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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 the difference between a Holter monitor or an event monitor?
CT
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

2. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Upper sternal area burning pain - associated with a productive cough
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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.
CBC

3. When is a lumbar puncture contraindicated?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
CT
Influenza - Rhinovirus - Adenovirus - Parainfluenza

4. What is a markers of CNS vertigo?
Hgb - Electrolytes - and TSH
Squamocolumnar junction=most common site of cervical cancer
Other brainstem or cranial nerve findings
Paroxysmal atrial fibrillation or supraventricular tachycardia

5. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
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.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Kids: Rotavirus Adults: Norwalk Virus
Non-cardiac causes of palpitations

6. Constipation: What are indications for lab testing?
Medication or chemical esophagitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Refractory constipation - a new onset of constipation in an older individual - heme-positive stools - and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

7. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Coag disorders
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

8. Diagnostic Evaluation of Abnoraml vaginal bleeding
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
LH surge triggers ovulation
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

9. 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
Less than 3 stools per week
Warts
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Furucnle

10. Name the skin lesion: erythema - warmth - edema - pain - fever
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cellulitis
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

11. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Rotator cuff tendonitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
HPV
Influenza - Rhinovirus - Adenovirus - Parainfluenza

12. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Furucnle
Scleroderma/polymyositis with secondary gastroesophageal reflux
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

13. What medications can cause heart palpitations?
Associated with hypotension
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Slow progression of cervical cancer changes -Availability of effective early treatment
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

14. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
>150mg per 24hrs
Pleurisy
BB or CCB - catheter ablation of identified bypass tract

15. Why is the pap smear one of the most effective cancer screening tools?
ACEi - ARBS - thiazide diuretics
Cholelithiasis
Slow progression of cervical cancer changes -Availability of effective early treatment
True

16. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Coronary artery disease/ angina
Less than 3 stools per week

17. Shoulder pain with pain radiating to elbow
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Upper sternal area burning pain - associated with a productive cough
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Cervical radiculopathy

18. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
A central clear area
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pancreatitis

19. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Cluster headache
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Acute headache - ataxia - profuse nausea - and vomiting
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

20. name the 4 emergent causes of chest pain
Viral infection of the semicircular apparatus
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
PE - MI - aortic dissection - pneumothorax
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

21. What are the three major risk factors for heart failure?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Hypertension - CAD - valvular heart disease
Irregular bleeding between cycles
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

22. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Presence of proteinuria on at least two separate ocassion
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
>150mg per 24hrs
Cholelithiasis

23. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Coag disorders
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

24. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Streptococci
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
HPV

25. Regular bleeding at intervals of less than 21 days
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
Polymenorrhea
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

26. 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
Peptic ulcer disease or gastritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Coag disorders

27. 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.
S. aureus- beta hemolytic streptococcus
Repeat Pap after infection treated
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

28. What is the Epley maneuver?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Lightheadedness - dizziness - syncope
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.
Furucnle

29. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Variability in the time for follicle development during the proliferative phase
Diuretics -BB -CCB -ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

30. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Analgesic headache
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Chest pain during pneumonia or PE
Refractory constipation - a new onset of constipation in an older individual - heme-positive stools - and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology

31. PE for a patient getting an abnormal vaginal bleeding work up
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Hypertension - CAD - valvular heart disease

32. After treatment of dysplasia - women need Pap smears every...
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

33. Menometrorrhagia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Tension headache
Excessive bleeding in amount - duration - or both at irregular intervals
MSK - pulmonary - GI - or psychological

34. 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)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Colposcopy - Endocervical curettage - and directed cervical biopsy
Analgesic headache

35. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Acute headache - ataxia - profuse nausea - and vomiting
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Other brainstem or cranial nerve findings

36. Why don't ACEi work well for the elderly and African Americans when treating HTN?
>3.5g of protein per 24hrs
These patients are associated with low renin states=less likely to respond to medication
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Loop diuretics (Check serum K+ levels before drug admin)

37. Define proteinuria
A 24hr urine protein collection and urine creatinine clearance determination
>150mg per 24hrs
Bulk forming: Psyllium - Methycellulose - Polycarbophil
HIV and syphilis

38. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Adhesive capsulitis (frozen shoulder): most common in middle age women
Refractory constipation - a new onset of constipation in an older individual - heme-positive stools - and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

39. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Irregular bleeding between cycles
Wolff-Parkinson-White syndrome
Polymenorrhea
Squamocolumnar junction=most common site of cervical cancer

40. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Pts with palpitations and dizziness - near syncope - or syncope
Rotator cuff tendonitis
Lightheadedness - dizziness - syncope

41. What are the signs of cerebral hemorrhage?
Cellulitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Acute headache - ataxia - profuse nausea - and vomiting
Serotypes 16 - 18 - 31 -52 -58

42. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Impetigo
Other brainstem or cranial nerve findings
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

43. Name 4 factors that predispose an individual to develop pneumonia.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Albumin; low molecular weight proteins

44. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
S. aureus- beta hemolytic streptococcus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

45. Discomfort with abducting the arm past 90 degress
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Common problem that resolves spontaneously and is most often seen in children and young adults
Rotator Cuff tendonitis
HPV

46. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Hypertension - CAD - valvular heart disease
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

47. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Rotator Cuff tendonitis

48. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Intermenstrual bleeding
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Loop diuretics (Check serum K+ levels before drug admin)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

49. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
E. Coli O157:H7
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Acute headache - ataxia - profuse nausea - and vomiting

50. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Repeat Pap after infection treated
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)