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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. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Loop diuretics (Check serum K+ levels before drug admin)
Pts with palpitations and dizziness - near syncope - or syncope
PE - MI - aortic dissection - pneumothorax
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

2. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Diuretics -BB -CCB -ACEi
HIV and syphilis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Furucnle

3. What is the role of LH in the menstrual cycle
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
LH surge triggers ovulation
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

4. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Warts
MSK - pulmonary - GI - or psychological
>150mg per 24hrs
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

5. Describes what occurs during squamous metaplasia of the cervix.
MSK - pulmonary - GI - or psychological
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Candida albicans
Variability in the time for follicle development during the proliferative phase

6. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Irregular bleeding between cycles
Bence-Jones
24 hour halter

7. What is the difference between a Holter monitor or an event monitor?
Possibility of Ischemic colitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

8. What test done in PE measures instability of shoulder?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Infectious esophagitis
Pain
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

9. What is afterload?
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

10. Pain in shoulder when throwing - swimming - or serving a tennis ball
100mg; means patient can be trace protein positive and not be detected
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Tension headache
Rotator cuff tendonitis

11. What is the role of FSH in one's menstrual cycle
Warts
Infectious esophagitis
LH surge triggers ovulation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

12. 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
Cluster 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
Irregular bleeding between cycles

13. How does systolic vs. diastolic heart failure present on the echocardiogram?
Lightheadedness - dizziness - syncope
A central clear area
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
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

14. Define nephrotic range proteinuria
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
>3.5g of protein per 24hrs
Candida albicans
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

15. Shoulder pain with pain radiating to elbow
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
Coag disorders
Cervical radiculopathy
Echocardiogram

16. Uterine bleeding between regular cycles
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Lightheadedness - dizziness - syncope
Intermenstrual bleeding

17. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Upper sternal area burning pain - associated with a productive cough
Squamocolumnar junction=most common site of cervical cancer
MSK - pulmonary - GI - or psychological

18. How is constipation clinically defined?
Viral gastroenteritis
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
Squamocolumnar junction=most common site of cervical cancer
Less than 3 stools per week

19. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Streptococci
Associated with hypotension
Colposcopy - Endocervical curettage - and directed cervical biopsy

20. 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
Scabies
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Varicella virus

21. What should be considered in younger patients with menorrhagia
LH surge triggers ovulation
Coag disorders
Bence-Jones
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

22. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Rotator Cuff tendonitis
PVC or Premature atrial contraction (PAC)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Scleroderma/polymyositis with secondary gastroesophageal reflux

23. What medications can cause heart palpitations?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Fever with frontal or maxillary tenderness
Lightheadedness - dizziness - syncope
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

24. Oligomenorrhea
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Regular bleeding at intervals of more than 35 days
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral gastroenteritis

25. How to NSAIDs contribute to gastritis and ulcer formation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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.
Excessive bleeding in amount - duration - or both at irregular intervals
Anticoag with warfarin to prevent thromboembolism

26. Pneumonia tx: suitable for healthy adults less than 60
Irregular bleeding between cycles
Varicella virus
Echocardiogram
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

27. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Temporal arteritis-biopsy of the temporal artery
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

28. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
A 24hr urine protein collection and urine creatinine clearance determination
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Rotator cuff tendonitis

29. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
These patients are associated with low renin states=less likely to respond to medication
Cellulitis

30. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
S. aureus- beta hemolytic streptococcus
HPV
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

31. Describe the history and PE of patient presenting with common cold
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff tendonitis
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
E. Coli O157:H7

32. Discomfort with abducting the arm past 90 degress
Wolff-Parkinson-White syndrome
Presence of proteinuria on at least two separate ocassion
MSK - pulmonary - GI - or psychological
Rotator Cuff tendonitis

33. What the consequences of decreased cardiac output?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
CBC

34. 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)
Lightheadedness - dizziness - syncope
Staphylococcal scalded skin syndrome
Coag disorders

35. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

36. What are the signs of malignant hypertension?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV
A central clear area
High blood pressure - focal neurologic defecit - or papilledema

37. How can GERD (or esophageal motility disorders) lead to chest pain?
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

38. Describe the presentation of myocardial pain?
Increase; 200 g/day
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
ACEi - ARBS - thiazide diuretics

39. Name some medications that can cause proteinuria
Upper sternal area burning pain - associated with a productive cough
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Cellulitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

40. History and PE for Pneumonia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Scabies

41. Pneumonia tx: suitable for healthy adults older than 60
Menorrhagia
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

42. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
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.
Viral gastroenteritis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

43. patients with herpes zoster may experience what symptom before the rash appear?
Hgb - Electrolytes - and TSH
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
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

44. Prenatal visit schedule for low-risk pregnancies
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Irregular bleeding between cycles
Rotator Cuff problem

45. What are the most common viral causes of diarrhea in kids and adults?
Chest pain during pneumonia or PE
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Kids: Rotavirus Adults: Norwalk Virus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

46. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Less abrupt onset and cessation of palpitations

47. What are the three types of lice?
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Folliculitis
HPV

48. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
High blood pressure - focal neurologic defecit - or papilledema
Staphylococcal scalded skin syndrome
Generalized Anxiety disorder and panic disorder
Less than 80 ml of blood

49. Name the skin lesion: honey colored crusts
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Impetigo
Intermenstrual bleeding

50. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Medication or chemical esophagitis
Irregular bleeding between cycles
Pleurisy