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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. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Echocardiogram
Medication or chemical esophagitis
Colposcopy - Endocervical curettage - and directed cervical biopsy

2. What drugs do you use to treat H.pylori + PUD?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Presence of proteinuria on at least two separate ocassion
Increase; 200 g/day

3. When should invasive eletrophysiologic study should be considered?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

4. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Kids: Rotavirus Adults: Norwalk Virus
Less abrupt onset and cessation of palpitations
Bulk forming: Psyllium - Methycellulose - Polycarbophil

5. What are the signs of acute sinusitis?
Scleroderma/polymyositis with secondary gastroesophageal reflux
E. Coli O157:H7
Fever with frontal or maxillary tenderness
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

6. What are the signs of cerebral hemorrhage?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Acute headache - ataxia - profuse nausea - and vomiting
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

7. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
S. aureus- beta hemolytic streptococcus
24 hour halter

8. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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
HPV
Less than 80 ml of blood

9. What diagnosis does the 'worse headache of my life' suggest?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Diuretics -BB -CCB -ACEi
Subarachnoid hemorrhage
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

10. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Variability in the time for follicle development during the proliferative phase
GERD
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Hypertension - CAD - valvular heart disease

11. What are the signs of malignant hypertension?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
High blood pressure - focal neurologic defecit - or papilledema
MSK - pulmonary - GI - or psychological

12. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Higher filling presure - pulmonary congestion - and decreasd cardiac return

13. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Less than 3 stools per week
Polymenorrhea
Bence-Jones
Cholelithiasis

14. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pts with palpitations and dizziness - near syncope - or syncope

15. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Menorrhagia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Diuretics -BB -CCB -ACEi

16. Define nephrotic range proteinuria
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
>3.5g of protein per 24hrs
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

17. How can GERD (or esophageal motility disorders) lead to chest pain?
True
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 the patient has symptoms in association with exercise or who describe chest pain or pressure
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

18. Cycle length variabilty is primarily due to what?
Medication or chemical esophagitis
Variability in the time for follicle development during the proliferative phase
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Regular bleeding at intervals of more than 35 days

19. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
LH surge triggers ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

20. What is the standard tool used for diagnosis of GERD?
CT
Less than 80 ml of blood
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
EGD

21. 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.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Wolff-Parkinson-White syndrome
Repeat Pap after infection treated
Echocardiogram

22. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Kids: Rotavirus Adults: Norwalk Virus

23. Predictors of cardiac etiology
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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.
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pain

24. What is the caUse of Meniere disease? What are the cardinal symptoms?
Albumin; low molecular weight proteins
DM - HTN - DVT - seizures - depression - or anxiety
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CBC

25. What should be considered in younger patients with menorrhagia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Irregular bleeding between cycles
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
Coag disorders

26. Complete the sentence: pericarditis can cause frictional rub and......
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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)
Scabies

27. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Cervical radiculopathy
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Non-cardiac causes of palpitations

28. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Wolff-Parkinson-White syndrome
Bence-Jones
Pancreatitis

29. After treatment of dysplasia - women need Pap smears every...
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pancreatitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

30. What is the goal of CHF treatment? What drugs should be used?
Kids: Rotavirus Adults: Norwalk Virus
Intermenstrual bleeding
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Scleroderma/polymyositis with secondary gastroesophageal reflux
Subarachnoid hemorrhage

32. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Coronary artery disease/ angina
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Possibility of Ischemic colitis

33. History for Acute bronchitis
Lightheadedness - dizziness - syncope
Regular bleeding at intervals of more than 35 days
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

34. HIgh risk pregnant patients should be evaluated for ____ and ____
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
HIV and syphilis
Loop diuretics (Check serum K+ levels before drug admin)

35. When is a lumbar puncture contraindicated?
HIV and syphilis
S. Aureus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

36. Describe the presentation of myocardial pain?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Anticoag with warfarin to prevent thromboembolism
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

37. MI - pericardial tamponade - PE - GI bleed - are...
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Irregular bleeding between cycles
Associated with hypotension
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

38. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Streptococci
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
Cluster headache

39. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Medication or chemical esophagitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
35 (exception for postmenopausal women who have recently been started on HRT)
>150mg per 24hrs

40. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Generalized Anxiety disorder and panic disorder
GERD

41. Name some medications that can cause proteinuria
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. What does orthostatic positional changes that bring on dizziness suggest?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Dehydration - anemia - cardiac causes
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

43. 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
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
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
Other brainstem or cranial nerve findings

44. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Coronary artery disease/ angina
MSK - pulmonary - GI - or psychological

45. 1+ protein level on urine dipstick usually represents how much protein in the urine?
High blood pressure - focal neurologic defecit - or papilledema
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Squamocolumnar junction=most common site of cervical cancer

46. When should a patient get a stress test?
Supraspinatus and bicipital tendons
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pleurisy

47. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cluster headache
E. Coli O157:H7
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

48. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Possibility of Ischemic colitis
24 hour halter
Repeat Pap after infection treated
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

49. Describe the presentation of pericardial pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Possibility of Ischemic colitis
Coronary artery disease/ angina
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

50. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
S. aureus- beta hemolytic streptococcus
Staphylococcal scalded skin syndrome
Echocardiogram
Colposcopy - Endocervical curettage - and directed cervical biopsy