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Family Medicine Shelf

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 does orthostatic positional changes that bring on dizziness suggest?
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
Dehydration - anemia - cardiac causes
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

2. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Kids: Rotavirus Adults: Norwalk Virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
35 (exception for postmenopausal women who have recently been started on HRT)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

3. Irregular cycles with excessive flow - duration - or both
RBC casts and old to moderate HTN
Non-cardiac causes of palpitations
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Menorrhagia

4. 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
Viral infection of the semicircular apparatus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Rotator Cuff problem

5. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
A 24hr urine protein collection and urine creatinine clearance determination
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

6. What is an acoustic neuroma?
Loop diuretics (Check serum K+ levels before drug admin)
Impetigo
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
CT

7. Describe the history and PE of patient presenting with common cold
S. Aureus
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest 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
Cluster headache

8. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Streptococci
Less than 80 ml of blood
Warts
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

9. Name the diagnosis of heartburn: severe constant mid abdominal pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Infectious esophagitis
Pancreatitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
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
Cluster headache

11. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
PE - MI - aortic dissection - pneumothorax
Tension headache
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
ACEi - ARBS - thiazide diuretics

12. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

13. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Supraspinatus and bicipital tendons
Furucnle
Rotator Cuff tendonitis

14. Describe the presentation of angina?
Scabies
Associated with hypotension
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
LH surge triggers ovulation

15. Isolated - extra pounding beats
S. Aureus
Loop diuretics (Check serum K+ levels before drug admin)
PVC or Premature atrial contraction (PAC)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

16. MI - pericardial tamponade - PE - GI bleed - are...
A central clear area
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Associated with hypotension
100mg; means patient can be trace protein positive and not be detected

17. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
S. aureus- beta hemolytic streptococcus
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.
Viral infection of the semicircular apparatus
Hgb - Electrolytes - and TSH

18. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Temporal arteritis-biopsy of the temporal artery
ACEi
HPV
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

19. What is the next best step if a patient has two or more positive dipstick tests?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
A 24hr urine protein collection and urine creatinine clearance determination

20. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Chest pain during pneumonia or PE
Wolff-Parkinson-White syndrome

21. Describe the presentation of pneumonia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

22. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
24 hour halter
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

23. Pneumonia tx: suitable for healthy adults older than 60
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Furucnle
CBC

24. What treatments are the cornerstone for treating cases of functional constipation?
These patients are associated with low renin states=less likely to respond to medication
Hgb - Electrolytes - and TSH
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Serotypes 16 - 18 - 31 -52 -58

25. What occurs after ovulation
Scleroderma/polymyositis with secondary gastroesophageal reflux
Intermenstrual bleeding
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

26. What places women at higher risk of getting cervical cancer?
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
>150mg per 24hrs
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Common problem that resolves spontaneously and is most often seen in children and young adults

27. What are the features of glomerular nephritis
BB or CCB - catheter ablation of identified bypass tract
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
RBC casts and old to moderate HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

28. What is the Epley maneuver?
Generalized Anxiety disorder and panic disorder
PE - MI - aortic dissection - pneumothorax
Bence-Jones
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.

29. How to NSAIDs contribute to gastritis and ulcer formation?
MSK - pulmonary - GI - or psychological
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.
Albumin; low molecular weight proteins

30. What is the goal of CHF treatment? What drugs should be used?
Dehydration - anemia - cardiac causes
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

31. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Wolff-Parkinson-White syndrome
Viral gastroenteritis

32. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Nonulcer dyspepsia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

33. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Staphylococcal scalded skin syndrome

34. Define the patient population typically affected by orthostatic or postural proteinuria
Streptococci
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
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
Regular bleeding at intervals of more than 35 days

35. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Pancreatitis
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
BB or CCB - catheter ablation of identified bypass tract

36. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

37. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
ACEi
Supraspinatus and bicipital tendons
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
Regular bleeding at intervals of more than 35 days

38. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Giardia
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Echocardiogram

39. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
These patients are associated with low renin states=less likely to respond to medication
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
Temporal arteritis-biopsy of the temporal artery
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

40. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Less abrupt onset and cessation of palpitations
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

41. What is a markers of CNS vertigo?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Other brainstem or cranial nerve findings
Slow progression of cervical cancer changes -Availability of effective early treatment
Anticoag with warfarin to prevent thromboembolism

42. How do you know if heart palpitations are due to stimulant or medication use?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Acute headache - ataxia - profuse nausea - and vomiting
Warts
Less abrupt onset and cessation of palpitations

43. How are fungal infections diagnosed?
Common problem that resolves spontaneously and is most often seen in children and young adults
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
With a KOH wet mount preparation
Repeat Pap after infection treated

44. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
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

45. Natural history of cervical cancer
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Albumin; low molecular weight proteins
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

46. How does CHF present on X-ray?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

47. What are symptoms are CHF?
RBC casts and old to moderate HTN
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Presence of proteinuria on at least two separate ocassion
Bulk forming: Psyllium - Methycellulose - Polycarbophil

48. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Excessive bleeding in amount - duration - or both at irregular intervals
Non-cardiac causes of palpitations
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

49. Name types of laxatives
HPV
Rotator Cuff problem
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

50. 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
Lightheadedness - dizziness - syncope
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Excessive bleeding in amount - duration - or both at irregular intervals
E. Coli O157:H7