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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. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

2. When should invasive eletrophysiologic study should be considered?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

3. Natural history of cervical cancer
Chest pain during pneumonia or PE
Viral infection of the semicircular apparatus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

4. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Upper sternal area burning pain - associated with a productive cough
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

5. How does CHF present on X-ray?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
PVC or Premature atrial contraction (PAC)

6. 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
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
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

7. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
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
CBC
Viral infection of the semicircular apparatus
Furucnle

8. How do you define persistent protein uria?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Presence of proteinuria on at least two separate ocassion
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

9. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Staphylococcal scalded skin syndrome
Echocardiogram
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Scleroderma/polymyositis with secondary gastroesophageal reflux

10. What is the standard tool used for diagnosis of GERD?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Polymenorrhea
BB or CCB - catheter ablation of identified bypass tract
EGD

11. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
CBC
Infectious esophagitis

12. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Increase; 200 g/day
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

13. Describes what occurs during squamous metaplasia of the cervix.
Irregular bleeding between cycles
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Adhesive capsulitis (frozen shoulder): most common in middle age women
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

14. What are the symptoms of palpitations?
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Lightheadedness - dizziness - syncope
Coag disorders

15. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

16. Describe the presentation of myocardial pain?
Kids: Rotavirus Adults: Norwalk Virus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cellulitis
Possibility of Ischemic colitis

17. Name some medications that can cause proteinuria
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
Loop diuretics (Check serum K+ levels before drug admin)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Less abrupt onset and cessation of palpitations

18. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Upper sternal area burning pain - associated with a productive cough
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

19. Chronic pain and shoulder stiffness with limited motion
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
Supraspinatus and bicipital tendons
Adhesive capsulitis (frozen shoulder): most common in middle age women

20. What medications can cause heart palpitations?
These patients are associated with low renin states=less likely to respond to medication
Varicella virus
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

21. What are the primary glomerular diseases?
Folliculitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Rotator Cuff problem
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

22. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Intermenstrual bleeding
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

23. What is considered normal blood loss during a menstrual cycle?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Streptococci
Less than 80 ml of blood
When the patient has symptoms in association with exercise or who describe chest pain or pressure

24. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Regular bleeding at intervals of more than 35 days
Slow progression of cervical cancer changes -Availability of effective early treatment

25. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
RBC casts and old to moderate HTN
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

26. Pneumonia tx: suitable for healthy adults less than 60
With a KOH wet mount preparation
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

27. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bulk forming: Psyllium - Methycellulose - Polycarbophil
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

28. Cycle length variabilty is primarily due to what?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Scabies
Variability in the time for follicle development during the proliferative phase
Higher filling presure - pulmonary congestion - and decreasd cardiac return

29. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
EGD
DM - HTN - DVT - seizures - depression - or anxiety

30. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Peptic ulcer disease or gastritis
Wolff-Parkinson-White syndrome
>150mg per 24hrs

31. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
With a KOH wet mount preparation
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.
These patients are associated with low renin states=less likely to respond to medication

32. What are the common causes for laryngitis?
Pts with palpitations and dizziness - near syncope - or syncope
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Colposcopy - Endocervical curettage - and directed cervical biopsy

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Giardia
EGD
Diuretics -BB -CCB -ACEi
35 (exception for postmenopausal women who have recently been started on HRT)

34. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cellulitis
Anticoag with warfarin to prevent thromboembolism
Cholelithiasis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

35. Predictors of cardiac etiology
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
BB or CCB - catheter ablation of identified bypass tract

36. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

37. Define nephrotic range proteinuria
Pts with palpitations and dizziness - near syncope - or syncope
>3.5g of protein per 24hrs
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Irregular bleeding between cycles
Medication or chemical esophagitis
Coronary artery disease/ angina
Possibility of Ischemic colitis

39. What the consequences of decreased cardiac output?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
These patients are associated with low renin states=less likely to respond to medication
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

40. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Rotator cuff tendonitis
Less abrupt onset and cessation of palpitations
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

41. What are the features of nephrotic syndrome?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Coag disorders

42. Regular bleeding at intervals of less than 21 days
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
>3.5g of protein per 24hrs
Polymenorrhea
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

43. What is the goal of CHF treatment? What drugs should be used?
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
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
Presence of proteinuria on at least two separate ocassion
HIV and syphilis

44. Tx of chronic or intermittent afibs
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Anticoag with warfarin to prevent thromboembolism
Molluscum contagiosum- pox virus

45. HIgh risk pregnant patients should be evaluated for ____ and ____
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.
LH surge triggers ovulation
Hgb - Electrolytes - and TSH
HIV and syphilis

46. 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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Warts
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Paroxysmal atrial fibrillation or supraventricular tachycardia

47. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
HIV and syphilis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
A 24hr urine protein collection and urine creatinine clearance determination
Scleroderma/polymyositis with secondary gastroesophageal reflux

48. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Possibility of Ischemic colitis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

49. Four muscles of rotator cuff
RBC casts and old to moderate HTN
Regular bleeding at intervals of more than 35 days
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
PVC or Premature atrial contraction (PAC)

50. What is afterload?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse