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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. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

2. What test done in PE measures instability of shoulder?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Loop diuretics (Check serum K+ levels before drug admin)

3. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Subarachnoid hemorrhage
35 (exception for postmenopausal women who have recently been started on HRT)

4. What HPV serotypes are most commonly associated with cervical cancer?
Temporal arteritis-biopsy of the temporal artery
35 (exception for postmenopausal women who have recently been started on HRT)
Serotypes 16 - 18 - 31 -52 -58
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

5. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
>3.5g of protein per 24hrs
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

6. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
CT
HIV and syphilis
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

7. When should invasive eletrophysiologic study should be considered?
These patients are associated with low renin states=less likely to respond to medication
PE - MI - aortic dissection - pneumothorax
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)

8. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Loop diuretics (Check serum K+ levels before drug admin)
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

9. What are the primary glomerular diseases?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

10. What is afterload?
With a KOH wet mount preparation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Analgesic headache
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

11. History for Acute bronchitis
Nonulcer dyspepsia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Generalized Anxiety disorder and panic disorder
Repeat Pap after infection treated

12. What is the goal of CHF treatment? What drugs should be used?
Pain
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Folliculitis
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

13. What is the role of FSH in one's menstrual cycle
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
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
Viral gastroenteritis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

14. What should preconception counseling include?
Pts with palpitations and dizziness - near syncope - or syncope
Tension headache
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
Peptic ulcer disease or gastritis

15. Prenatal visit schedule for low-risk pregnancies
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
BB or CCB - catheter ablation of identified bypass tract
CBC
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Pancreatitis

17. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

18. What are the indiciations for neuroimaging?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
100mg; means patient can be trace protein positive and not be detected

19. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Coag disorders

20. What is the caUse of Meniere disease? What are the cardinal symptoms?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Subarachnoid hemorrhage
Scabies
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

21. What are the features of glomerular nephritis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH

22. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Diuretics -BB -CCB -ACEi

23. What is the caUse of benign positional vertigo?
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.
Pts with palpitations and dizziness - near syncope - or syncope
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.
HIV and syphilis

24. 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.
Possibility of Ischemic colitis
Tension headache
100mg; means patient can be trace protein positive and not be detected
E. Coli O157:H7

25. What are the most common viral causes of diarrhea in kids and adults?
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
Supraspinatus and bicipital tendons
Scabies
Kids: Rotavirus Adults: Norwalk Virus

26. What does the classic ring worm lesion have?
A central clear area
Coag disorders
Temporal arteritis-biopsy of the temporal artery
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

27. What is a markers of CNS vertigo?
Polymenorrhea
Other brainstem or cranial nerve findings
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
When the patient has symptoms in association with exercise or who describe chest pain or pressure

28. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
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
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
Infectious esophagitis
Folliculitis

29. What the consequences of decreased cardiac output?
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
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
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
Excessive bleeding in amount - duration - or both at irregular intervals

30. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
S. Aureus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HPV
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

31. Oligomenorrhea
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
Regular bleeding at intervals of more than 35 days
Polymenorrhea
MSK - pulmonary - GI - or psychological

32. 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)
Polymenorrhea
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

33. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Analgesic headache
Streptococci
RBC casts and old to moderate HTN
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

34. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Intermenstrual bleeding
24 hour halter
A 24hr urine protein collection and urine creatinine clearance determination
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

35. What is the difference between a Holter monitor or an event monitor?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

36. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
Pleurisy
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

37. What are the physical exam signs of CHF?
DM - HTN - DVT - seizures - depression - or anxiety
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
24 hour halter
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

39. Where does the development of abnormal cervical cells begin?
Non-cardiac causes of palpitations
Rotator Cuff problem
Cholelithiasis
Squamocolumnar junction=most common site of cervical cancer

40. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Fever with frontal or maxillary tenderness
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

41. What is the next best step if a patient has two or more positive dipstick tests?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A 24hr urine protein collection and urine creatinine clearance determination
Scleroderma/polymyositis with secondary gastroesophageal reflux
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

42. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
PE - MI - aortic dissection - pneumothorax
100mg; means patient can be trace protein positive and not be detected
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
ACEi

43. Isolated - extra pounding beats
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.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
PVC or Premature atrial contraction (PAC)
Squamocolumnar junction=most common site of cervical cancer

44. Describe the presentation of myocardial 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
Repeat Pap after infection treated
Cellulitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

45. What is the preload?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
High blood pressure - focal neurologic defecit - or papilledema
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

46. 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.
Pleurisy
Supraspinatus and bicipital tendons
Giardia
Cluster headache

47. Complete the sentence: pericarditis can cause frictional rub and......
Non-cardiac causes of palpitations
Acute headache - ataxia - profuse nausea - and vomiting
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

48. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Variability in the time for follicle development during the proliferative phase
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
Less than 80 ml of blood

49. What treatments are the cornerstone for treating cases of functional constipation?
Coronary artery disease/ angina
Increase; 200 g/day
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Increasing fluid (8 - 8oz glasses of water/day) -fiber

50. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Slow progression of cervical cancer changes -Availability of effective early treatment
HPV
Possibility of Ischemic colitis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase