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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. Natural history of cervical cancer
Giardia
Associated with hypotension
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
35 (exception for postmenopausal women who have recently been started on HRT)

2. Name the skin lesion: erythema - warmth - edema - pain - fever
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
PVC or Premature atrial contraction (PAC)
Cellulitis
Tension headache

3. 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
Warts
PVC or Premature atrial contraction (PAC)
BB or CCB - catheter ablation of identified bypass tract
Repeat Pap after infection treated

4. How do you know if heart palpitations are due to stimulant or medication use?
Anticoag with warfarin to prevent thromboembolism
Acute headache - ataxia - profuse nausea - and vomiting
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Less abrupt onset and cessation of palpitations

5. What are signs of pulmonary congestion?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Pleurisy

6. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Hypertension - CAD - valvular heart disease
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Giardia
Varicella virus

7. What is an acoustic neuroma?
Loop diuretics (Check serum K+ levels before drug admin)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral gastroenteritis

8. Name the diagnosis of heartburn: severe constant mid abdominal pain
With a KOH wet mount preparation
S. aureus- beta hemolytic streptococcus
Pancreatitis
Molluscum contagiosum- pox virus

9. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV

10. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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.
Generalized Anxiety disorder and panic disorder
Analgesic headache

11. name the 4 emergent causes of chest pain
Coronary artery disease/ angina
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
PE - MI - aortic dissection - pneumothorax
RBC casts and old to moderate HTN

12. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
35 (exception for postmenopausal women who have recently been started on HRT)
Molluscum contagiosum- pox virus
Less than 3 stools per week
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

13. How do you define persistent protein uria?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
RBC casts and old to moderate HTN
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Presence of proteinuria on at least two separate ocassion

14. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Supraspinatus and bicipital tendons
Possibility of Ischemic colitis
Loop diuretics (Check serum K+ levels before drug admin)
S. aureus- beta hemolytic streptococcus

15. What should be considered in younger patients with menorrhagia
Coag disorders
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Polymenorrhea

16. Four muscles of rotator cuff
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
GERD
Associated with hypotension
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

17. When should a patient get a stress test?
Less than 3 stools per week
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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.
Cholelithiasis

18. What does the classic ring worm lesion have?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
A central clear area
With a KOH wet mount preparation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

19. Name types of laxatives
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Diuretics -BB -CCB -ACEi
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

20. Why don't ACEi work well for the elderly and African Americans when treating HTN?
35 (exception for postmenopausal women who have recently been started on HRT)
Impetigo
Viral gastroenteritis
These patients are associated with low renin states=less likely to respond to medication

21. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
100mg; means patient can be trace protein positive and not be detected
Presence of proteinuria on at least two separate ocassion
Viral infection of the semicircular apparatus

22. Regular bleeding at intervals of less than 21 days
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Polymenorrhea
Chest pain during pneumonia or PE

23. 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
Polymenorrhea
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

24. What lab tests are recommended for newly diagnosed hypertensive patients?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
100mg; means patient can be trace protein positive and not be detected

25. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Colposcopy - Endocervical curettage - and directed cervical biopsy
Non-cardiac causes of palpitations
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

26. Describe the history and PE of patient presenting with common cold
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
Hypertension - CAD - valvular heart disease
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

27. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Giardia
E. Coli O157:H7
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

28. What is the role of FSH in one's menstrual cycle
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

29. What are the signs of acute sinusitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Fever with frontal or maxillary tenderness
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
With a KOH wet mount preparation

30. Cycle length variabilty is primarily due to what?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Temporal arteritis-biopsy of the temporal artery
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Variability in the time for follicle development during the proliferative phase

31. What is the preload?
Pts with palpitations and dizziness - near syncope - or syncope
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

32. What is benign transient proteinuria?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Common problem that resolves spontaneously and is most often seen in children and young adults
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
RBC casts and old to moderate HTN

33. 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
DM - HTN - DVT - seizures - depression - or anxiety
Cervical radiculopathy
Menorrhagia

34. Diarrhea from custard filled pastries
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
EGD
S. Aureus
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.

35. What type of imaging is need for chronic sinusitis?
Giardia
CT
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
Viral infection of the semicircular apparatus

36. What is the mechanism of action for stimulant agents in treating constipation?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Variability in the time for follicle development during the proliferative phase
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

37. Define proteinuria
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
>150mg per 24hrs
Associated with hypotension

38. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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
PE - MI - aortic dissection - pneumothorax
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
DM - HTN - DVT - seizures - depression - or anxiety

39. What test done in PE measures instability of shoulder?
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
CBC
Rotator Cuff problem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

40. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Diuretics -BB -CCB -ACEi

41. Shoulder pain with pain radiating to elbow
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
Cervical radiculopathy
Impetigo
Common problem that resolves spontaneously and is most often seen in children and young adults

42. Define nephrotic range proteinuria
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
>3.5g of protein per 24hrs
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

43. Metrorrhagia
Irregular bleeding between cycles
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

44. What are the signs of cerebral hemorrhage?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
These patients are associated with low renin states=less likely to respond to medication
Acute headache - ataxia - profuse nausea - and vomiting
Increasing fluid (8 - 8oz glasses of water/day) -fiber

45. Oligomenorrhea
Rotator Cuff tendonitis
Supraspinatus and bicipital tendons
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
Regular bleeding at intervals of more than 35 days

46. What are the 2 psych disorders most commonly associated with palpitations?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Generalized Anxiety disorder and panic disorder
Cholelithiasis

47. PE for a patient getting an abnormal vaginal bleeding work up
Anticoag with warfarin to prevent thromboembolism
These patients are associated with low renin states=less likely to respond to medication
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

48. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Possibility of Ischemic colitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Scabies
Diuretics -BB -CCB -ACEi

49. HIgh risk pregnant patients should be evaluated for ____ and ____
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
HIV and syphilis
Cholelithiasis

50. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Intermenstrual bleeding
Colposcopy - Endocervical curettage - and directed cervical biopsy
Influenza - Rhinovirus - Adenovirus - Parainfluenza