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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. Name the skin lesion: pustule in association with a hair follice
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
Polymenorrhea
Folliculitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

2. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Lightheadedness - dizziness - syncope
Associated with hypotension
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

3. Diagnostic Evaluation of Abnoraml vaginal bleeding
Pts with palpitations and dizziness - near syncope - or syncope
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

4. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
24 hour halter
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

5. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pts with palpitations and dizziness - near syncope - or syncope
Adhesive capsulitis (frozen shoulder): most common in middle age women
Squamocolumnar junction=most common site of cervical cancer

6. Predictors of cardiac etiology
Rotator Cuff problem
Fever with frontal or maxillary tenderness
Coag disorders
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

7. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Regular bleeding at intervals of more than 35 days

8. After treatment of dysplasia - women need Pap smears every...
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

9. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Paroxysmal atrial fibrillation or supraventricular tachycardia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
LH surge triggers ovulation

10. What should be considered in younger patients with menorrhagia
Rotator cuff tendonitis
Coag disorders
When the patient has symptoms in association with exercise or who describe chest pain or pressure
PE - MI - aortic dissection - pneumothorax

11. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Rotator Cuff problem
Scleroderma/polymyositis with secondary gastroesophageal reflux
Common problem that resolves spontaneously and is most often seen in children and young adults

12. What is the next best step if a patient has two or more positive dipstick tests?
MSK - pulmonary - GI - or psychological
A 24hr urine protein collection and urine creatinine clearance determination
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
Candida albicans

13. Chronic pain and shoulder stiffness with limited motion
Candida albicans
Pts with palpitations and dizziness - near syncope - or syncope
Adhesive capsulitis (frozen shoulder): most common in middle age women
When the patient has symptoms in association with exercise or who describe chest pain or pressure

14. Name the diagnosis of heartburn: regurgitation - dysphagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
Upper sternal area burning pain - associated with a productive cough
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
GERD

15. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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.
Diuretics -BB -CCB -ACEi
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

16. What are the features of glomerular nephritis
24 hour halter
RBC casts and old to moderate HTN
Dehydration - anemia - cardiac causes
Lightheadedness - dizziness - syncope

17. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Associated with hypotension
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increase; 200 g/day
HPV

18. What are signs of pulmonary congestion?
Intermenstrual bleeding
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

19. What are the consequences of diastolic dysfunction?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Intermenstrual bleeding
Higher filling presure - pulmonary congestion - and decreasd cardiac return

20. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Analgesic headache
Infectious esophagitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
HPV

21. Initial treatment for Rhinosinusitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Molluscum contagiosum- pox virus
>3.5g of protein per 24hrs
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

22. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Scleroderma/polymyositis with secondary gastroesophageal reflux
Albumin; low molecular weight proteins
Streptococci
Supraspinatus and bicipital tendons

23. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Molluscum contagiosum- pox virus
Candida albicans
Nonulcer dyspepsia
Temporal arteritis-biopsy of the temporal artery

24. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Candida albicans
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Temporal arteritis-biopsy of the temporal artery
Hgb - Electrolytes - and TSH

25. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Folliculitis
Giardia
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

26. Pneumonia tx: suitable for healthy adults less than 60
Subarachnoid hemorrhage
Cervical radiculopathy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

27. What is the role of FSH in one's menstrual cycle
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

28. Menometrorrhagia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Excessive bleeding in amount - duration - or both at irregular intervals
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

29. What is the difference between a Holter monitor or an event monitor?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
24 hour halter

30. What is the Barany maneuver?
Pain
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

31. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
ACEi - ARBS - thiazide diuretics
Adhesive capsulitis (frozen shoulder): most common in middle age women
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

32. What are the 2 psych disorders most commonly associated with 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
GERD
Presence of proteinuria on at least two separate ocassion
Generalized Anxiety disorder and panic disorder

33. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Cellulitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Cluster headache
Peptic ulcer disease or gastritis

34. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Furucnle
Bence-Jones
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

35. What does orthostatic positional changes that bring on dizziness suggest?
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
ACEi - ARBS - thiazide diuretics
Dehydration - anemia - cardiac causes

36. What should preconception counseling include?
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.
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
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
Pts with palpitations and dizziness - near syncope - or syncope

37. What does the classic ring worm lesion have?
RBC casts and old to moderate HTN
Less than 80 ml of blood
A central clear area
Chest pain during pneumonia or PE

38. Treatment for supraventricular tachycardias
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
BB or CCB - catheter ablation of identified bypass tract
Hgb - Electrolytes - and TSH
24 hour halter

39. Define nephrotic range proteinuria
Diuretics -BB -CCB -ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
>3.5g of protein per 24hrs
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

40. 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.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Tension headache
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

41. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
ACEi - ARBS - thiazide diuretics
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Irregular bleeding between cycles

42. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Cellulitis
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HIV and syphilis

43. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
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.
Increasing fluid (8 - 8oz glasses of water/day) -fiber

44. Describe the presentation of pneumonia
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
Rotator Cuff problem
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Variability in the time for follicle development during the proliferative phase

45. When should invasive eletrophysiologic study should be considered?
Diuretics -BB -CCB -ACEi
Scabies
With a KOH wet mount preparation
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

46. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
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
Increase; 200 g/day
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

47. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Medication or chemical esophagitis
Echocardiogram
CT
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

48. What are the three types of lice?
100mg; means patient can be trace protein positive and not be detected
ACEi - ARBS - thiazide diuretics
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

49. What is benign transient proteinuria?
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
Temporal arteritis-biopsy of the temporal artery
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

50. Isolated - extra pounding beats
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
PVC or Premature atrial contraction (PAC)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Colposcopy - Endocervical curettage - and directed cervical biopsy