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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. What is the Epley maneuver?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

2. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Varicella virus
Viral infection of the semicircular apparatus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

3. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
35 (exception for postmenopausal women who have recently been started on HRT)
Non-cardiac causes of palpitations
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
>3.5g of protein per 24hrs

4. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
DM - HTN - DVT - seizures - depression - or anxiety

5. What are symptoms are CHF?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Bence-Jones
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

6. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Impetigo
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

7. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Staphylococcal scalded skin syndrome
Rotator Cuff tendonitis
Less abrupt onset and cessation of palpitations

8. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Analgesic headache
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Echocardiogram
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

9. Who should have Xray testing for shoulder pain?
Regular bleeding at intervals of more than 35 days
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral infection of the semicircular apparatus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

10. At was quantity does urine dipstick test detect elevated protein?
HPV
BB or CCB - catheter ablation of identified bypass tract
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
100mg; means patient can be trace protein positive and not be detected

11. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
EGD
Lightheadedness - dizziness - syncope
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

12. Describes what occurs during squamous metaplasia of the cervix.
Rotator cuff tendonitis
Less than 80 ml of blood
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

13. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Temporal arteritis-biopsy of the temporal artery
Pts with palpitations and dizziness - near syncope - or syncope
Associated with hypotension

14. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Analgesic headache
Loop diuretics (Check serum K+ levels before drug admin)

15. Name types of laxatives
E. Coli O157:H7
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
>3.5g of protein per 24hrs
Kids: Rotavirus Adults: Norwalk Virus

16. Isolated - extra pounding beats
Squamocolumnar junction=most common site of cervical cancer
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
PVC or Premature atrial contraction (PAC)
Impetigo

17. Difference between Pneumonia and Bronchitis
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
PE - MI - aortic dissection - pneumothorax
Less than 3 stools per week
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

18. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Diuretics -BB -CCB -ACEi
S. Aureus
Candida albicans

19. Clinical Manifestations of HTN
Increase; 200 g/day
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
RBC casts and old to moderate HTN

20. HIgh risk pregnant patients should be evaluated for ____ and ____
MSK - pulmonary - GI - or psychological
Lightheadedness - dizziness - syncope
HIV and syphilis
Intermenstrual bleeding

21. Things that need to be included in history of shoulder pain
Varicella virus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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

22. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Folliculitis

23. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
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
Varicella virus
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

24. Name the diagnosis of heartburn: severe constant mid abdominal pain
Subarachnoid hemorrhage
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Pancreatitis

25. What is the Barany maneuver?
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
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
Anticoag with warfarin to prevent thromboembolism
Bence-Jones

26. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Serotypes 16 - 18 - 31 -52 -58
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

27. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
35 (exception for postmenopausal women who have recently been started on HRT)
Possibility of Ischemic colitis

28. What is the difference between a Holter monitor or an event monitor?
Cervical radiculopathy
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
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
Loop diuretics (Check serum K+ levels before drug admin)

29. Chronic pain and shoulder stiffness with limited motion
Staphylococcal scalded skin syndrome
Dehydration - anemia - cardiac causes
Echocardiogram
Adhesive capsulitis (frozen shoulder): most common in middle age women

30. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

31. What are the two common clinical presentations of acute diarrhea?
Folliculitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

32. What is a markers of CNS vertigo?
Fever with frontal or maxillary tenderness
Hypertension - CAD - valvular heart disease
Other brainstem or cranial nerve findings
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

33. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

34. What does orthostatic positional changes that bring on dizziness suggest?
Regular bleeding at intervals of more than 35 days
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.
Dehydration - anemia - cardiac causes
Common problem that resolves spontaneously and is most often seen in children and young adults

35. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Temporal arteritis-biopsy of the temporal artery

36. What is the next best step if a patient has two or more positive dipstick tests?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
A 24hr urine protein collection and urine creatinine clearance determination
Menorrhagia

37. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
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

38. Describe the presentation of myocardial pain?
S. aureus- beta hemolytic streptococcus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

39. Diagnosis of HTN
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dehydration - anemia - cardiac causes
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Impetigo

40. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Menorrhagia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

41. Describe the presentation of pneumonia
Chest pain during pneumonia or PE
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Common problem that resolves spontaneously and is most often seen in children and young adults
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

42. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Analgesic headache
Streptococci

43. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
35 (exception for postmenopausal women who have recently been started on HRT)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

44. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Acute headache - ataxia - profuse nausea - and vomiting
Upper sternal area burning pain - associated with a productive cough
Increasing fluid (8 - 8oz glasses of water/day) -fiber

45. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Scleroderma/polymyositis with secondary gastroesophageal reflux
Adhesive capsulitis (frozen shoulder): most common in middle age women

46. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Viral gastroenteritis
Coag disorders

47. What is the goal of CHF treatment? What drugs should be used?
Staphylococcal scalded skin syndrome
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

48. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pts with palpitations and dizziness - near syncope - or syncope
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cholelithiasis

49. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Albumin; low molecular weight proteins
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
Rotator Cuff tendonitis
Streptococci

50. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Presence of proteinuria on at least two separate ocassion
>3.5g of protein per 24hrs
Medication or chemical esophagitis
Giardia