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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 are the three major risk factors for heart failure?
Peptic ulcer disease or gastritis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Hypertension - CAD - valvular heart disease

2. What are the physical exam signs of CHF?
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
Viral gastroenteritis
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
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

3. 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.
Tension headache
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

4. 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
ACEi
Streptococci
Acute headache - ataxia - profuse nausea - and vomiting

5. What is the Epley maneuver?
Echocardiogram
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.
HIV and syphilis
Adhesive capsulitis (frozen shoulder): most common in middle age women

6. Describe the presentation of angina?
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
Upper sternal area burning pain - associated with a productive cough
100mg; means patient can be trace protein positive and not be detected
35 (exception for postmenopausal women who have recently been started on HRT)

7. Name 4 factors that predispose an individual to develop pneumonia.
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Infectious esophagitis
HPV
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

8. Predictors of cardiac etiology
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Paroxysmal atrial fibrillation or supraventricular tachycardia

9. Define proteinuria
GERD
Serotypes 16 - 18 - 31 -52 -58
>150mg per 24hrs
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

10. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Polymenorrhea
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

11. Natural history of cervical cancer
Warts
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Less abrupt onset and cessation of palpitations

12. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
S. aureus- beta hemolytic streptococcus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Paroxysmal atrial fibrillation or supraventricular tachycardia

13. 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
Rotator Cuff tendonitis
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

14. Metrorrhagia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Slow progression of cervical cancer changes -Availability of effective early treatment
Irregular bleeding between cycles
Pleurisy

15. Describe the presentation tracheobronchitis
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Upper sternal area burning pain - associated with a productive cough
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

16. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

17. What does the classic ring worm lesion have?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
A central clear area
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

18. What are symptoms are CHF?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Dehydration - anemia - cardiac causes
Cellulitis

19. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Cervical radiculopathy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

20. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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.
Increase; 200 g/day
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

21. Describes what occurs during squamous metaplasia of the cervix.
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
GERD
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

22. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Nonulcer dyspepsia
Bence-Jones

23. What places women at higher risk of getting cervical cancer?
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
Less than 3 stools per week
>150mg per 24hrs
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

24. When does troponin rise following myocardial injury or infarction?
>3.5g of protein per 24hrs
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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.

25. Constipation: What are indications for lab testing?
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
True
LH surge triggers ovulation
Rotator Cuff tendonitis

26. History and PE for Pneumonia
Excessive bleeding in amount - duration - or both at irregular intervals
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Supraspinatus and bicipital tendons
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

27. What is the standard tool used for diagnosis of GERD?
Upper sternal area burning pain - associated with a productive cough
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
EGD

28. 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
24 hour halter
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
E. Coli O157:H7

29. At was quantity does urine dipstick test detect elevated protein?
ACEi
Chest pain during pneumonia or PE
Less than 3 stools per week
100mg; means patient can be trace protein positive and not be detected

30. Name the diagnosis of heartburn: regurgitation - dysphagia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
GERD

31. Carcinoma in situ is generally referred to a gynecologist and requires ______
With a KOH wet mount preparation
PE - MI - aortic dissection - pneumothorax
Presence of proteinuria on at least two separate ocassion
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. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Increase; 200 g/day
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Nonulcer dyspepsia
Menorrhagia

33. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Intermenstrual bleeding
Colposcopy - Endocervical curettage - and directed cervical biopsy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

34. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Echocardiogram
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
Serotypes 16 - 18 - 31 -52 -58
Chest pain during pneumonia or PE

35. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
ACEi - ARBS - thiazide diuretics
Anticoag with warfarin to prevent thromboembolism
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

36. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
HPV testing -Pos=colposcopy -Neg=repeat pap smear
LH surge triggers ovulation
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

37. 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
Peptic ulcer disease or gastritis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

38. What are the signs of acute sinusitis?
These patients are associated with low renin states=less likely to respond to medication
Fever with frontal or maxillary tenderness
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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

39. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
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
Rotator Cuff tendonitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

40. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Cervical radiculopathy
Furucnle
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

41. Clinical Manifestations of 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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pleurisy
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

42. Describe the presentation of myocardial pain?
Associated with hypotension
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Less abrupt onset and cessation of palpitations

43. Describe the history and PE of patient presenting with common cold
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

44. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pancreatitis

45. How does systolic vs. diastolic heart failure present on the echocardiogram?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Wolff-Parkinson-White syndrome
Streptococci

46. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Acute headache - ataxia - profuse nausea - and vomiting
100mg; means patient can be trace protein positive and not be detected
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

47. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Varicella virus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

48. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Increase; 200 g/day
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

49. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Giardia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Acute headache - ataxia - profuse nausea - and vomiting

50. How is constipation clinically defined?
Less than 80 ml of blood
HIV and syphilis
Less than 3 stools per week
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