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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 benign transient proteinuria?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Rotator Cuff tendonitis
Common problem that resolves spontaneously and is most often seen in children and young adults
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

2. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Less abrupt onset and cessation of palpitations
Cholelithiasis

3. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Less than 80 ml of blood
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
ACEi
24 hour halter

4. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Furucnle
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

5. 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
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
Slow progression of cervical cancer changes -Availability of effective early treatment
DM - HTN - DVT - seizures - depression - or anxiety

6. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Loop diuretics (Check serum K+ levels before drug admin)
Scabies

7. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Infectious esophagitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
>3.5g of protein per 24hrs

8. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
EGD
Chest pain during pneumonia or PE
Infectious esophagitis
Diuretics -BB -CCB -ACEi

9. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Wolff-Parkinson-White syndrome
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

10. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Less than 80 ml of blood
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

11. What diagnosis does the 'worse headache of my life' suggest?
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
S. aureus- beta hemolytic streptococcus
Colposcopy - Endocervical curettage - and directed cervical biopsy
Subarachnoid hemorrhage

12. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Hgb - Electrolytes - and TSH
Pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

13. Chronic pain and shoulder stiffness with limited motion
ACEi
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Adhesive capsulitis (frozen shoulder): most common in middle age women

14. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
CT
Presence of proteinuria on at least two separate ocassion
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

15. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Temporal arteritis-biopsy of the temporal artery

16. When should a patient get a stress test?
S. Aureus
Lightheadedness - dizziness - syncope
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Less than 80 ml of blood

17. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
HPV
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
Slow progression of cervical cancer changes -Availability of effective early treatment

18. 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
ACEi - ARBS - thiazide diuretics
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

19. What are the two common clinical presentations of acute diarrhea?
With a KOH wet mount preparation
Menorrhagia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

20. How are fungal infections diagnosed?
Warts
Giardia
With a KOH wet mount preparation
Wolff-Parkinson-White syndrome

21. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Subarachnoid hemorrhage
GERD
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

22. Name some medications that can cause proteinuria
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Echocardiogram

23. Describe the history and PE of patient presenting with common cold
Cellulitis
Bence-Jones
PE - MI - aortic dissection - pneumothorax
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

24. Shoulder pain with pain radiating to elbow
Lightheadedness - dizziness - syncope
Cervical radiculopathy
Slow progression of cervical cancer changes -Availability of effective early treatment
Impetigo

25. How do you know if heart palpitations are due to stimulant or medication use?
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
Less abrupt onset and cessation of palpitations
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

26. Complete the sentence: pericarditis can cause frictional rub and......
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
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

27. What is the peripheral caUse of vertigo?
Associated with hypotension
Anticoag with warfarin to prevent thromboembolism
E. Coli O157:H7
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

28. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
PE - MI - aortic dissection - pneumothorax
Cholelithiasis
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
CBC

29. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Cervical radiculopathy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

30. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
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
Loop diuretics (Check serum K+ levels before drug admin)
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

31. What is the caUse of benign positional vertigo?
Possibility of Ischemic colitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
RBC casts and old to moderate HTN
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.

32. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
24 hour halter
CBC
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

33. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Cluster headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
ACEi - ARBS - thiazide diuretics

34. Diarrhea from custard filled pastries
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
S. Aureus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

35. Difference between Pneumonia and Bronchitis
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
Chest pain during pneumonia or PE
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

36. 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
Cluster headache
Less abrupt onset and cessation of palpitations
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Albumin; low molecular weight proteins

37. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bulk forming: Psyllium - Methycellulose - Polycarbophil
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Medication or chemical esophagitis

38. What are the signs of acute sinusitis?
Echocardiogram
Fever with frontal or maxillary tenderness
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Supraspinatus and bicipital tendons

39. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Viral infection of the semicircular apparatus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Supraspinatus and bicipital tendons
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

40. Predictors of cardiac etiology
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pleurisy
Squamocolumnar junction=most common site of cervical cancer

41. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
RBC casts and old to moderate HTN
Intermenstrual bleeding
Varicella virus

42. What are the indiciations for neuroimaging?
Less than 3 stools per week
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Streptococci
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

43. History and PE for Pneumonia
Less abrupt onset and cessation of palpitations
Bence-Jones
With a KOH wet mount preparation
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

44. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Repeat Pap after infection treated
Echocardiogram
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

45. How can GERD (or esophageal motility disorders) lead to chest pain?
Possibility of Ischemic colitis
Medication or chemical esophagitis
A 24hr urine protein collection and urine creatinine clearance determination
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

46. Diarrhea is defined as an ____ in stool weight to more than ____g per day
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Furucnle
Associated with hypotension
Increase; 200 g/day

47. 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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Diuretics -BB -CCB -ACEi
With a KOH wet mount preparation

48. What HPV serotypes are most commonly associated with cervical cancer?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Serotypes 16 - 18 - 31 -52 -58
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

49. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

50. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Common problem that resolves spontaneously and is most often seen in children and young adults
Supraspinatus and bicipital tendons
Colposcopy - Endocervical curettage - and directed cervical biopsy
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool