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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. Four muscles of rotator cuff
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

2. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Cholelithiasis
>150mg per 24hrs
Temporal arteritis-biopsy of the temporal artery
Other brainstem or cranial nerve findings

3. What is the role of FSH in one's menstrual cycle
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
Intermenstrual bleeding
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

4. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
BB or CCB - catheter ablation of identified bypass tract
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

5. Regular bleeding at intervals of less than 21 days
RBC casts and old to moderate HTN
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
24 hour halter
Polymenorrhea

6. Describe the presentation of myocardial 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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Scleroderma/polymyositis with secondary gastroesophageal reflux
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

7. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
S. aureus- beta hemolytic streptococcus
Pleurisy

8. What is the mechanism of action for stimulant agents in treating constipation?
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
PVC or Premature atrial contraction (PAC)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

9. History for Sinusitis

10. Describe the presentation tracheobronchitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Upper sternal area burning pain - associated with a productive cough
Cellulitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

11. How to NSAIDs contribute to gastritis and ulcer formation?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Coag disorders
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.

12. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Scabies
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
With a KOH wet mount preparation

13. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
>3.5g of protein per 24hrs
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
Pancreatitis
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

14. 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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
100mg; means patient can be trace protein positive and not be detected
Peptic ulcer disease or gastritis

15. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
EGD
Possibility of Ischemic colitis

16. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
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.
Coronary artery disease/ angina

17. Uterine bleeding between regular cycles
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
35 (exception for postmenopausal women who have recently been started on HRT)
Intermenstrual bleeding

18. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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.
Varicella virus
Increase; 200 g/day

19. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
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
Lightheadedness - dizziness - syncope
Menorrhagia

20. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Molluscum contagiosum- pox virus
BB or CCB - catheter ablation of identified bypass tract
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

21. patients with herpes zoster may experience what symptom before the rash appear?
Streptococci
EGD
Pain
GERD

22. Prenatal visit schedule for low-risk pregnancies
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Polymenorrhea
Kids: Rotavirus Adults: Norwalk Virus

23. Things that need to be included in history of shoulder pain
Scleroderma/polymyositis with secondary gastroesophageal reflux
>3.5g of protein per 24hrs
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

24. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Loop diuretics (Check serum K+ levels before drug admin)
DM - HTN - DVT - seizures - depression - or anxiety
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

25. What are the physical exam signs of CHF?
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
Viral infection of the semicircular apparatus
Rotator cuff tendonitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

26. What are the most common causes for the common cold?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Scabies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

27. Lab testing for heart palpitation
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
35 (exception for postmenopausal women who have recently been started on HRT)
Hgb - Electrolytes - and TSH
Adhesive capsulitis (frozen shoulder): most common in middle age women

28. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Molluscum contagiosum- pox virus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
35 (exception for postmenopausal women who have recently been started on HRT)

29. Name types of laxatives
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Viral infection of the semicircular apparatus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

30. 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
CT
True
ACEi - ARBS - thiazide diuretics
Cervical radiculopathy

31. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Increase; 200 g/day
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

32. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pain
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
GERD

33. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
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
Anticoag with warfarin to prevent thromboembolism
Cellulitis

34. What is the Epley maneuver?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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.

35. How is constipation clinically defined?
Less than 3 stools per week
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

36. What are the signs of cerebral hemorrhage?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Giardia
Acute headache - ataxia - profuse nausea - and vomiting
Viral infection of the semicircular apparatus

37. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Squamocolumnar junction=most common site of cervical cancer
Pleurisy

38. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Scabies
PVC or Premature atrial contraction (PAC)
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
Molluscum contagiosum- pox virus

39. When does troponin rise following myocardial injury or infarction?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
LH surge triggers ovulation
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Influenza - Rhinovirus - Adenovirus - Parainfluenza

40. 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
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Varicella virus

41. What is benign transient proteinuria?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
DM - HTN - DVT - seizures - depression - or anxiety
Repeat Pap after infection treated

42. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Bence-Jones
Nonulcer dyspepsia
DM - HTN - DVT - seizures - depression - or anxiety
With a KOH wet mount preparation

43. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Coag disorders
Infectious esophagitis

44. What is the caUse of benign positional vertigo?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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.
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.
GERD

45. What are the indiciations for neuroimaging?
Less than 80 ml of blood
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Associated with hypotension

46. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Nonulcer dyspepsia
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.

47. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Chest pain during pneumonia or PE
S. aureus- beta hemolytic streptococcus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Medication or chemical esophagitis

48. What are symptoms are CHF?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

49. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Medication or chemical esophagitis
Intermenstrual bleeding
Coag disorders

50. What type of imaging is need for chronic sinusitis?
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
E. Coli O157:H7
CT
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides