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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. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Squamocolumnar junction=most common site of cervical cancer
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pleurisy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

2. How can GERD (or esophageal motility disorders) lead to chest pain?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

3. What are the consequences of diastolic dysfunction?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Variability in the time for follicle development during the proliferative phase
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Higher filling presure - pulmonary congestion - and decreasd cardiac return

4. 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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
MSK - pulmonary - GI - or psychological
Supraspinatus and bicipital tendons
Regular bleeding at intervals of more than 35 days

5. What are the signs of malignant hypertension?
Polymenorrhea
Dehydration - anemia - cardiac causes
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
High blood pressure - focal neurologic defecit - or papilledema

6. PE for a patient getting an abnormal vaginal bleeding work up
Colposcopy - Endocervical curettage - and directed cervical biopsy
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

7. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Nonulcer dyspepsia
Albumin; low molecular weight proteins
Squamocolumnar junction=most common site of cervical cancer

8. Vaccines that should be updated before planned pregnancy
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

9. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

10. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Hypertension - CAD - valvular heart disease
Other brainstem or cranial nerve findings
Infectious esophagitis
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

11. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
HIV and syphilis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
DM - HTN - DVT - seizures - depression - or anxiety

12. What medications can cause heart palpitations?
Nonulcer dyspepsia
RBC casts and old to moderate HTN
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Excessive bleeding in amount - duration - or both at irregular intervals

13. Name some medications that can cause proteinuria
Excessive bleeding in amount - duration - or both at irregular intervals
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
These patients are associated with low renin states=less likely to respond to medication

14. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Supraspinatus and bicipital tendons
Hypertension - CAD - valvular heart disease
Candida albicans

15. What does treatment for migrans include?
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.
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
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
E. Coli O157:H7

16. What treatments are the cornerstone for treating cases of functional constipation?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Echocardiogram
Tension headache

17. What is the preload?
Wolff-Parkinson-White syndrome
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

18. patients with herpes zoster may experience what symptom before the rash appear?
Pain
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pleurisy
Presence of proteinuria on at least two separate ocassion

19. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Giardia
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
EGD

20. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Staphylococcal scalded skin syndrome
Temporal arteritis-biopsy of the temporal artery
Pts with palpitations and dizziness - near syncope - or syncope

21. What are the two common clinical presentations of acute diarrhea?
Giardia
Impetigo
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

22. What is benign transient proteinuria?
HIV and syphilis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Common problem that resolves spontaneously and is most often seen in children and young adults
Pleurisy

23. What are the three major risk factors for heart failure?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Hypertension - CAD - valvular heart disease
Supraspinatus and bicipital tendons

24. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
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.
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
Cholelithiasis
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

25. What are the indiciations for neuroimaging?
Pts with palpitations and dizziness - near syncope - or syncope
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

26. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Generalized Anxiety disorder and panic disorder
Hypertension - CAD - valvular heart disease
Wolff-Parkinson-White syndrome
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

27. How do you define persistent protein uria?
Regular bleeding at intervals of more than 35 days
Possibility of Ischemic colitis
Presence of proteinuria on at least two separate ocassion
Common problem that resolves spontaneously and is most often seen in children and young adults

28. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC
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
Anticoag with warfarin to prevent thromboembolism

29. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Bence-Jones
CBC
Albumin; low molecular weight proteins

30. History for Acute bronchitis
S. aureus- beta hemolytic streptococcus
A 24hr urine protein collection and urine creatinine clearance determination
True
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

31. HIgh risk pregnant patients should be evaluated for ____ and ____
Possibility of Ischemic colitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
HIV and syphilis
EGD

32. Four muscles of rotator cuff
RBC casts and old to moderate HTN
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
High blood pressure - focal neurologic defecit - or papilledema
Squamocolumnar junction=most common site of cervical cancer

33. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV
Generalized Anxiety disorder and panic disorder
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

34. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
HIV and syphilis
S. Aureus
BB or CCB - catheter ablation of identified bypass tract
Giardia

35. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
E. Coli O157:H7
24 hour halter
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
Streptococci

36. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Cervical radiculopathy
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

37. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Nonulcer dyspepsia
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral gastroenteritis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

38. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

39. What type of imaging is need for chronic sinusitis?
Polymenorrhea
PVC or Premature atrial contraction (PAC)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
CT

40. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
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
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

41. Metrorrhagia
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
Nonulcer dyspepsia
Intermenstrual bleeding
Irregular bleeding between cycles

42. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Increase; 200 g/day

43. 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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
35 (exception for postmenopausal women who have recently been started on HRT)
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.

44. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Rotator Cuff problem
Diuretics -BB -CCB -ACEi
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

45. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi - ARBS - thiazide diuretics
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

46. After treatment of dysplasia - women need Pap smears every...
EGD
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Albumin; low molecular weight proteins

47. Initial treatment for Rhinosinusitis
Menorrhagia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Echocardiogram
Non-cardiac causes of palpitations

48. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Polymenorrhea
Staphylococcal scalded skin syndrome
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
Peptic ulcer disease or gastritis

49. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
LH surge triggers ovulation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

50. What is the next best step if a patient has two or more positive dipstick tests?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Giardia
Other brainstem or cranial nerve findings
A 24hr urine protein collection and urine creatinine clearance determination