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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. Four muscles of rotator cuff
ACEi - ARBS - thiazide diuretics
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

2. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Furucnle
ACEi
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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. 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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Giardia

4. Where does the development of abnormal cervical cells begin?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
>150mg per 24hrs
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.
Squamocolumnar junction=most common site of cervical cancer

5. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Viral infection of the semicircular apparatus
Dehydration - anemia - cardiac causes
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

6. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Medication or chemical esophagitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
>3.5g of protein per 24hrs

7. Regular bleeding at intervals of less than 21 days
Molluscum contagiosum- pox virus
Rotator Cuff tendonitis
True
Polymenorrhea

8. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Repeat Pap after infection treated

9. What is the next best step if a patient has two or more positive dipstick tests?
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
A 24hr urine protein collection and urine creatinine clearance determination
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

10. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Upper sternal area burning pain - associated with a productive cough
Furucnle

11. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Less than 80 ml of blood
Warts
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

12. What should blood work include for suspected heart failure?
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
Echocardiogram
RBC casts and old to moderate HTN
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

13. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
DM - HTN - DVT - seizures - depression - or anxiety
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
Coronary artery disease/ angina

14. Name the skin lesion: pustule in association with a hair follice
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Folliculitis
DM - HTN - DVT - seizures - depression - or anxiety

15. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Rotator Cuff tendonitis

16. Initial treatment for Rhinosinusitis
A central clear area
Molluscum contagiosum- pox virus
Rotator cuff tendonitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

17. What are the secondly causes of glomerular disease?
PVC or Premature atrial contraction (PAC)
Rotator Cuff problem
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

18. Predictors of cardiac etiology
Colposcopy - Endocervical curettage - and directed cervical biopsy
Staphylococcal scalded skin syndrome
Diuretics -BB -CCB -ACEi
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

19. 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
Furucnle
Chest pain during pneumonia or PE
Viral gastroenteritis

20. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Associated with hypotension

21. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
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
Anticoag with warfarin to prevent thromboembolism
Rotator Cuff problem

22. What diagnosis does the 'worse headache of my life' suggest?
HIV and syphilis
Nonulcer dyspepsia
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.
Subarachnoid hemorrhage

23. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Non-cardiac causes of palpitations

24. Name the diagnosis of heartburn: severe constant mid abdominal pain
Regular bleeding at intervals of more than 35 days
Cellulitis
Pancreatitis
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

25. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Diuretics -BB -CCB -ACEi

26. How can GERD (or esophageal motility disorders) lead to chest pain?
Pain
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

27. Chronic pain and shoulder stiffness with limited motion
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Furucnle
Infectious esophagitis
Adhesive capsulitis (frozen shoulder): most common in middle age women

28. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Impetigo
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Repeat Pap after infection treated
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

29. What places women at higher risk of getting cervical cancer?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less abrupt onset and cessation of palpitations
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

30. Treatment for supraventricular tachycardias
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
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
BB or CCB - catheter ablation of identified bypass tract
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

31. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Colposcopy - Endocervical curettage - and directed cervical biopsy
Albumin; low molecular weight proteins
GERD
Associated with hypotension

32. Clinical Manifestations of HTN
E. Coli O157:H7
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

33. What occurs after ovulation
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

34. 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.
These patients are associated with low renin states=less likely to respond to medication
Supraspinatus and bicipital tendons
Generalized Anxiety disorder and panic disorder
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

35. How do you know if heart palpitations are due to stimulant or medication use?
Coronary artery disease/ angina
Less abrupt onset and cessation of palpitations
Warts
Increasing fluid (8 - 8oz glasses of water/day) -fiber

36. How does CHF present on X-ray?
Impetigo
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Anticoag with warfarin to prevent thromboembolism

37. At was quantity does urine dipstick test detect elevated protein?
True
Possibility of Ischemic colitis
100mg; means patient can be trace protein positive and not be detected
Coronary artery disease/ angina

38. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Analgesic headache
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
Possibility of Ischemic colitis

39. Cycle length variabilty is primarily due to what?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Excessive bleeding in amount - duration - or both at irregular intervals
Variability in the time for follicle development during the proliferative phase

40. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Squamocolumnar junction=most common site of cervical cancer
Nonulcer dyspepsia

41. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Coronary artery disease/ angina
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. What are the signs of malignant hypertension?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
High blood pressure - focal neurologic defecit - or papilledema
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

43. How is constipation clinically defined?
Squamocolumnar junction=most common site of cervical cancer
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
HIV and syphilis
Less than 3 stools per week

44. MI - pericardial tamponade - PE - GI bleed - are...
Cervical radiculopathy
True
Associated with hypotension
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

45. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Bence-Jones
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
Coronary artery disease/ angina

46. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Serotypes 16 - 18 - 31 -52 -58
S. aureus- beta hemolytic streptococcus
Rotator cuff tendonitis

47. Why is the pap smear one of the most effective cancer screening tools?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Variability in the time for follicle development during the proliferative phase

48. patients with herpes zoster may experience what symptom before the rash appear?
Polymenorrhea
Pain
Menorrhagia
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

49. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cellulitis
Pancreatitis

50. Oligomenorrhea
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Regular bleeding at intervals of more than 35 days
35 (exception for postmenopausal women who have recently been started on HRT)