinical Manifestations of HTN
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Variability in the time for follicle development during the proliferative phase
Hgb - Electrolytes - and TSH

34. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Cluster headache
Loop diuretics (Check serum K+ levels before drug admin)
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

35. What are the features of glomerular nephritis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Influenza - Rhinovirus - Adenovirus - Parainfluenza
RBC casts and old to moderate HTN

36. Menometrorrhagia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
100mg; means patient can be trace protein positive and not be detected
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Excessive bleeding in amount - duration - or both at irregular intervals

37. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Streptococci
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

38. 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
Less than 80 ml of blood
E. Coli O157:H7
Viral gastroenteritis
Rotator Cuff problem

39. Difference between Pneumonia and Bronchitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Less abrupt onset and cessation of palpitations
Echocardiogram

40. How do you know if heart palpitations are due to stimulant or medication use?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Less abrupt onset and cessation of palpitations
Pts with palpitations and dizziness - near syncope - or syncope
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

41. How are fungal infections diagnosed?
With a KOH wet mount preparation
Cellulitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

42. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
HIV and syphilis

43. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
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
Echocardiogram
S. Aureus
CBC

44. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Impetigo
Tension headache
Pain
ACEi

45. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Loop diuretics (Check serum K+ levels before drug admin)
MSK - pulmonary - GI - or psychological

46. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Diuretics -BB -CCB -ACEi

47. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Analgesic headache
Slow progression of cervical cancer changes -Availability of effective early treatment

48. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase; 200 g/day
Impetigo
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

49. Constipation: What are indications for lab testing?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
HPV
ACEi

50. Complete the sentence: pericarditis can cause frictional rub and......
Less than 3 stools per week
Temporal arteritis-biopsy of the temporal artery
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses