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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. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Cervical radiculopathy
Irregular bleeding between cycles

2. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
Squamocolumnar junction=most common site of cervical cancer
Presence of proteinuria on at least two separate ocassion
Intermenstrual bleeding

3. Describe the history and PE of patient presenting with common cold
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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

4. Complete the sentence: pericarditis can cause frictional rub and......
Irregular bleeding between cycles
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
Infectious esophagitis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

5. What are the common causes for laryngitis?
Fever with frontal or maxillary tenderness
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cellulitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza

6. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
ACEi - ARBS - thiazide diuretics
Subarachnoid hemorrhage
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

7. What should be considered in younger patients with menorrhagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Kids: Rotavirus Adults: Norwalk Virus
Coag disorders
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

8. What should blood work include for suspected heart failure?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

9. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Repeat Pap after infection treated
Less than 80 ml of blood

10. 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
Echocardiogram
Giardia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

11. What is the caUse of Meniere disease? What are the cardinal symptoms?
35 (exception for postmenopausal women who have recently been started on HRT)
Tension headache
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

12. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
With a KOH wet mount preparation
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Colposcopy - Endocervical curettage - and directed cervical biopsy
Molluscum contagiosum- pox virus

13. What diagnosis does the 'worse headache of my life' suggest?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
A 24hr urine protein collection and urine creatinine clearance determination
Colposcopy - Endocervical curettage - and directed cervical biopsy
Subarachnoid hemorrhage

14. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
True
Medication or chemical esophagitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

15. What medications can cause heart palpitations?
Supraspinatus and bicipital tendons
Loop diuretics (Check serum K+ levels before drug admin)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Infectious esophagitis

16. 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
HPV
Presence of proteinuria on at least two separate ocassion
ACEi

17. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Medication or chemical esophagitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Viral gastroenteritis
RBC casts and old to moderate HTN

18. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Candida albicans

19. Describe the presentation of angina?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
High blood pressure - focal neurologic defecit - or papilledema
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

20. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Rotator Cuff problem
Hgb - Electrolytes - and TSH
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
Chest pain during pneumonia or PE

21. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Supraspinatus and bicipital tendons
Associated with hypotension

22. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Streptococci
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

23. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
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

24. Lab testing for heart palpitation
Impetigo
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Hgb - Electrolytes - and TSH
Menorrhagia

25. What is the Barany maneuver?
Serotypes 16 - 18 - 31 -52 -58
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Slow progression of cervical cancer changes -Availability of effective early treatment
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

26. What is the difference between a Holter monitor or an event monitor?
S. Aureus
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
Albumin; low molecular weight proteins
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

27. Describes what occurs during squamous metaplasia of the cervix.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

28. History for Sinusitis

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29. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
A 24hr urine protein collection and urine creatinine clearance determination
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

30. What is the role of FSH in one's menstrual cycle
Analgesic headache
Rotator Cuff tendonitis
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

31. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Scabies
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
Diuretics -BB -CCB -ACEi
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

32. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Rotator cuff tendonitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Nonulcer dyspepsia
Supraspinatus and bicipital tendons

33. What are the features of glomerular nephritis
Dehydration - anemia - cardiac causes
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Furucnle
RBC casts and old to moderate HTN

34. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
These patients are associated with low renin states=less likely to respond to medication

35. Name types of laxatives
Polymenorrhea
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

36. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
These patients are associated with low renin states=less likely to respond to medication
>150mg per 24hrs
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Rotator Cuff problem

37. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Hgb - Electrolytes - and TSH
Impetigo

38. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Paroxysmal atrial fibrillation or supraventricular tachycardia
Hgb - Electrolytes - and TSH
MSK - pulmonary - GI - or psychological

39. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Possibility of Ischemic colitis
Anticoag with warfarin to prevent thromboembolism
Molluscum contagiosum- pox virus

40. Describe the presentation of pneumonia
Cellulitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
With a KOH wet mount preparation

41. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
True
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
100mg; means patient can be trace protein positive and not be detected

42. Define proteinuria
Diuretics -BB -CCB -ACEi
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
EGD
>150mg per 24hrs

43. What are the indiciations for neuroimaging?
Associated with hypotension
ACEi
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

44. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Pancreatitis
Wolff-Parkinson-White syndrome
Anticoag with warfarin to prevent thromboembolism
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

45. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Generalized Anxiety disorder and panic disorder
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

46. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Warts
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

47. What HPV serotypes are most commonly associated with cervical cancer?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Serotypes 16 - 18 - 31 -52 -58
Molluscum contagiosum- pox virus

48. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
CT
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Irregular bleeding between cycles

49. What is the caUse of benign positional vertigo?
Less than 3 stools per week
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.
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

50. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Excessive bleeding in amount - duration - or both at irregular intervals
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.
PE - MI - aortic dissection - pneumothorax