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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. How does systolic vs. diastolic heart failure present on the echocardiogram?
Associated with hypotension
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
Staphylococcal scalded skin syndrome
Viral gastroenteritis

2. 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.
Cholelithiasis
ACEi
Tension headache
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

3. What are symptoms are CHF?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

4. What are the three major risk factors for heart failure?
A 24hr urine protein collection and urine creatinine clearance determination
E. Coli O157:H7
Hypertension - CAD - valvular heart disease
HPV testing -Pos=colposcopy -Neg=repeat pap smear

5. name the 4 emergent causes of chest pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
PE - MI - aortic dissection - pneumothorax

6. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
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
Varicella virus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

7. Name 4 factors that predispose an individual to develop pneumonia.
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
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

8. Difference between Pneumonia and Bronchitis
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
Coronary artery disease/ angina
Regular bleeding at intervals of more than 35 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

9. Pneumonia tx: suitable for healthy adults less than 60
Acute headache - ataxia - profuse nausea - and vomiting
PVC or Premature atrial contraction (PAC)
Wolff-Parkinson-White syndrome
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

10. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
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
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
S. aureus- beta hemolytic streptococcus

11. What is the Epley maneuver?
Less than 80 ml of blood
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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.
Scabies

12. How can GERD (or esophageal motility disorders) lead to chest pain?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
ACEi

13. 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
Candida albicans
Warts
Repeat Pap after infection treated
Regular bleeding at intervals of more than 35 days

14. How is constipation clinically defined?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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.

15. Pneumothorax - sudden sharp chest pain - preceded by viral illness
E. Coli O157:H7
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pleurisy

16. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Folliculitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Possibility of Ischemic colitis

17. 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
Increase; 200 g/day
EGD
Cellulitis

18. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Medication or chemical esophagitis

19. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Pleurisy
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

20. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Regular bleeding at intervals of more than 35 days

21. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
HIV and syphilis
S. Aureus
Colposcopy - Endocervical curettage - and directed cervical biopsy

22. What is the next best step if a patient has two or more positive dipstick tests?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
A 24hr urine protein collection and urine creatinine clearance determination
CT
Irregular bleeding between cycles

23. What type of imaging is need for chronic sinusitis?
PVC or Premature atrial contraction (PAC)
Kids: Rotavirus Adults: Norwalk Virus
CT
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

24. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Analgesic headache
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Varicella virus

25. How does CHF present on X-ray?
Generalized Anxiety disorder and panic disorder
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pain

26. Vaccines that should be updated before planned pregnancy
Pts with palpitations and dizziness - near syncope - or syncope
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

27. What places women at higher risk of getting cervical cancer?
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
These patients are associated with low renin states=less likely to respond to medication
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
True

28. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
True
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

29. What is the difference between a Holter monitor or an event monitor?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Menorrhagia
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.
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

30. Name the skin lesion: erythema - warmth - edema - pain - fever
A central clear area
Cellulitis
Viral gastroenteritis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

31. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
EGD
Colposcopy - Endocervical curettage - and directed cervical biopsy
Presence of proteinuria on at least two separate ocassion

32. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Candida albicans
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
True

33. What should preconception counseling include?
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
Infectious esophagitis
Possibility of Ischemic colitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

34. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
E. Coli O157:H7
BB or CCB - catheter ablation of identified bypass tract
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
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

35. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
High blood pressure - focal neurologic defecit - or papilledema
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bence-Jones

36. Oligomenorrhea
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pleurisy
Regular bleeding at intervals of more than 35 days
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

37. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Rotator Cuff problem
These patients are associated with low renin states=less likely to respond to medication
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

38. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Analgesic headache
Chest pain during pneumonia or PE
Varicella virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

39. Mainstay treatment for soft tissue inflammation (Shoulder)
Candida albicans
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pleurisy

40. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
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
Supraspinatus and bicipital tendons
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

41. Describe the history and PE of patient presenting with common cold
Repeat Pap after infection treated
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Less than 80 ml of blood
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

42. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
HPV testing -Pos=colposcopy -Neg=repeat pap smear
E. Coli O157:H7
Peptic ulcer disease or gastritis
Impetigo

43. 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)
Temporal arteritis-biopsy of the temporal artery
Dehydration - anemia - cardiac causes
Molluscum contagiosum- pox virus

44. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Albumin; low molecular weight proteins
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
Loop diuretics (Check serum K+ levels before drug admin)
ACEi

45. Constipation: What are indications for lab testing?
Anticoag with warfarin to prevent thromboembolism
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
ACEi
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

46. What is the Barany maneuver?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
S. Aureus

47. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
ACEi - ARBS - thiazide diuretics
Intermenstrual bleeding
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
HPV testing -Pos=colposcopy -Neg=repeat pap smear

48. What does the classic ring worm lesion have?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
>150mg per 24hrs
Slow progression of cervical cancer changes -Availability of effective early treatment
A central clear area

49. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Bulk forming: Psyllium - Methycellulose - Polycarbophil

50. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Diuretics -BB -CCB -ACEi
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
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