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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?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Subarachnoid hemorrhage
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
Serotypes 16 - 18 - 31 -52 -58

2. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral infection of the semicircular apparatus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Echocardiogram

3. SE Of Beta blockers?
Excessive bleeding in amount - duration - or both at irregular intervals
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Cholelithiasis
Variability in the time for follicle development during the proliferative phase

4. Describe the presentation of pericardial pain
Other brainstem or cranial nerve findings
Varicella virus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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.

5. Why is the pap smear one of the most effective cancer screening tools?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Variability in the time for follicle development during the proliferative phase
Slow progression of cervical cancer changes -Availability of effective early treatment
Adhesive capsulitis (frozen shoulder): most common in middle age women

6. Diarrhea from custard filled pastries
S. Aureus
S. aureus- beta hemolytic streptococcus
Cholelithiasis
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

7. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Scabies
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Medication or chemical esophagitis
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

8. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Bence-Jones
Chest pain during pneumonia or PE
Coag disorders

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

10. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Warts
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

11. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Echocardiogram
Coag disorders
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
35 (exception for postmenopausal women who have recently been started on HRT)

12. Define the patient population typically affected by orthostatic or postural proteinuria
Cluster headache
Fever with frontal or maxillary tenderness
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

13. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
GERD
Scleroderma/polymyositis with secondary gastroesophageal reflux

14. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
These patients are associated with low renin states=less likely to respond to medication
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
Staphylococcal scalded skin syndrome

15. How do you know if heart palpitations are due to stimulant or medication use?
Molluscum contagiosum- pox virus
Subarachnoid hemorrhage
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Less abrupt onset and cessation of palpitations

16. 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
GERD
CBC
Presence of proteinuria on at least two separate ocassion

17. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
Rotator cuff tendonitis
Loop diuretics (Check serum K+ levels before drug admin)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

18. Discomfort with abducting the arm past 90 degress
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Rotator Cuff tendonitis

19. What diagnosis does the 'worse headache of my life' suggest?
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
Subarachnoid hemorrhage
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

20. Uterine bleeding between regular cycles
>150mg per 24hrs
Kids: Rotavirus Adults: Norwalk Virus
EGD
Intermenstrual bleeding

21. 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
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.
Dehydration - anemia - cardiac causes
CT
True

22. Treatment for supraventricular tachycardias
Coronary artery disease/ angina
>150mg per 24hrs
Coag disorders
BB or CCB - catheter ablation of identified bypass tract

23. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Furucnle
Coronary artery disease/ angina
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
CT

24. 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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Echocardiogram
High blood pressure - focal neurologic defecit - or papilledema

25. After treatment of dysplasia - women need Pap smears every...
Squamocolumnar junction=most common site of cervical cancer
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

26. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Nonulcer dyspepsia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

27. How are fungal infections diagnosed?
These patients are associated with low renin states=less likely to respond to medication
With a KOH wet mount preparation
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

28. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
E. Coli O157:H7
Fever with frontal or maxillary tenderness

29. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Hypertension - CAD - valvular heart disease
Chest pain during pneumonia or PE
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

30. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Viral gastroenteritis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Increasing fluid (8 - 8oz glasses of water/day) -fiber

31. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Cholelithiasis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

32. Where does the development of abnormal cervical cells begin?
Analgesic headache
24 hour halter
Varicella virus
Squamocolumnar junction=most common site of cervical cancer

33. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
CT
CBC

34. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Squamocolumnar junction=most common site of cervical cancer

35. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Candida albicans
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

36. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
HIV and syphilis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

37. What is the Barany maneuver?
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
RBC casts and old to moderate HTN
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

38. Describe the presentation of angina?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

39. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

40. Initial treatment for Rhinosinusitis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Squamocolumnar junction=most common site of cervical cancer
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

41. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
MSK - pulmonary - GI - or psychological
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
>150mg per 24hrs
Diuretics -BB -CCB -ACEi

42. How is constipation clinically defined?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Less than 3 stools per week
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

43. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Giardia
Temporal arteritis-biopsy of the temporal artery
Supraspinatus and bicipital tendons
E. Coli O157:H7

44. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Cervical radiculopathy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Kids: Rotavirus Adults: Norwalk Virus
Giardia

45. History and PE for Pneumonia
ACEi - ARBS - thiazide diuretics
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
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
Folliculitis

46. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Cervical radiculopathy
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

47. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
HPV testing -Pos=colposcopy -Neg=repeat pap smear
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

48. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Streptococci
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

49. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

50. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Furucnle
A central clear area
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema