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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. What is the caUse of benign positional vertigo?
>3.5g of protein per 24hrs
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

2. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Giardia
Upper sternal area burning pain - associated with a productive cough
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

3. What are the 2 psych disorders most commonly associated with palpitations?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Generalized Anxiety disorder and panic disorder
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

4. Four muscles of rotator cuff
Anticoag with warfarin to prevent thromboembolism
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Serotypes 16 - 18 - 31 -52 -58

5. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Giardia
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
Furucnle
Tension headache

6. What the consequences of decreased cardiac output?
True
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
GERD

7. What is the role of FSH in one's menstrual cycle
Subarachnoid hemorrhage
Viral infection of the semicircular apparatus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

8. Describe the history and PE of patient presenting with common cold
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pancreatitis
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

9. What test done in PE measures instability of shoulder?
S. Aureus
Slow progression of cervical cancer changes -Availability of effective early treatment
RBC casts and old to moderate HTN
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

10. What is the difference between a Holter monitor or an event monitor?
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
S. Aureus
Slow progression of cervical cancer changes -Availability of effective early treatment

11. name the 4 emergent causes of chest pain
Pts with palpitations and dizziness - near syncope - or syncope
PE - MI - aortic dissection - pneumothorax
Hypertension - CAD - valvular heart disease
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

12. History for Sinusitis

13. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cholelithiasis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Intermenstrual bleeding

14. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
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
Molluscum contagiosum- pox virus
Coronary artery disease/ angina

15. Predictors of cardiac etiology
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Cholelithiasis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

16. What is the caUse of Meniere disease? What are the cardinal symptoms?
Pancreatitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Non-cardiac causes of palpitations
S. Aureus

17. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

18. What lab tests are recommended for newly diagnosed hypertensive patients?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Possibility of Ischemic colitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
S. Aureus

19. Discomfort with abducting the arm past 90 degress
GERD
Supraspinatus and bicipital tendons
Rotator Cuff tendonitis
Temporal arteritis-biopsy of the temporal artery

20. Describes what occurs during squamous metaplasia of the cervix.
Temporal arteritis-biopsy of the temporal artery
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
ACEi
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

21. 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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
PE - MI - aortic dissection - pneumothorax
Scabies

22. Describe the presentation of pneumonia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator Cuff problem
Increase; 200 g/day
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

23. Why is the pap smear one of the most effective cancer screening tools?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Possibility of Ischemic colitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Slow progression of cervical cancer changes -Availability of effective early treatment

24. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

25. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

26. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Pain
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
E. Coli O157:H7

27. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Tension headache
Varicella virus

28. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
S. Aureus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Lightheadedness - dizziness - syncope

29. Name some medications that can cause proteinuria
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Temporal arteritis-biopsy of the temporal artery
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

30. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A 24hr urine protein collection and urine creatinine clearance determination

31. Carcinoma in situ is generally referred to a gynecologist and requires ______
Kids: Rotavirus Adults: Norwalk Virus
Subarachnoid hemorrhage
A central clear area
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

32. Uterine bleeding between regular cycles
24 hour halter
Intermenstrual bleeding
Irregular bleeding between cycles
Cervical radiculopathy

33. Describe the presentation of myocardial pain?
Impetigo
Chest pain during pneumonia or PE
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

34. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Temporal arteritis-biopsy of the temporal artery
Hypertension - CAD - valvular heart disease
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
Viral infection of the semicircular apparatus

35. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
24 hour halter
Bence-Jones
Rotator cuff tendonitis

36. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Colposcopy - Endocervical curettage - and directed cervical biopsy
Albumin; low molecular weight proteins
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

37. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Impetigo
CBC
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

38. What is the next best step if a patient has two or more positive dipstick tests?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
A 24hr urine protein collection and urine creatinine clearance determination
Cholelithiasis

39. Shoulder pain with pain radiating to elbow
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Cervical radiculopathy
Associated with hypotension
Higher filling presure - pulmonary congestion - and decreasd cardiac return

40. What does treatment for migrans include?
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
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
Viral gastroenteritis
Regular bleeding at intervals of more than 35 days

41. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Cluster headache
Polymenorrhea
Analgesic headache

42. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Anticoag with warfarin to prevent thromboembolism
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

43. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Viral gastroenteritis
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
Pts with palpitations and dizziness - near syncope - or syncope
>3.5g of protein per 24hrs

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
24 hour halter
Temporal arteritis-biopsy of the temporal artery
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Analgesic headache

45. Pneumonia tx: suitable for healthy adults older than 60
Less than 3 stools per week
Bence-Jones
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV

46. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Folliculitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

47. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Presence of proteinuria on at least two separate ocassion

48. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Menorrhagia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Giardia
Hypertension - CAD - valvular heart disease

49. What is the Epley maneuver?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
S. aureus- beta hemolytic streptococcus
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.
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

50. How to NSAIDs contribute to gastritis and ulcer formation?
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
Albumin; low molecular weight proteins
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.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema