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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. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Giardia

2. What is an acoustic neuroma?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
When the patient has symptoms in association with exercise or who describe chest pain or pressure

3. Who should have Xray testing for shoulder pain?
100mg; means patient can be trace protein positive and not be detected
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

4. What is the role of LH in the menstrual cycle
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
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
LH surge triggers ovulation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

5. What places women at higher risk of getting cervical cancer?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Echocardiogram
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

6. What type of imaging is need for chronic sinusitis?
Possibility of Ischemic colitis
Loop diuretics (Check serum K+ levels before drug admin)
Upper sternal area burning pain - associated with a productive cough
CT

7. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Pain
Rotator cuff tendonitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

8. When is a lumbar puncture contraindicated?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Pancreatitis

9. Irregular cycles with excessive flow - duration - or both
Menorrhagia
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
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
Acute headache - ataxia - profuse nausea - and vomiting

10. What are the four classes of medications that are most commonly used for 1st line agents in 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
Diuretics -BB -CCB -ACEi
Presence of proteinuria on at least two separate ocassion
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

11. What should be considered in younger patients with menorrhagia
Loop diuretics (Check serum K+ levels before drug admin)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Coag disorders

12. What does the classic ring worm lesion have?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
A central clear area
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

13. What are symptoms are CHF?
Less than 3 stools per week
Acute headache - ataxia - profuse nausea - and vomiting
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

14. Isolated - extra pounding beats
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Nonulcer dyspepsia
PVC or Premature atrial contraction (PAC)
Menorrhagia

15. What are signs of pulmonary congestion?
Molluscum contagiosum- pox virus
CBC
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

16. How are fungal infections diagnosed?
With a KOH wet mount preparation
RBC casts and old to moderate HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Streptococci

17. Describe the presentation of angina?
Pts with palpitations and dizziness - near syncope - or syncope
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
Cervical radiculopathy
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

18. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Rotator cuff tendonitis
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
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
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

19. Name the skin lesion: pustule in association with a hair follice
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
A 24hr urine protein collection and urine creatinine clearance determination
Folliculitis
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.

20. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
PVC or Premature atrial contraction (PAC)
Viral gastroenteritis
DM - HTN - DVT - seizures - depression - or anxiety
Lightheadedness - dizziness - syncope

21. Discomfort with abducting the arm past 90 degress
Candida albicans
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
Rotator Cuff tendonitis
35 (exception for postmenopausal women who have recently been started on HRT)

22. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Other brainstem or cranial nerve findings
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
RBC casts and old to moderate HTN
HPV testing -Pos=colposcopy -Neg=repeat pap smear

23. Mainstay treatment for soft tissue inflammation (Shoulder)
Acute headache - ataxia - profuse nausea - and vomiting
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
E. Coli O157:H7
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

24. 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.
Intermenstrual bleeding
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Subarachnoid hemorrhage
Tension headache

25. SE Of Beta blockers?
Common problem that resolves spontaneously and is most often seen in children and young adults
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

26. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Acute headache - ataxia - profuse nausea - and vomiting
Peptic ulcer disease or gastritis
Bence-Jones
Candida albicans

27. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Upper sternal area burning pain - associated with a productive cough
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

28. Diarrhea from custard filled pastries
Slow progression of cervical cancer changes -Availability of effective early treatment
Streptococci
S. Aureus
Cholelithiasis

29. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Varicella virus
Lightheadedness - dizziness - syncope

30. What treatments are the cornerstone for treating cases of functional constipation?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Medication or chemical esophagitis
Furucnle
Increasing fluid (8 - 8oz glasses of water/day) -fiber

31. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cholelithiasis
Upper sternal area burning pain - associated with a productive cough
Warts

32. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Tension headache
True
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

33. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Common problem that resolves spontaneously and is most often seen in children and young adults
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

34. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Menorrhagia
Albumin; low molecular weight proteins

35. PE for a patient getting an abnormal vaginal bleeding work up
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Loop diuretics (Check serum K+ levels before drug admin)

36. Vaccines that should be updated before planned pregnancy
Cellulitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Infectious esophagitis
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

37. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Staphylococcal scalded skin syndrome
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
These patients are associated with low renin states=less likely to respond to medication

38. What is the preload?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pts with palpitations and dizziness - near syncope - or syncope
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.

39. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
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
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
Regular bleeding at intervals of more than 35 days

40. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pleurisy

41. What is the standard tool used for diagnosis of GERD?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
A 24hr urine protein collection and urine creatinine clearance determination
EGD

42. What is benign transient proteinuria?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Coronary artery disease/ angina
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

43. name the 4 emergent causes of chest 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
PE - MI - aortic dissection - pneumothorax
Scleroderma/polymyositis with secondary gastroesophageal reflux
Folliculitis

44. Cycle length variabilty is primarily due to what?
Tension headache
Variability in the time for follicle development during the proliferative phase
Temporal arteritis-biopsy of the temporal artery
Rotator Cuff tendonitis

45. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Cluster headache
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
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

46. Regular bleeding at intervals of less than 21 days
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
GERD
Polymenorrhea
Giardia

47. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
These patients are associated with low renin states=less likely to respond to medication

48. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

49. What drugs do you use to treat H.pylori + PUD?
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
Repeat Pap after infection treated
Acute headache - ataxia - profuse nausea - and vomiting
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

50. 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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pts with palpitations and dizziness - near syncope - or syncope
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis