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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 type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
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
Tension headache
Diuretics -BB -CCB -ACEi
Loop diuretics (Check serum K+ levels before drug admin)

2. What is the Barany maneuver?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Viral gastroenteritis
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

3. Define nephrotic range proteinuria
Acute headache - ataxia - profuse nausea - and vomiting
Less abrupt onset and cessation 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
>3.5g of protein per 24hrs

4. What are symptoms are CHF?
Less abrupt onset and cessation of palpitations
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Less than 3 stools per week

5. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
High blood pressure - focal neurologic defecit - or papilledema
Less abrupt onset and cessation of palpitations
S. aureus- beta hemolytic streptococcus
HPV

6. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
35 (exception for postmenopausal women who have recently been started on HRT)
Folliculitis
Bence-Jones

7. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
>3.5g of protein per 24hrs
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Adhesive capsulitis (frozen shoulder): most common in middle age women
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

8. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

9. What is considered normal blood loss during a menstrual cycle?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
ACEi - ARBS - thiazide diuretics
Less than 80 ml of blood

10. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Acute headache - ataxia - profuse nausea - and vomiting
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

11. patients with herpes zoster may experience what symptom before the rash appear?
Pain
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
Serotypes 16 - 18 - 31 -52 -58
With a KOH wet mount preparation

12. 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
RBC casts and old to moderate HTN
Generalized Anxiety disorder and panic disorder
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

13. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
These patients are associated with low renin states=less likely to respond to medication
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Coag disorders
>3.5g of protein per 24hrs

14. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bulk forming: Psyllium - Methycellulose - Polycarbophil

15. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Tension headache
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

16. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Repeat Pap after infection treated
Chest pain during pneumonia or PE
Presence of proteinuria on at least two separate ocassion
LH surge triggers ovulation

17. What is the Epley maneuver?
Regular bleeding at intervals of more than 35 days
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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.
>150mg per 24hrs

18. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
A 24hr urine protein collection and urine creatinine clearance determination
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
E. Coli O157:H7

19. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

20. What is the caUse of benign positional vertigo?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
MSK - pulmonary - GI - or psychological
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.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

21. 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.
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
Repeat Pap after infection treated
LH surge triggers ovulation
Loop diuretics (Check serum K+ levels before drug admin)

22. What are the most common viral causes of diarrhea in kids and adults?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Kids: Rotavirus Adults: Norwalk Virus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in 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

23. What is the next best step if a patient has two or more positive dipstick tests?
Warts
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
RBC casts and old to moderate HTN
A 24hr urine protein collection and urine creatinine clearance determination

24. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Possibility of Ischemic colitis

25. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Varicella virus
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

26. How can GERD (or esophageal motility disorders) lead to chest pain?
Medication or chemical esophagitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hgb - Electrolytes - and TSH

27. 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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
35 (exception for postmenopausal women who have recently been started on HRT)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

28. What occurs after ovulation
Pts with palpitations and dizziness - near syncope - or syncope
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Albumin; low molecular weight proteins
Streptococci

29. Discomfort with abducting the arm past 90 degress
Diuretics -BB -CCB -ACEi
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Rotator Cuff tendonitis
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

30. Describe the presentation of angina?
Dehydration - anemia - cardiac causes
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
Other brainstem or cranial nerve findings
Furucnle

31. What should blood work include for suspected heart failure?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi
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

32. PE for a patient getting an abnormal vaginal bleeding work up
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Rotator cuff tendonitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

33. What are the two common clinical presentations of acute diarrhea?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Coronary artery disease/ angina

34. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Lightheadedness - dizziness - syncope
Peptic ulcer disease or gastritis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

35. Prenatal visit schedule for low-risk pregnancies
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Regular bleeding at intervals of more than 35 days
Slow progression of cervical cancer changes -Availability of effective early treatment

36. Oligomenorrhea
Polymenorrhea
Peptic ulcer disease or gastritis
Regular bleeding at intervals of more than 35 days
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

37. What type of imaging is need for chronic sinusitis?
CT
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Higher filling presure - pulmonary congestion - and decreasd cardiac return

38. Name the skin lesion: honey colored crusts
Impetigo
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

39. What should be considered in younger patients with menorrhagia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Less than 80 ml of blood
Coag disorders
Viral gastroenteritis

40. What are the physical exam signs of CHF?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

41. What does orthostatic positional changes that bring on dizziness suggest?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dehydration - anemia - cardiac causes
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Chest pain during pneumonia or PE

42. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Non-cardiac causes of palpitations
Giardia
Less than 80 ml of blood

43. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Scabies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

44. Name the skin lesion: erythema - warmth - edema - pain - fever
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Presence of proteinuria on at least two separate ocassion
Cellulitis
Varicella virus

45. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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.
True

46. What is an acoustic neuroma?
Rotator Cuff tendonitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Temporal arteritis-biopsy of the temporal artery
RBC casts and old to moderate HTN

47. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Pleurisy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
EGD

48. Pneumonia tx: suitable for healthy adults less than 60
Hgb - Electrolytes - and TSH
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Medication or chemical esophagitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

49. What are the features of glomerular nephritis
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.
Pancreatitis
RBC casts and old to moderate HTN
Cellulitis

50. What is the caUse of Meniere disease? What are the cardinal symptoms?
Viral infection of the semicircular apparatus
Varicella virus
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss