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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 places women at higher risk of getting cervical cancer?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Less than 80 ml of blood
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

2. What are the signs of cerebral hemorrhage?
Non-cardiac causes of palpitations
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
24 hour halter
Acute headache - ataxia - profuse nausea - and vomiting

3. At was quantity does urine dipstick test detect elevated protein?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
100mg; means patient can be trace protein positive and not be detected
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

4. How are fungal infections diagnosed?
With a KOH wet mount preparation
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

5. How is constipation clinically defined?
MSK - pulmonary - GI - or psychological
Possibility of Ischemic colitis
GERD
Less than 3 stools per week

6. Constipation: What are indications for lab testing?
Hgb - Electrolytes - and TSH
Pts with palpitations and dizziness - near syncope - or syncope
True
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

7. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Staphylococcal scalded skin syndrome
Viral gastroenteritis
Rotator Cuff problem
Cholelithiasis

8. Diarrhea from custard filled pastries
EGD
MSK - pulmonary - GI - or psychological
S. Aureus
Candida albicans

9. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
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
Albumin; low molecular weight proteins

10. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Serotypes 16 - 18 - 31 -52 -58
Rotator Cuff problem
GERD

11. What are the physical exam signs of CHF?
Infectious esophagitis
Less than 80 ml of blood
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure

12. name the 4 emergent causes of chest pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
PE - MI - aortic dissection - pneumothorax

13. What is the standard tool used for diagnosis of GERD?
Hgb - Electrolytes - and TSH
EGD
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Influenza - Rhinovirus - Adenovirus - Parainfluenza

14. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
PE - MI - aortic dissection - pneumothorax

15. How do you define persistent protein uria?
Cervical radiculopathy
Presence of proteinuria on at least two separate ocassion
ACEi - ARBS - thiazide diuretics
LH surge triggers ovulation

16. Metrorrhagia
Irregular bleeding between cycles
Serotypes 16 - 18 - 31 -52 -58
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

17. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

18. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

19. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Diuretics -BB -CCB -ACEi

20. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Squamocolumnar junction=most common site of cervical cancer
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
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.

21. What HPV serotypes are most commonly associated with cervical cancer?
Kids: Rotavirus Adults: Norwalk Virus
Cellulitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Serotypes 16 - 18 - 31 -52 -58

22. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Infectious esophagitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
GERD

23. 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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
E. Coli O157:H7

24. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Furucnle
Scleroderma/polymyositis with secondary gastroesophageal reflux
Chest pain during pneumonia or PE
MSK - pulmonary - GI - or psychological

25. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Furucnle
Hgb - Electrolytes - and TSH
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Non-cardiac causes of palpitations

26. What is the preload?
Other brainstem or cranial nerve findings
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Wolff-Parkinson-White syndrome
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

27. When is a lumbar puncture contraindicated?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Streptococci
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

28. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Presence of proteinuria on at least two separate ocassion
Giardia
Peptic ulcer disease or gastritis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

29. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Anticoag with warfarin to prevent thromboembolism
Dehydration - anemia - cardiac causes
Squamocolumnar junction=most common site of cervical cancer
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

30. History and PE for Pneumonia
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
Menorrhagia
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
Warts

31. Initial treatment for Rhinosinusitis
A 24hr urine protein collection and urine creatinine clearance determination
Possibility of Ischemic colitis
Viral infection of the semicircular apparatus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

32. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Pleurisy
Polymenorrhea
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.

33. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Cholelithiasis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Pancreatitis

34. 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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
MSK - pulmonary - GI - or psychological
Wolff-Parkinson-White syndrome

35. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
Bence-Jones
Streptococci
Tension headache

36. Describes what occurs during squamous metaplasia of the cervix.
Pts with palpitations and dizziness - near syncope - or syncope
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

37. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Albumin; low molecular weight proteins
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Echocardiogram
Coronary artery disease/ angina
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Repeat Pap after infection treated

39. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Colposcopy - Endocervical curettage - and directed cervical biopsy

40. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
100mg; means patient can be trace protein positive and not be detected
Variability in the time for follicle development during the proliferative phase
RBC casts and old to moderate HTN
Pts with palpitations and dizziness - near syncope - or syncope

41. What is afterload?
Varicella virus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
CBC
>150mg per 24hrs

42. How to NSAIDs contribute to gastritis and ulcer formation?
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
Diuretics -BB -CCB -ACEi
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.
BB or CCB - catheter ablation of identified bypass tract

43. Define the patient population typically affected by orthostatic or postural proteinuria
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
24 hour halter
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

44. What is the caUse of Meniere disease? What are the cardinal symptoms?
Viral gastroenteritis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Cellulitis

45. Discomfort with abducting the arm past 90 degress
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
Rotator Cuff tendonitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Increasing fluid (8 - 8oz glasses of water/day) -fiber

46. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Supraspinatus and bicipital tendons
True

47. What is the Barany maneuver?
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
MSK - pulmonary - GI - or psychological

48. What is the next best step if a patient has two or more positive dipstick tests?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
A 24hr urine protein collection and urine creatinine clearance determination
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Rotator cuff tendonitis

49. Mainstay treatment for soft tissue inflammation (Shoulder)
Variability in the time for follicle development during the proliferative phase
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Upper sternal area burning pain - associated with a productive cough

50. Isolated - extra pounding beats
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
PVC or Premature atrial contraction (PAC)
Pts with palpitations and dizziness - near syncope - or syncope
Male - report irregular heartbeat Sx duration >5min - hx of heart disease