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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. 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
Regular bleeding at intervals of more than 35 days
Molluscum contagiosum- pox virus
Fever with frontal or maxillary tenderness
Viral gastroenteritis

2. What occurs after ovulation
PVC or Premature atrial contraction (PAC)
Viral gastroenteritis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Albumin; low molecular weight proteins

3. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
GERD
Pain

4. What is the preload?
E. Coli O157:H7
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
ACEi
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

5. What does treatment for migrans include?
Warts
Regular bleeding at intervals of more than 35 days
Folliculitis
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

6. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
EGD
Cholelithiasis
Coronary artery disease/ angina
Temporal arteritis-biopsy of the temporal artery

7. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
CBC
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

8. Define proteinuria
Less abrupt onset and cessation of palpitations
>150mg per 24hrs
Bence-Jones
Less than 80 ml of blood

9. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Other brainstem or cranial nerve findings
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
When the patient has symptoms in association with exercise or who describe chest pain or pressure

10. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Presence of proteinuria on at least two separate ocassion
Irregular bleeding between cycles
Serotypes 16 - 18 - 31 -52 -58

11. What test done in PE measures instability of shoulder?
Other brainstem or cranial nerve findings
With a KOH wet mount preparation
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Influenza - Rhinovirus - Adenovirus - Parainfluenza

12. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
MSK - pulmonary - GI - or psychological

13. Mainstay treatment for soft tissue inflammation (Shoulder)
Less than 3 stools per week
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

14. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Slow progression of cervical cancer changes -Availability of effective early treatment
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Paroxysmal atrial fibrillation or supraventricular tachycardia
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

15. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Serotypes 16 - 18 - 31 -52 -58
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
Coronary artery disease/ angina

16. Tx of chronic or intermittent afibs
Coag disorders
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Anticoag with warfarin to prevent thromboembolism

17. How are fungal infections diagnosed?
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
With a KOH wet mount preparation
ACEi
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

18. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Bence-Jones
Increase; 200 g/day
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

19. 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
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
EGD
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

20. Regular bleeding at intervals of less than 21 days
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Possibility of Ischemic colitis
Polymenorrhea

21. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Pleurisy
Scabies
Furucnle

22. Things that need to be included in history of shoulder pain
Common problem that resolves spontaneously and is most often seen in children and young adults
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Irregular bleeding between cycles
High blood pressure - focal neurologic defecit - or papilledema

23. Name 4 factors that predispose an individual to develop pneumonia.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Hypertension - CAD - valvular heart disease
Colposcopy - Endocervical curettage - and directed cervical biopsy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

24. What are the features of glomerular nephritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
RBC casts and old to moderate HTN
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

25. Difference between Pneumonia and Bronchitis
Hgb - Electrolytes - and TSH
Analgesic headache
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
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

26. What are the two common clinical presentations of acute diarrhea?
PE - MI - aortic dissection - pneumothorax
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
Irregular bleeding between cycles
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

27. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Albumin; low molecular weight proteins
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

28. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Pts with palpitations and dizziness - near syncope - or syncope

29. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Viral gastroenteritis
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.

30. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

31. What are the three types of lice?
Folliculitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Giardia

32. Who should have Xray testing for shoulder pain?
Regular bleeding at intervals of more than 35 days
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

33. Carcinoma in situ is generally referred to a gynecologist and requires ______
Viral infection of the semicircular apparatus
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Associated with hypotension

34. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral infection of the semicircular apparatus
CBC
Temporal arteritis-biopsy of the temporal artery

35. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
ACEi - ARBS - thiazide diuretics
Rotator cuff tendonitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

36. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Nonulcer dyspepsia
Medication or chemical esophagitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza

37. What is the mechanism of action for stimulant agents in treating constipation?
Menorrhagia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
MSK - pulmonary - GI - or psychological
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

38. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Viral gastroenteritis
Pleurisy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

39. What does the classic ring worm lesion have?
Cervical radiculopathy
A central clear area
S. Aureus
Fever with frontal or maxillary tenderness

40. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Colposcopy - Endocervical curettage - and directed cervical biopsy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

41. What are the most common causes for the common cold?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Serotypes 16 - 18 - 31 -52 -58
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

42. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
CBC
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Staphylococcal scalded skin syndrome

43. What diagnosis does the 'worse headache of my life' suggest?
Irregular bleeding between cycles
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
ACEi
Subarachnoid hemorrhage

44. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

45. What medications can cause heart palpitations?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Other brainstem or cranial nerve findings
Medication or chemical esophagitis

46. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
>150mg per 24hrs
Other brainstem or cranial nerve findings
Hgb - Electrolytes - and TSH

47. 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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Scleroderma/polymyositis with secondary gastroesophageal reflux

48. Pain in shoulder when throwing - swimming - or serving a tennis ball
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pts with palpitations and dizziness - near syncope - or syncope
Rotator cuff tendonitis

49. Diagnosis of HTN
Rotator Cuff problem
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Possibility of Ischemic colitis
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

50. Name the skin lesion: erythema - warmth - edema - pain - fever
Viral infection of the semicircular apparatus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Cellulitis
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