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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. Pneumonia tx: suitable for healthy adults less than 60
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
S. aureus- beta hemolytic streptococcus
PE - MI - aortic dissection - pneumothorax
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

2. Name 4 factors that predispose an individual to develop pneumonia.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
DM - HTN - DVT - seizures - depression - or anxiety
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

3. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Viral infection of the semicircular apparatus

4. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Colposcopy - Endocervical curettage - and directed cervical biopsy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
A central clear area

5. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
RBC casts and old to moderate HTN
Coag disorders
Paroxysmal atrial fibrillation or supraventricular tachycardia
Influenza - Rhinovirus - Adenovirus - Parainfluenza

6. Initial treatment for Rhinosinusitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Varicella virus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

7. What is the role of FSH in one's menstrual cycle
Staphylococcal scalded skin syndrome
100mg; means patient can be trace protein positive and not be detected
Colposcopy - Endocervical curettage - and directed cervical biopsy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

8. How is constipation clinically defined?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Albumin; low molecular weight proteins
Less than 3 stools per week
Viral infection of the semicircular apparatus

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Coronary artery disease/ angina
Giardia
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Medication or chemical esophagitis
S. Aureus
100mg; means patient can be trace protein positive and not be detected

11. What does orthostatic positional changes that bring on dizziness suggest?
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
Intermenstrual bleeding
Dehydration - anemia - cardiac causes
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

12. What are the two common clinical presentations of acute diarrhea?
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
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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

13. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Streptococci
Viral gastroenteritis
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
Loop diuretics (Check serum K+ levels before drug admin)

14. When should a patient get a stress test?
Possibility of Ischemic colitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Subarachnoid hemorrhage
Upper sternal area burning pain - associated with a productive cough

15. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
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
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
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

16. Cycle length variabilty is primarily due to what?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Furucnle
Polymenorrhea
Variability in the time for follicle development during the proliferative phase

17. What is the caUse of Meniere disease? What are the cardinal symptoms?
Serotypes 16 - 18 - 31 -52 -58
LH surge triggers ovulation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

18. What is the mechanism of action for stimulant agents in treating constipation?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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.
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
These patients are associated with low renin states=less likely to respond to medication

19. Name the diagnosis of heartburn: severe constant mid abdominal pain
Upper sternal area burning pain - associated with a productive cough
Temporal arteritis-biopsy of the temporal artery
Folliculitis
Pancreatitis

20. What should preconception counseling include?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

21. Describe the presentation of angina?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
CBC
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

22. Oligomenorrhea
High blood pressure - focal neurologic defecit - or papilledema
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Dehydration - anemia - cardiac causes
Regular bleeding at intervals of more than 35 days

23. Diagnosis of HTN
Coag disorders
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
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.

24. Describe the history and PE of patient presenting with common cold
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Excessive bleeding in amount - duration - or both at irregular intervals
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

25. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Peptic ulcer disease or gastritis
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

26. Lab testing for heart palpitation
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 than 3 stools per week
Hgb - Electrolytes - and TSH
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

27. 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
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
Excessive bleeding in amount - duration - or both at irregular intervals
E. Coli O157:H7
Loop diuretics (Check serum K+ levels before drug admin)

28. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
With a KOH wet mount preparation
Hypertension - CAD - valvular heart disease
Pts with palpitations and dizziness - near syncope - or syncope

29. When does troponin rise following myocardial injury or infarction?
With a KOH wet mount preparation
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Analgesic headache
Supraspinatus and bicipital tendons
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
Coag disorders

31. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Medication or chemical esophagitis
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

32. What the consequences of decreased cardiac output?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Activation of the RAAS - increased levels of catecholamines - secretion of atrial natriuretic hormone -This leads to vasoconstriction - fluid retention - increased afterload - which further inhibits cardiac output -late changes are mycoardial and vas

33. Difference between Pneumonia and Bronchitis
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
>150mg per 24hrs
Echocardiogram

34. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Pleurisy
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

35. What is benign transient proteinuria?
Rotator Cuff problem
Common problem that resolves spontaneously and is most often seen in children and young adults
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Bence-Jones

36. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Generalized Anxiety disorder and panic disorder
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
Fever with frontal or maxillary tenderness
Albumin; low molecular weight proteins

37. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
When the patient has symptoms in association with exercise or who describe chest pain or pressure
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

38. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Nonulcer dyspepsia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Staphylococcal scalded skin syndrome

39. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
ACEi - ARBS - thiazide diuretics
Increase; 200 g/day
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

40. Prenatal visit schedule for low-risk pregnancies
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
Giardia
Rotator Cuff problem
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

41. What are the three types of lice?
High blood pressure - focal neurologic defecit - or papilledema
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Repeat Pap after infection treated

42. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
>150mg per 24hrs
Analgesic headache
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Less abrupt onset and cessation of palpitations

43. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

44. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Non-cardiac causes of palpitations
Warts
Slow progression of cervical cancer changes -Availability of effective early treatment

45. Diarrhea from custard filled pastries
S. Aureus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
ACEi

46. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Infectious esophagitis
CT
Scabies
Furucnle

47. How are fungal infections diagnosed?
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
Streptococci
With a KOH wet mount preparation
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

48. 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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Warts

49. Regular bleeding at intervals of less than 21 days
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Polymenorrhea
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

50. SE Of Beta blockers?
Activation of the RAAS - increased levels of catecholamines - secretion of atrial natriuretic hormone -This leads to vasoconstriction - fluid retention - increased afterload - which further inhibits cardiac output -late changes are mycoardial and vas
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Increase; 200 g/day
DM - HTN - DVT - seizures - depression - or anxiety