Test your basic knowledge |

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. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
High blood pressure - focal neurologic defecit - or papilledema

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Scleroderma/polymyositis with secondary gastroesophageal reflux
24 hour halter
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

3. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Nonulcer dyspepsia
Paroxysmal atrial fibrillation or supraventricular tachycardia
Rotator Cuff problem
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

4. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Upper sternal area burning pain - associated with a productive cough
When the patient has symptoms in association with exercise or who describe chest pain or pressure

5. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Peptic ulcer disease or gastritis
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
Possibility of Ischemic colitis

6. What is benign transient proteinuria?
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.
Common problem that resolves spontaneously and is most often seen in children and young adults
True
Candida albicans

7. Name some medications that can cause proteinuria
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Generalized Anxiety disorder and panic disorder
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

8. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Albumin; low molecular weight proteins
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.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

9. 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
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
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
Scleroderma/polymyositis with secondary gastroesophageal reflux

10. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Pancreatitis
Excessive bleeding in amount - duration - or both at irregular intervals
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

11. Irregular cycles with excessive flow - duration - or both
Chest pain during pneumonia or PE
Menorrhagia
HIV and syphilis
Peptic ulcer disease or gastritis

12. 1+ protein level on urine dipstick usually represents how much protein in the urine?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Influenza - Rhinovirus - Adenovirus - Parainfluenza
>150mg per 24hrs

13. What does orthostatic positional changes that bring on dizziness suggest?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Dehydration - anemia - cardiac causes
Candida albicans

14. What are the signs of malignant hypertension?
Irregular bleeding between cycles
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Tension headache
High blood pressure - focal neurologic defecit - or papilledema

15. What does treatment for migrans include?
Albumin; low molecular weight proteins
HPV
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

16. Discomfort with abducting the arm past 90 degress
Colposcopy - Endocervical curettage - and directed cervical biopsy
Rotator Cuff tendonitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

17. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
>150mg per 24hrs
Molluscum contagiosum- pox virus
Temporal arteritis-biopsy of the temporal artery

18. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

19. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
EGD
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Menorrhagia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

20. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
GERD

21. What are the two common clinical presentations of acute diarrhea?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Menorrhagia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

22. 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.
Repeat Pap after infection treated
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Supraspinatus and bicipital tendons

23. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Rotator Cuff problem
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
Rotator cuff tendonitis

24. When does troponin rise following myocardial injury or infarction?
Increase; 200 g/day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

25. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Rotator cuff tendonitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

26. Oligomenorrhea
Pain
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Regular bleeding at intervals of more than 35 days
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

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
Pancreatitis
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
S. Aureus
E. Coli O157:H7

28. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Rotator cuff tendonitis
Medication or chemical esophagitis
RBC casts and old to moderate HTN

29. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
35 (exception for postmenopausal women who have recently been started on HRT)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

30. Initial treatment for Rhinosinusitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Less than 80 ml of blood

31. 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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Scabies

32. Difference between Pneumonia and Bronchitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Tension headache
>3.5g of protein per 24hrs
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

33. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
CT
Irregular bleeding between cycles

34. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Scabies
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
Bence-Jones
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

35. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

36. 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)
35 (exception for postmenopausal women who have recently been started on HRT)
Repeat Pap after infection treated
Variability in the time for follicle development during the proliferative phase

37. Treatment for supraventricular tachycardias
Pain
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
BB or CCB - catheter ablation of identified bypass tract

38. What are the most common viral causes of diarrhea in kids and adults?
100mg; means patient can be trace protein positive and not be detected
Scleroderma/polymyositis with secondary gastroesophageal reflux
Scabies
Kids: Rotavirus Adults: Norwalk Virus

39. What is a markers of CNS vertigo?
Associated with hypotension
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Other brainstem or cranial nerve findings
PVC or Premature atrial contraction (PAC)

40. Describe the presentation of pneumonia
GERD
HIV and syphilis
Slow progression of cervical cancer changes -Availability of effective early treatment
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

41. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Scabies
High blood pressure - focal neurologic defecit - or papilledema
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cholelithiasis

42. What are the most common causes for the common cold?
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.

43. SE Of Beta blockers?
Staphylococcal scalded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

44. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
>150mg per 24hrs
Coag disorders

45. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
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
Increase; 200 g/day
Cellulitis

46. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pts with palpitations and dizziness - near syncope - or syncope
Anticoag with warfarin to prevent thromboembolism

47. Describe the history and PE of patient presenting with common cold
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
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
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

48. How can GERD (or esophageal motility disorders) lead to chest pain?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

49. Cycle length variabilty is primarily due to what?
Rotator Cuff tendonitis
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Variability in the time for follicle development during the proliferative phase

50. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Wolff-Parkinson-White syndrome
24 hour halter