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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 microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Coag disorders
S. aureus- beta hemolytic streptococcus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

2. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PVC or Premature atrial contraction (PAC)

3. What places women at higher risk of getting cervical cancer?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
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

4. When should a patient get a stress test?
Albumin; low molecular weight proteins
Menorrhagia
A 24hr urine protein collection and urine creatinine clearance determination
When the patient has symptoms in association with exercise or who describe chest pain or pressure

5. What are the most common causes for the common cold?
Regular bleeding at intervals of more than 35 days
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
35 (exception for postmenopausal women who have recently been started on HRT)
Peptic ulcer disease or gastritis

6. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Squamocolumnar junction=most common site of cervical cancer
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Menorrhagia
True

7. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Adhesive capsulitis (frozen shoulder): most common in middle age women
Furucnle
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

8. What is the Barany maneuver?
Dehydration - anemia - cardiac causes
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hgb - Electrolytes - and TSH
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

9. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Irregular bleeding between cycles
Cluster headache
EGD
Bulk forming: Psyllium - Methycellulose - Polycarbophil

10. When is a lumbar puncture contraindicated?
Regular bleeding at intervals of more than 35 days
Molluscum contagiosum- pox virus
Staphylococcal scalded skin syndrome
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

11. What is the caUse of benign positional vertigo?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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.
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

12. 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
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.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Candida albicans
Molluscum contagiosum- pox virus

13. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

14. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Cervical radiculopathy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Molluscum contagiosum- pox virus

15. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

16. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
24 hour halter
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Anticoag with warfarin to prevent thromboembolism

17. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Cluster headache
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Possibility of Ischemic colitis

18. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Cervical radiculopathy
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Analgesic headache

19. Natural history of cervical cancer
Hgb - Electrolytes - and TSH
Presence of proteinuria on at least two separate ocassion
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

20. What is considered normal blood loss during a menstrual cycle?
Pain
Less than 80 ml of blood
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

21. What treatments are the cornerstone for treating cases of functional constipation?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
GERD

22. name the 4 emergent causes of chest pain
HPV testing -Pos=colposcopy -Neg=repeat pap smear
PE - MI - aortic dissection - pneumothorax
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

23. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Varicella virus
35 (exception for postmenopausal women who have recently been started on HRT)
Rotator Cuff problem
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

24. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
CBC
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Loop diuretics (Check serum K+ levels before drug admin)

25. Pneumonia tx: suitable for healthy adults older than 60
Slow progression of cervical cancer changes -Availability of effective early treatment
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

26. What is afterload?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
When the patient has symptoms in association with exercise or who describe chest pain or pressure

27. Name the diagnosis of heartburn: regurgitation - dysphagia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
GERD
Warts
Furucnle

28. Vaccines that should be updated before planned pregnancy
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
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

29. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Albumin; low molecular weight proteins
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

30. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Streptococci
ACEi - ARBS - thiazide diuretics

31. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Intermenstrual bleeding

32. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Streptococci
Lightheadedness - dizziness - syncope
Viral gastroenteritis

33. What are symptoms are CHF?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

34. What are the secondly causes of glomerular disease?
CBC
Diuretics -BB -CCB -ACEi
Staphylococcal scalded skin syndrome
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

35. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Other brainstem or cranial nerve findings
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Echocardiogram
Anticoag with warfarin to prevent thromboembolism

36. Discomfort with abducting the arm past 90 degress
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.
Bence-Jones
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Rotator Cuff tendonitis

37. Four muscles of rotator cuff
Repeat Pap after infection treated
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Cervical radiculopathy
Echocardiogram

38. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Fever with frontal or maxillary tenderness
Staphylococcal scalded skin syndrome
Loop diuretics (Check serum K+ levels before drug admin)

39. What medications can cause heart palpitations?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Other brainstem or cranial nerve findings
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

40. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Lightheadedness - dizziness - syncope
Scleroderma/polymyositis with secondary gastroesophageal reflux

41. Describes what occurs during squamous metaplasia of the cervix.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

42. What is the preload?
True
Bence-Jones
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
>3.5g of protein per 24hrs

43. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
CBC
Subarachnoid hemorrhage
Presence of proteinuria on at least two separate ocassion

44. What are the physical exam signs of CHF?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
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
Tension headache

45. Mainstay treatment for soft tissue inflammation (Shoulder)
Staphylococcal scalded skin syndrome
Less than 3 stools per week
Subarachnoid hemorrhage
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

46. Metrorrhagia
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Squamocolumnar junction=most common site of cervical cancer
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
Irregular bleeding between cycles

47. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Rotator Cuff tendonitis
Cluster headache
Infectious esophagitis

48. Diagnosis of HTN
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Hgb - Electrolytes - and TSH
>150mg per 24hrs

49. What are the features of nephrotic syndrome?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Anticoag with warfarin to prevent thromboembolism
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

50. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A 24hr urine protein collection and urine creatinine clearance determination
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses