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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 is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Non-cardiac causes of palpitations
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

2. Natural history of cervical cancer
Nonulcer dyspepsia
Giardia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Bence-Jones
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

4. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
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
HPV
Subarachnoid hemorrhage

5. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Albumin; low molecular weight proteins
Loop diuretics (Check serum K+ levels before drug admin)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

6. Mainstay treatment for soft tissue inflammation (Shoulder)
MSK - pulmonary - GI - or psychological
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Furucnle
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

7. What type of imaging is need for chronic sinusitis?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
CT

8. What are the most common causes for the common cold?
Diuretics -BB -CCB -ACEi
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

9. Name the skin lesion: honey colored crusts
ACEi - ARBS - thiazide diuretics
HIV and syphilis
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
Impetigo

10. When should invasive eletrophysiologic study should be considered?
Giardia
Dehydration - anemia - cardiac causes
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
HPV

11. Metrorrhagia
Possibility of Ischemic colitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Scabies
Irregular bleeding between cycles

12. Who should have Xray testing for shoulder pain?
Candida albicans
Possibility of Ischemic colitis
Hgb - Electrolytes - and TSH
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

13. 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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Molluscum contagiosum- pox virus
Repeat Pap after infection treated
BB or CCB - catheter ablation of identified bypass tract

14. History and PE for Pneumonia
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
S. Aureus
DM - HTN - DVT - seizures - depression - or anxiety
100mg; means patient can be trace protein positive and not be detected

15. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Warts
Increase; 200 g/day
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

16. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pleurisy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

17. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Giardia
EGD
E. Coli O157:H7

18. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Scabies

19. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
ACEi - ARBS - thiazide diuretics
ACEi

20. How are fungal infections diagnosed?
With a KOH wet mount preparation
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

21. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Viral gastroenteritis
Acute headache - ataxia - profuse nausea - and vomiting

22. How can GERD (or esophageal motility disorders) lead to chest pain?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
CBC
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

23. What the consequences of decreased cardiac output?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

24. What is benign transient proteinuria?
100mg; means patient can be trace protein positive and not be detected
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Common problem that resolves spontaneously and is most often seen in children and young adults
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

25. Describes what occurs during squamous metaplasia of the cervix.
Associated with hypotension
S. aureus- beta hemolytic streptococcus
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)

26. 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
Other brainstem or cranial nerve findings
Fever with frontal or maxillary tenderness
Cluster headache
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

27. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Upper sternal area burning pain - associated with a productive cough
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Common problem that resolves spontaneously and is most often seen in children and young adults

28. History for Acute bronchitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
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

29. 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
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

30. What is considered normal blood loss during a menstrual cycle?
Impetigo
Less than 80 ml of blood
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Scabies

31. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Pain
Bence-Jones
Variability in the time for follicle development during the proliferative phase
Temporal arteritis-biopsy of the temporal artery

32. Things that need to be included in history of shoulder pain
Molluscum contagiosum- pox virus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dehydration - anemia - cardiac causes

33. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Increase; 200 g/day
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

34. What are the 2 psych disorders most commonly associated with palpitations?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Generalized Anxiety disorder and panic disorder
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

35. What are the three major risk factors for heart failure?
Repeat Pap after infection treated
>3.5g of protein per 24hrs
Hypertension - CAD - valvular heart disease
Hgb - Electrolytes - and TSH

36. Vaccines that should be updated before planned pregnancy
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
HPV testing -Pos=colposcopy -Neg=repeat pap smear
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

37. Diarrhea from custard filled pastries
Presence of proteinuria on at least two separate ocassion
S. Aureus
Excessive bleeding in amount - duration - or both at irregular intervals
Staphylococcal scalded skin syndrome

38. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
PVC or Premature atrial contraction (PAC)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pancreatitis
Wolff-Parkinson-White syndrome

39. What are the symptoms of palpitations?
RBC casts and old to moderate HTN
Dehydration - anemia - cardiac causes
Lightheadedness - dizziness - syncope
Other brainstem or cranial nerve findings

40. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Acute headache - ataxia - profuse nausea - and vomiting
LH surge triggers ovulation

41. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Tension headache
Viral infection of the semicircular apparatus

42. Pain in shoulder when throwing - swimming - or serving a tennis ball
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator cuff tendonitis
LH surge triggers ovulation
Warts

43. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
PVC or Premature atrial contraction (PAC)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

44. Clinical Manifestations of HTN
Viral gastroenteritis
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Fever with frontal or maxillary tenderness

45. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Impetigo
Pleurisy

46. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
CT
Menorrhagia
Streptococci
Medication or chemical esophagitis

47. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

48. What is the Barany maneuver?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

49. How is constipation clinically defined?
ACEi
PE - MI - aortic dissection - pneumothorax
Less than 3 stools per week
A 24hr urine protein collection and urine creatinine clearance determination

50. What is the role of LH in the menstrual cycle
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
LH surge triggers ovulation
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Diuretics -BB -CCB -ACEi