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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. Things that need to be included in history of shoulder pain
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pleurisy
HIV and syphilis

2. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
High blood pressure - focal neurologic defecit - or papilledema
Wolff-Parkinson-White syndrome
Upper sternal area burning pain - associated with a productive cough
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

3. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
24 hour halter
Intermenstrual bleeding
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

4. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
ACEi
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Medication or chemical esophagitis

5. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Varicella virus
S. Aureus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Diuretics -BB -CCB -ACEi

6. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

7. 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
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
Molluscum contagiosum- pox virus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

8. Cycle length variabilty is primarily due to what?
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.
Variability in the time for follicle development during the proliferative phase
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

9. 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
Scabies
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
EGD

10. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
HPV
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
Loop diuretics (Check serum K+ levels before drug admin)
Cluster headache

11. 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)
Cholelithiasis
Coag disorders
Other brainstem or cranial nerve findings

12. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Coag disorders
Conization (or LEEP): removeal of a portion of the cervix and thus patients are at risk of preterm labor - incompetent cervix - or cervical stenosis in future pregnancies

13. What HPV serotypes are most commonly associated with cervical cancer?
EGD
Temporal arteritis-biopsy of the temporal artery
Serotypes 16 - 18 - 31 -52 -58
Hypertension - CAD - valvular heart disease

14. What are the symptoms 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
Lightheadedness - dizziness - syncope
Possibility of Ischemic colitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

15. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Variability in the time for follicle development during the proliferative phase
Kids: Rotavirus Adults: Norwalk Virus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Echocardiogram

16. When does troponin rise following myocardial injury or infarction?
ACEi
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

17. How do you define persistent protein uria?
Slow progression of cervical cancer changes -Availability of effective early treatment
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
High blood pressure - focal neurologic defecit - or papilledema
Presence of proteinuria on at least two separate ocassion

18. What are the physical exam signs of CHF?
Associated with hypotension
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
Less abrupt onset and cessation of palpitations
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

19. SE Of Beta blockers?
Presence of proteinuria on at least two separate ocassion
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

20. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Analgesic headache
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Tension headache
HPV

21. Initial treatment for Rhinosinusitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

22. How to NSAIDs contribute to gastritis and ulcer formation?
100mg; means patient can be trace protein positive and not be detected
Polymenorrhea
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.
RBC casts and old to moderate HTN

23. What test done in PE measures instability of shoulder?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
With a KOH wet mount preparation
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

24. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Possibility of Ischemic colitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

25. When should invasive eletrophysiologic study should be considered?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

26. 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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PVC or Premature atrial contraction (PAC)
Rotator Cuff tendonitis

27. What drugs do you use to treat H.pylori + PUD?
Chest pain during pneumonia or PE
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
BB or CCB - catheter ablation of identified bypass tract
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

28. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

29. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Diuretics -BB -CCB -ACEi

30. What are the features of glomerular nephritis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Bence-Jones
RBC casts and old to moderate HTN

31. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
LH surge triggers ovulation
Rotator Cuff tendonitis

32. What are the 2 psych disorders most commonly associated with palpitations?
Non-cardiac causes of palpitations
Generalized Anxiety disorder and panic disorder
Hypertension - CAD - valvular heart disease
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

33. Difference between Pneumonia and Bronchitis
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
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
Echocardiogram
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

34. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
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
MSK - pulmonary - GI - or psychological
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

35. What is considered normal blood loss during a menstrual cycle?
With a KOH wet mount preparation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Less than 80 ml of blood

36. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Streptococci
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

37. What is afterload?
Rotator cuff tendonitis
Dehydration - anemia - cardiac causes
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Viral infection of the semicircular apparatus

38. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Presence of proteinuria on at least two separate ocassion
CBC
Infectious esophagitis

39. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cervical radiculopathy
PE - MI - aortic dissection - pneumothorax

40. Discomfort with abducting the arm past 90 degress
Adhesive capsulitis (frozen shoulder): most common in middle age women
Rotator Cuff tendonitis
Upper sternal area burning pain - associated with a productive cough
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

41. What are the three types of lice?
S. aureus- beta hemolytic streptococcus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

42. What are the indiciations for neuroimaging?
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
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
CT
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

43. Treatment for supraventricular tachycardias
>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
BB or CCB - catheter ablation of identified bypass tract
Scabies

44. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Peptic ulcer disease or gastritis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
High blood pressure - focal neurologic defecit - or papilledema
S. aureus- beta hemolytic streptococcus

45. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cluster headache
Pleurisy

46. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
PVC or Premature atrial contraction (PAC)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Upper sternal area burning pain - associated with a productive cough

47. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Squamocolumnar junction=most common site of cervical cancer
Echocardiogram
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

48. What are the three major risk factors for heart failure?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Hypertension - CAD - valvular heart disease
Increase; 200 g/day
Varicella virus

49. What does the classic ring worm lesion have?
A central clear area
HPV
CBC
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

50. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Regular bleeding at intervals of more than 35 days
Other brainstem or cranial nerve findings
Giardia