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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 the indiciations for neuroimaging?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
These patients are associated with low renin states=less likely to respond to medication
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

2. What does treatment for migrans include?
S. Aureus
GERD
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
Loop diuretics (Check serum K+ levels before drug admin)

3. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Regular bleeding at intervals of more than 35 days
Giardia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Polymenorrhea

4. What is the peripheral caUse of vertigo?
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
Presence of proteinuria on at least two separate ocassion
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

5. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Tension headache
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Increase; 200 g/day

6. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Coag disorders
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
These patients are associated with low renin states=less likely to respond to medication

7. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Impetigo
Presence of proteinuria on at least two separate ocassion
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Staphylococcal scalded skin syndrome

8. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Diuretics -BB -CCB -ACEi
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

9. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Less than 3 stools per week
Pleurisy
Analgesic headache

10. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
PVC or Premature atrial contraction (PAC)
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
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

11. How do you define persistent protein uria?
CT
Scleroderma/polymyositis with secondary gastroesophageal reflux
Common problem that resolves spontaneously and is most often seen in children and young adults
Presence of proteinuria on at least two separate ocassion

12. Diarrhea from custard filled pastries
Fever with frontal or maxillary tenderness
S. Aureus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

13. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
True
HIV and syphilis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Loop diuretics (Check serum K+ levels before drug admin)

14. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Colposcopy - Endocervical curettage - and directed cervical biopsy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
High blood pressure - focal neurologic defecit - or papilledema

15. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Less than 80 ml of blood
When the patient has symptoms in association with exercise or who describe chest pain or pressure
ACEi - ARBS - thiazide diuretics
Analgesic headache

16. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Scleroderma/polymyositis with secondary gastroesophageal reflux
Albumin; low molecular weight proteins
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

17. 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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Irregular bleeding between cycles
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cluster headache

18. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Medication or chemical esophagitis
Lightheadedness - dizziness - syncope
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

19. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Slow progression of cervical cancer changes -Availability of effective early treatment
ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

20. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Medication or chemical esophagitis
Polymenorrhea
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

21. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cholelithiasis

22. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Increase; 200 g/day
Molluscum contagiosum- pox virus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

23. What are the signs of malignant hypertension?
PVC or Premature atrial contraction (PAC)
Serotypes 16 - 18 - 31 -52 -58
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
High blood pressure - focal neurologic defecit - or papilledema

24. Describe the presentation of pericardial pain
Coronary artery disease/ angina
Staphylococcal scalded skin syndrome
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Rotator Cuff tendonitis

25. After treatment of dysplasia - women need Pap smears every...
Viral gastroenteritis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

26. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Generalized Anxiety disorder and panic disorder

27. Name some medications that can cause proteinuria
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pain
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

28. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
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
Scleroderma/polymyositis with secondary gastroesophageal reflux

29. How does CHF present on X-ray?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Giardia
Impetigo

30. What is the standard tool used for diagnosis of GERD?
EGD
Subarachnoid hemorrhage
Less than 3 stools per week
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

31. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Possibility of Ischemic colitis

32. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
With a KOH wet mount preparation

33. When should a patient get a stress test?
Less than 3 stools per week
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

34. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
BB or CCB - catheter ablation of identified bypass tract
Molluscum contagiosum- pox virus
Other brainstem or cranial nerve findings

35. What does the classic ring worm lesion have?
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
A central clear area
Acute headache - ataxia - profuse nausea - and vomiting

36. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
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
Pleurisy
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

37. Uterine bleeding between regular cycles
Serotypes 16 - 18 - 31 -52 -58
CT
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
Intermenstrual bleeding

38. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Excessive bleeding in amount - duration - or both at irregular intervals
Less than 3 stools per week
Candida albicans

39. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
ACEi

40. When does troponin rise following myocardial injury or infarction?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pain
Cluster headache

41. Lab testing for heart palpitation
Polymenorrhea
Viral gastroenteritis
Hgb - Electrolytes - and TSH
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

42. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Folliculitis
Diuretics -BB -CCB -ACEi
Albumin; low molecular weight proteins
DM - HTN - DVT - seizures - depression - or anxiety

43. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Impetigo
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Peptic ulcer disease or gastritis

44. Name types of laxatives
Polymenorrhea
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

45. Initial treatment for Rhinosinusitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Anticoag with warfarin to prevent thromboembolism

46. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Generalized Anxiety disorder and panic disorder
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.
MSK - pulmonary - GI - or psychological
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

47. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Acute headache - ataxia - profuse nausea - and vomiting
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

48. Prenatal visit schedule for low-risk pregnancies
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
CBC
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

49. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Common problem that resolves spontaneously and is most often seen in children and young adults
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Infectious esophagitis

50. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Medication or chemical esophagitis
Increase; 200 g/day