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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. Shoulder pain with pain radiating to elbow
Variability in the time for follicle development during the proliferative phase
Cervical radiculopathy
Rotator Cuff problem
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

2. What are signs of pulmonary congestion?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Acute headache - ataxia - profuse nausea - and vomiting
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

3. How is constipation clinically defined?
Less than 3 stools per week
Supraspinatus and bicipital tendons
35 (exception for postmenopausal women who have recently been started on HRT)
Viral infection of the semicircular apparatus

4. 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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A central clear area
EGD

5. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Serotypes 16 - 18 - 31 -52 -58
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Paroxysmal atrial fibrillation or supraventricular tachycardia
RBC casts and old to moderate HTN

6. What are the signs of malignant hypertension?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
High blood pressure - focal neurologic defecit - or papilledema

7. 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
EGD
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

8. What are the secondly causes of glomerular disease?
Adhesive capsulitis (frozen shoulder): most common in middle age women
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
EGD

9. What lab tests are recommended for newly diagnosed hypertensive patients?
LH surge triggers ovulation
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cholelithiasis
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

10. What is the goal of CHF treatment? What drugs should be used?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Infectious esophagitis
Pain
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

11. Prenatal visit schedule for low-risk pregnancies
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Coag disorders

12. What occurs after ovulation
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Staphylococcal scalded skin syndrome
Dehydration - anemia - cardiac causes

13. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
These patients are associated with low renin states=less likely to respond to medication
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

14. SE Of Beta blockers?
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
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

15. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
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.
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

16. What are the symptoms of palpitations?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Pain
Impetigo
Lightheadedness - dizziness - syncope

17. 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.
Scabies
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Colposcopy - Endocervical curettage - and directed cervical biopsy
Tension headache

18. What should preconception counseling include?
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
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
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
Possibility of Ischemic colitis

19. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
DM - HTN - DVT - seizures - depression - or anxiety
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 is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Less than 80 ml of blood
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Temporal arteritis-biopsy of the temporal artery

21. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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.
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

22. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Streptococci
Higher filling presure - pulmonary congestion - and decreasd cardiac return

23. Why is the pap smear one of the most effective cancer screening tools?
Tension headache
DM - HTN - DVT - seizures - depression - or anxiety
E. Coli O157:H7
Slow progression of cervical cancer changes -Availability of effective early treatment

24. Diarrhea from custard filled pastries
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
S. Aureus
>3.5g of protein per 24hrs
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

25. Describes what occurs during squamous metaplasia of the cervix.
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
Upper sternal area burning pain - associated with a productive cough
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

26. How does CHF present on X-ray?
Irregular bleeding between cycles
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

27. How does systolic vs. diastolic heart failure present on the echocardiogram?
Warts
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

28. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Diuretics -BB -CCB -ACEi

29. Vaccines that should be updated before planned pregnancy
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Peptic ulcer disease or gastritis
Supraspinatus and bicipital tendons
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

30. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Non-cardiac causes of palpitations
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

31. What is benign transient proteinuria?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults
Pleurisy

32. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
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

33. What are the primary glomerular diseases?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
ACEi - ARBS - thiazide diuretics
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

34. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
>150mg per 24hrs
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

35. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
LH surge triggers ovulation
CBC
Slow progression of cervical cancer changes -Availability of effective early treatment

36. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Less abrupt onset and cessation of palpitations
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
Rotator Cuff problem
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

37. What does treatment for migrans include?
Repeat Pap after infection treated
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
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

38. Pneumonia tx: suitable for healthy adults less than 60
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

39. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Viral gastroenteritis
Peptic ulcer disease or gastritis

40. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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.
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Staphylococcal scalded skin syndrome
Bence-Jones

41. Irregular cycles with excessive flow - duration - or both
Lightheadedness - dizziness - syncope
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
>150mg per 24hrs
Menorrhagia

42. How are fungal infections diagnosed?
Polymenorrhea
MSK - pulmonary - GI - or psychological
Serotypes 16 - 18 - 31 -52 -58
With a KOH wet mount preparation

43. What is a markers of CNS vertigo?
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
100mg; means patient can be trace protein positive and not be detected

44. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Viral infection of the semicircular apparatus
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

45. What is the role of FSH in one's menstrual cycle
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cluster headache
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Generalized Anxiety disorder and panic disorder

46. What are the signs of acute sinusitis?
Analgesic headache
Fever with frontal or maxillary tenderness
Medication or chemical esophagitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

47. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
LH surge triggers ovulation
ACEi

48. 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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Higher filling presure - pulmonary congestion - and decreasd cardiac return

49. What drugs do you use to treat H.pylori + PUD?
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.
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Varicella virus

50. PE for a patient getting an abnormal vaginal bleeding work up
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
24 hour halter
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)