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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. Metrorrhagia
Analgesic headache
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Irregular bleeding between cycles
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

2. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Serotypes 16 - 18 - 31 -52 -58
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

3. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Non-cardiac causes of palpitations
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

4. What is the preload?
Echocardiogram
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Chest pain during pneumonia or PE

5. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
ACEi - ARBS - thiazide diuretics
Pain
Less abrupt onset and cessation of palpitations

6. 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
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
Chest pain during pneumonia or PE
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cluster headache

7. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Generalized Anxiety disorder and panic disorder
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hypertension - CAD - valvular heart disease

8. Describe the presentation of pericardial pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

9. What is the goal of CHF treatment? What drugs should be used?
High blood pressure - focal neurologic defecit - or papilledema
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
E. Coli O157:H7

10. What drugs do you use to treat H.pylori + PUD?
Dehydration - anemia - cardiac causes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
35 (exception for postmenopausal women who have recently been started on HRT)
Cholelithiasis

11. What are the signs of acute sinusitis?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Irregular bleeding between cycles
Fever with frontal or maxillary tenderness
ACEi

12. SE Of Beta blockers?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

13. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
S. Aureus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

14. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Anticoag with warfarin to prevent thromboembolism
ACEi
Diuretics -BB -CCB -ACEi

15. What are the symptoms of palpitations?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
True
E. Coli O157:H7
Lightheadedness - dizziness - syncope

16. How are fungal infections diagnosed?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
With a KOH wet mount preparation
DM - HTN - DVT - seizures - depression - or anxiety
Common problem that resolves spontaneously and is most often seen in children and young adults

17. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Possibility of Ischemic colitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

18. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Dehydration - anemia - cardiac causes
24 hour halter
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

19. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Albumin; low molecular weight proteins
Loop diuretics (Check serum K+ levels before drug admin)
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

20. Name the skin lesion: honey colored crusts
GERD
Impetigo
Irregular bleeding between cycles
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

21. After treatment of dysplasia - women need Pap smears every...
Cluster headache
Analgesic headache
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

22. What type of imaging is need for chronic sinusitis?
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
CT
Viral infection of the semicircular apparatus
24 hour halter

23. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
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
>3.5g of protein per 24hrs
Pancreatitis

24. Define proteinuria
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
>150mg per 24hrs
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Hgb - Electrolytes - and TSH

25. 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 abrupt onset and cessation of palpitations
Warts
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
Repeat Pap after infection treated

26. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

27. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Higher filling presure - pulmonary congestion - and decreasd cardiac return

28. Where does the development of abnormal cervical cells begin?
Impetigo
Squamocolumnar junction=most common site of cervical cancer
Warts
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

29. What is the mechanism of action for stimulant agents in treating constipation?
Menorrhagia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

30. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Varicella virus
ACEi - ARBS - thiazide diuretics
Wolff-Parkinson-White syndrome
Impetigo

31. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
ACEi
S. Aureus
Fever with frontal or maxillary tenderness
Streptococci

32. Diarrhea from custard filled pastries
S. Aureus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

33. At was quantity does urine dipstick test detect elevated protein?
Cervical radiculopathy
100mg; means patient can be trace protein positive and not be detected
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Common problem that resolves spontaneously and is most often seen in children and young adults

34. Define the patient population typically affected by orthostatic or postural proteinuria
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Tension headache

35. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

36. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Rotator cuff tendonitis
Cholelithiasis
These patients are associated with low renin states=less likely to respond to medication
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

37. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Nonulcer dyspepsia
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

38. Natural history of cervical cancer
Furucnle
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

39. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cholelithiasis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

40. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Tension headache
Furucnle
Adhesive capsulitis (frozen shoulder): most common in middle age women
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. Describe the presentation of angina?
Cellulitis
High blood pressure - focal neurologic defecit - or papilledema
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

42. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Kids: Rotavirus Adults: Norwalk Virus
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
HIV and syphilis

43. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Other brainstem or cranial nerve findings
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

44. What are the physical exam signs of CHF?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Warts
Rotator Cuff tendonitis

45. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
True
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Echocardiogram
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.

46. 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
CBC
Serotypes 16 - 18 - 31 -52 -58
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Molluscum contagiosum- pox virus

47. Tx of chronic or intermittent afibs
CBC
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Anticoag with warfarin to prevent thromboembolism
100mg; means patient can be trace protein positive and not be detected

48. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

49. PE for a patient getting an abnormal vaginal bleeding work up
Regular bleeding at intervals of more than 35 days
S. Aureus
Repeat Pap after infection treated
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

50. What diagnosis does the 'worse headache of my life' suggest?
>3.5g of protein per 24hrs
Acute headache - ataxia - profuse nausea - and vomiting
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Subarachnoid hemorrhage