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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. What are signs of pulmonary congestion?
Tension 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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cervical radiculopathy

2. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hypertension - CAD - valvular heart disease
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

3. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Cholelithiasis
100mg; means patient can be trace protein positive and not be detected
Viral infection of the semicircular apparatus

4. When should a patient get a stress test?
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Kids: Rotavirus Adults: Norwalk 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

5. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
DM - HTN - DVT - seizures - depression - or anxiety
Less abrupt onset and cessation of palpitations

6. Diagnostic Evaluation of Abnoraml vaginal bleeding
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Impetigo
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
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

7. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Other brainstem or cranial nerve findings
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

8. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Molluscum contagiosum- pox virus
HPV testing -Pos=colposcopy -Neg=repeat pap smear

9. What occurs after ovulation
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
ACEi
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

10. What drugs do you use to treat H.pylori + PUD?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pts with palpitations and dizziness - near syncope - or syncope
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

11. What is considered normal blood loss during a menstrual cycle?
These patients are associated with low renin states=less likely to respond to medication
Less than 80 ml of blood
Staphylococcal scalded skin syndrome
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

12. 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
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
Folliculitis

13. Describe the presentation of pericardial pain
These patients are associated with low renin states=less likely to respond to medication
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
MSK - pulmonary - GI - or psychological

14. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Pancreatitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Increase; 200 g/day
HPV testing -Pos=colposcopy -Neg=repeat pap smear

15. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
35 (exception for postmenopausal women who have recently been started on HRT)
High blood pressure - focal neurologic defecit - or papilledema

16. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

17. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
With a KOH wet mount preparation
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
Coronary artery disease/ angina

18. 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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Cluster headache
Pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

19. What is the Barany maneuver?
Menorrhagia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Less than 80 ml of blood

20. Carcinoma in situ is generally referred to a gynecologist and requires ______
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

21. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
24 hour halter
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Viral infection of the semicircular apparatus

22. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
ACEi - ARBS - thiazide diuretics
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Viral infection of the semicircular apparatus

23. Define proteinuria
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
>150mg per 24hrs
Squamocolumnar junction=most common site of cervical cancer
Nonulcer dyspepsia

24. Metrorrhagia
Warts
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Irregular bleeding between cycles
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

25. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
BB or CCB - catheter ablation of identified bypass tract

26. When is a lumbar puncture contraindicated?
Candida albicans
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected
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

27. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Acute headache - ataxia - profuse nausea - and vomiting
Pleurisy
RBC casts and old to moderate HTN

28. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Anticoag with warfarin to prevent thromboembolism
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

29. What are the physical exam signs of CHF?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Menorrhagia
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
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

30. What are the most common viral causes of diarrhea in kids and adults?
Nonulcer dyspepsia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Kids: Rotavirus Adults: Norwalk Virus

31. Oligomenorrhea
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Generalized Anxiety disorder and panic disorder
Regular bleeding at intervals of more than 35 days

32. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Hgb - Electrolytes - and TSH
Wolff-Parkinson-White syndrome
DM - HTN - DVT - seizures - depression - or anxiety

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Diuretics -BB -CCB -ACEi
S. aureus- beta hemolytic streptococcus
Cervical radiculopathy

34. What are the features of glomerular nephritis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
RBC casts and old to moderate HTN
Lightheadedness - dizziness - syncope
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

35. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
ACEi - ARBS - thiazide diuretics
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

36. How are fungal infections diagnosed?
With a KOH wet mount preparation
Pancreatitis
Cholelithiasis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

37. What treatments are the cornerstone for treating cases of functional constipation?
Pleurisy
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Increasing fluid (8 - 8oz glasses of water/day) -fiber
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

38. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Viral infection of the semicircular apparatus
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

39. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Menorrhagia
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
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.

40. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cluster headache
MSK - pulmonary - GI - or psychological

41. Describe the presentation of angina?
Acute headache - ataxia - profuse nausea - and vomiting
HIV and syphilis
Staphylococcal scalded skin 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

42. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Acute headache - ataxia - profuse nausea - and vomiting
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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.

43. How does CHF present on X-ray?
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Increasing fluid (8 - 8oz glasses of water/day) -fiber

44. 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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Scabies
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Fever with frontal or maxillary tenderness

45. Things that need to be included in history of shoulder pain
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

46. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Loop diuretics (Check serum K+ levels before drug admin)

47. 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
Excessive bleeding in amount - duration - or both at irregular intervals
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
Molluscum contagiosum- pox virus
Warts

48. Tx of chronic or intermittent afibs
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Anticoag with warfarin to prevent thromboembolism
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

49. Uterine bleeding between regular cycles
Intermenstrual bleeding
Paroxysmal atrial fibrillation or supraventricular tachycardia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Irregular bleeding between cycles

50. What is the standard tool used for diagnosis of GERD?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
EGD
Intermenstrual bleeding