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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. Shoulder pain with pain radiating to elbow
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Rotator Cuff problem
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cervical radiculopathy

2. 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.
DM - HTN - DVT - seizures - depression - or anxiety
Loop diuretics (Check serum K+ levels before drug admin)
Serotypes 16 - 18 - 31 -52 -58
Tension headache

3. 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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Molluscum contagiosum- pox virus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

4. Pneumonia tx: suitable for healthy adults older than 60
Other brainstem or cranial nerve findings
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Polymenorrhea

5. Diagnostic Evaluation of Abnoraml vaginal bleeding
Lightheadedness - dizziness - syncope
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
Rotator Cuff tendonitis
>3.5g of protein per 24hrs

6. Mainstay treatment for soft tissue inflammation (Shoulder)
True
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
35 (exception for postmenopausal women who have recently been started on HRT)
Associated with hypotension

7. How does CHF present on X-ray?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

8. SE Of Beta blockers?
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

9. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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
35 (exception for postmenopausal women who have recently been started on HRT)
CBC
Pleurisy

10. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Dehydration - anemia - cardiac causes
Warts
Regular bleeding at intervals of more than 35 days
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

11. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Repeat Pap after infection treated
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

12. 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
Loop diuretics (Check serum K+ levels before drug admin)
CT
Increase; 200 g/day

13. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Viral gastroenteritis
Colposcopy - Endocervical curettage - and directed cervical biopsy
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

14. What are the secondly causes of glomerular disease?
LH surge triggers ovulation
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
MSK - pulmonary - GI - or psychological

15. What is the Epley maneuver?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Giardia
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.

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
These patients are associated with low renin states=less likely to respond to medication
24 hour halter
Rotator cuff tendonitis
Coag disorders

17. Oligomenorrhea
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Regular bleeding at intervals of more than 35 days
Rotator cuff tendonitis

18. What is the standard tool used for diagnosis of GERD?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
EGD
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

19. Name the skin lesion: pustule in association with a hair follice
ACEi
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Slow progression of cervical cancer changes -Availability of effective early treatment
Folliculitis

20. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Common problem that resolves spontaneously and is most often seen in children and young adults
Slow progression of cervical cancer changes -Availability of effective early treatment
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

21. What places women at higher risk of getting cervical cancer?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Squamocolumnar junction=most common site of cervical cancer
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

22. Diagnosis of HTN
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
S. Aureus

23. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Infectious esophagitis
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
Less than 80 ml of blood

24. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Kids: Rotavirus Adults: Norwalk Virus
Medication or chemical esophagitis
>150mg per 24hrs
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

25. Irregular cycles with excessive flow - duration - or both
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Menorrhagia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Warts

26. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

27. What lab tests are recommended for newly diagnosed hypertensive patients?
Furucnle
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
True
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

28. Things that need to be included in history of shoulder pain
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Repeat Pap after infection treated

29. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
These patients are associated with low renin states=less likely to respond to medication
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

30. 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
Intermenstrual bleeding
Cluster headache
A central clear area
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

31. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Rotator Cuff problem

32. What are the most common viral causes of diarrhea in kids and adults?
GERD
Molluscum contagiosum- pox virus
Kids: Rotavirus Adults: Norwalk Virus
Generalized Anxiety disorder and panic disorder

33. What the consequences of decreased cardiac output?
Warts
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Impetigo
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

34. Diarrhea from custard filled pastries
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
S. Aureus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cluster headache

35. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Pts with palpitations and dizziness - near syncope - or syncope
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Medication or chemical esophagitis

36. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
True
Less than 3 stools per week
Giardia

37. What drugs do you use to treat H.pylori + PUD?
Coronary artery disease/ angina
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Infectious esophagitis

38. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Menorrhagia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
BB or CCB - catheter ablation of identified bypass tract

39. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

40. Describe the presentation of myocardial pain?
Serotypes 16 - 18 - 31 -52 -58
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

41. Describe the history and PE of patient presenting with common cold
Increase; 200 g/day
Kids: Rotavirus Adults: Norwalk Virus
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

42. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Impetigo
True
Cluster headache

43. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
35 (exception for postmenopausal women who have recently been started on HRT)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Viral gastroenteritis

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
PE - MI - aortic dissection - pneumothorax
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
Temporal arteritis-biopsy of the temporal artery

45. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
ACEi - ARBS - thiazide diuretics
Coag disorders
CBC

46. What are the features of glomerular nephritis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Higher filling presure - pulmonary congestion - and decreasd cardiac return
RBC casts and old to moderate HTN
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

47. Why don't ACEi work well for the elderly and African Americans when treating HTN?
S. Aureus
These patients are associated with low renin states=less likely to respond to medication
HIV and syphilis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

48. Name the diagnosis of heartburn: severe constant mid abdominal 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
LH surge triggers ovulation
Tension headache
Pancreatitis

49. What is afterload?
RBC casts and old to moderate HTN
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
24 hour halter
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

50. What is the role of LH in the menstrual cycle
Upper sternal area burning pain - associated with a productive cough
MSK - pulmonary - GI - or psychological
LH surge triggers ovulation
>3.5g of protein per 24hrs