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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. Who should have Xray testing for shoulder pain?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
CBC
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

2. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Regular bleeding at intervals of more than 35 days
Chest pain during pneumonia or PE
Candida albicans
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

3. What are the three major risk factors for heart failure?
Analgesic headache
35 (exception for postmenopausal women who have recently been started on HRT)
These patients are associated with low renin states=less likely to respond to medication
Hypertension - CAD - valvular heart disease

4. Initial treatment for Rhinosinusitis
BB or CCB - catheter ablation of identified bypass tract
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

5. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Albumin; low molecular weight proteins
HPV
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Less abrupt onset and cessation of palpitations

6. What lab tests are recommended for newly diagnosed hypertensive patients?
Infectious esophagitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pain
Lightheadedness - dizziness - syncope

7. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Cholelithiasis
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

8. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Variability in the time for follicle development during the proliferative phase
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
Loop diuretics (Check serum K+ levels before drug admin)
Dehydration - anemia - cardiac causes

9. What are the features of glomerular nephritis
Loop diuretics (Check serum K+ levels before drug admin)
RBC casts and old to moderate HTN
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
Peptic ulcer disease or gastritis

10. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
LH surge triggers ovulation
Dehydration - anemia - cardiac causes
Slow progression of cervical cancer changes -Availability of effective early treatment

11. At was quantity does urine dipstick test detect elevated protein?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
100mg; means patient can be trace protein positive and not be detected

12. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Rotator cuff tendonitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

13. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Lightheadedness - dizziness - syncope
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
CBC
Rotator cuff tendonitis

14. Treatment for supraventricular tachycardias
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
Diuretics -BB -CCB -ACEi
BB or CCB - catheter ablation of identified bypass tract
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

15. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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.

16. What should be considered in younger patients with menorrhagia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Anticoag with warfarin to prevent thromboembolism
Coag disorders
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

17. What occurs after ovulation
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Wolff-Parkinson-White syndrome

18. What is an acoustic neuroma?
Serotypes 16 - 18 - 31 -52 -58
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

19. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
EGD
Rotator Cuff tendonitis
Varicella virus

20. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

21. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Common problem that resolves spontaneously and is most often seen in children and young adults
These patients are associated with low renin states=less likely to respond to medication
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

22. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Giardia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

23. What is the Epley maneuver?
Intermenstrual bleeding
Kids: Rotavirus Adults: Norwalk Virus
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.
Infectious esophagitis

24. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Other brainstem or cranial nerve findings

25. What is the role of LH in the menstrual cycle
CT
HIV and syphilis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
LH surge triggers ovulation

26. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Cholelithiasis
Infectious esophagitis
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

27. Oligomenorrhea
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Regular bleeding at intervals of more than 35 days
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Giardia

28. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Coronary artery disease/ angina
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
Pancreatitis

29. What places women at higher risk of getting cervical cancer?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Acute headache - ataxia - profuse nausea - and vomiting
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

30. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Diuretics -BB -CCB -ACEi
Increase; 200 g/day

31. Cycle length variabilty is primarily due to what?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Generalized Anxiety disorder and panic disorder
Variability in the time for follicle development during the proliferative phase

32. What HPV serotypes are most commonly associated with cervical cancer?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dehydration - anemia - cardiac causes
Serotypes 16 - 18 - 31 -52 -58

33. How do you know if heart palpitations are due to stimulant or medication use?
Cellulitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
EGD
Less abrupt onset and cessation of palpitations

34. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pain

35. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Viral gastroenteritis
DM - HTN - DVT - seizures - depression - or anxiety
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

36. What is the mechanism of action for stimulant agents in treating constipation?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Candida albicans
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

37. Metrorrhagia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Irregular bleeding between cycles
Increasing fluid (8 - 8oz glasses of water/day) -fiber

38. What is the goal of CHF treatment? What drugs should be used?
Wolff-Parkinson-White syndrome
Streptococci
Upper sternal area burning pain - associated with a productive cough
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

39. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
E. Coli O157:H7
Regular bleeding at intervals of more than 35 days
Rotator Cuff problem
Cholelithiasis

40. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Tension headache
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.
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

41. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Fever with frontal or maxillary tenderness
Impetigo
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Generalized Anxiety disorder and panic disorder
CBC
Cellulitis

43. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Pts with palpitations and dizziness - near syncope - or syncope
Staphylococcal scalded skin syndrome
Associated with hypotension
PE - MI - aortic dissection - pneumothorax

44. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Regular bleeding at intervals of more than 35 days
Bence-Jones
A 24hr urine protein collection and urine creatinine clearance determination

45. What are the primary glomerular diseases?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
RBC casts and old to moderate HTN

46. Describe the presentation of pericardial pain
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

47. What are the consequences of diastolic dysfunction?
HPV
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

48. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
BB or CCB - catheter ablation of identified bypass tract
Rotator Cuff problem
E. Coli O157:H7
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

49. Pneumonia tx: suitable for healthy adults older than 60
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
A 24hr urine protein collection and urine creatinine clearance determination
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

50. How is constipation clinically defined?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Less than 3 stools per week
Streptococci
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids