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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. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
HIV and syphilis
Coronary artery disease/ angina
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Peptic ulcer disease or gastritis

2. When does troponin rise following myocardial injury or infarction?
Pancreatitis
Possibility of Ischemic colitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

3. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Less than 3 stools per week
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

4. MI - pericardial tamponade - PE - GI bleed - are...
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Associated with hypotension
Slow progression of cervical cancer changes -Availability of effective early treatment
LH surge triggers ovulation

5. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
S. aureus- beta hemolytic streptococcus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Kids: Rotavirus Adults: Norwalk Virus
Albumin; low molecular weight proteins

6. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Subarachnoid hemorrhage
Slow progression of cervical cancer changes -Availability of effective early treatment
Possibility of Ischemic colitis

7. At was quantity does urine dipstick test detect elevated protein?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
100mg; means patient can be trace protein positive and not be detected
Temporal arteritis-biopsy of the temporal artery
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

8. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Medication or chemical esophagitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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.

9. 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
Rotator Cuff problem
Kids: Rotavirus Adults: Norwalk Virus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

10. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Temporal arteritis-biopsy of the temporal artery
Infectious esophagitis
Rotator Cuff tendonitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

11. How does CHF present on X-ray?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV testing -Pos=colposcopy -Neg=repeat pap smear

12. What are the most common viral causes of diarrhea in kids and adults?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Tension headache
Kids: Rotavirus Adults: Norwalk Virus

13. Who should have Xray testing for shoulder pain?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

14. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Irregular bleeding between cycles
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

15. Describe the presentation of angina?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

16. How are fungal infections diagnosed?
Excessive bleeding in amount - duration - or both at irregular intervals
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Cervical radiculopathy
With a KOH wet mount preparation

17. Pneumonia tx: suitable for healthy adults older than 60
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
HPV
S. Aureus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

18. What are the signs of acute sinusitis?
Coronary artery disease/ angina
Fever with frontal or maxillary tenderness
Analgesic headache
Folliculitis

19. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pts with palpitations and dizziness - near syncope - or syncope
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
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

20. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
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
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

21. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Cellulitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

22. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
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
LH surge triggers ovulation

23. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Pleurisy
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
Analgesic headache
Bence-Jones

24. Oligomenorrhea
Non-cardiac causes of palpitations
Fever with frontal or maxillary tenderness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Regular bleeding at intervals of more than 35 days

25. When should a patient get a stress test?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Viral infection of the semicircular apparatus
When the patient has symptoms in association with exercise or who describe chest pain or pressure

26. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

27. What type of imaging is need for chronic sinusitis?
CT
Medication or chemical esophagitis
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

28. History and PE for Pneumonia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Wolff-Parkinson-White syndrome
High blood pressure - focal neurologic defecit - or papilledema

29. Name the diagnosis of heartburn: severe constant mid abdominal pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Echocardiogram
Pancreatitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

30. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
DM - HTN - DVT - seizures - depression - or anxiety
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

31. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Presence of proteinuria on at least two separate ocassion
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Supraspinatus and bicipital tendons

32. What is a markers of CNS vertigo?
Molluscum contagiosum- pox virus
Other brainstem or cranial nerve findings
Anticoag with warfarin to prevent thromboembolism
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

33. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Cholelithiasis
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
Irregular bleeding between cycles
Increase; 200 g/day

34. What are the most common causes for the common cold?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Nonulcer dyspepsia
Non-cardiac causes of palpitations
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

35. What are the three types of lice?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
>150mg per 24hrs
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A 24hr urine protein collection and urine creatinine clearance determination

36. What lab tests are recommended for newly diagnosed hypertensive patients?
Anticoag with warfarin to prevent thromboembolism
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Squamocolumnar junction=most common site of cervical cancer

37. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
ACEi
Bence-Jones
Analgesic headache

38. What does the classic ring worm lesion have?
A central clear area
With a KOH wet mount preparation
Analgesic headache
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.

39. What are the signs of cerebral hemorrhage?
Paroxysmal atrial fibrillation or supraventricular tachycardia
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Acute headache - ataxia - profuse nausea - and vomiting

40. When is a lumbar puncture contraindicated?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

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

42. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
ACEi
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.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

43. What test done in PE measures instability of shoulder?
Generalized Anxiety disorder and panic disorder
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

44. What is the peripheral caUse of vertigo?
Acute headache - ataxia - profuse nausea - and vomiting
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Associated with hypotension

45. 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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

46. What are the 2 psych disorders most commonly associated with palpitations?
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
Lightheadedness - dizziness - syncope
Acute headache - ataxia - profuse nausea - and vomiting
Generalized Anxiety disorder and panic disorder

47. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Coronary artery disease/ angina

48. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
E. Coli O157:H7
Presence of proteinuria on at least two separate ocassion
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

49. What HPV serotypes are most commonly associated with cervical cancer?
Rotator Cuff tendonitis
Serotypes 16 - 18 - 31 -52 -58
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

50. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
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