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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. Who should have Xray testing for shoulder pain?
Rotator cuff tendonitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

2. When does troponin rise following myocardial injury or infarction?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Upper sternal area burning pain - associated with a productive cough

3. How does systolic vs. diastolic heart failure present on the echocardiogram?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Warts
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

4. Name the skin lesion: erythema - warmth - edema - pain - fever
DM - HTN - DVT - seizures - depression - or anxiety
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Cellulitis
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

5. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Chest pain during pneumonia or PE
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

6. 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
Warts
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

7. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Scleroderma/polymyositis with secondary gastroesophageal reflux
RBC casts and old to moderate HTN
Cluster headache

8. Metrorrhagia
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
Pts with palpitations and dizziness - near syncope - or syncope
Irregular bleeding between cycles
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

9. PE for a patient getting an abnormal vaginal bleeding work up
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Presence of proteinuria on at least two separate ocassion
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

10. What medications can cause heart palpitations?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
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

11. 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
Infectious esophagitis
Cluster headache
Lightheadedness - dizziness - syncope
Furucnle

12. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Wolff-Parkinson-White syndrome
Pts with palpitations and dizziness - near syncope - or syncope
Streptococci
These patients are associated with low renin states=less likely to respond to medication

13. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Presence of proteinuria on at least two separate ocassion
100mg; means patient can be trace protein positive and not be detected
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.
Scabies

14. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Subarachnoid hemorrhage

15. How to NSAIDs contribute to gastritis and ulcer formation?
These patients are associated with low renin states=less likely to respond to medication
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
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.
Increase; 200 g/day

16. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Viral gastroenteritis
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
Pain

17. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
35 (exception for postmenopausal women who have recently been started on HRT)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
True
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

18. Describe the presentation of pericardial pain
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

19. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Dehydration - anemia - cardiac causes
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

20. What does the classic ring worm lesion have?
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
Hypertension - CAD - valvular heart disease
A central clear area
Kids: Rotavirus Adults: Norwalk Virus

21. What is the next best step if a patient has two or more positive dipstick tests?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
A 24hr urine protein collection and urine creatinine clearance determination
24 hour halter
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

22. MI - pericardial tamponade - PE - GI bleed - are...
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Associated with hypotension
35 (exception for postmenopausal women who have recently been started on HRT)

23. What is considered normal blood loss during a menstrual cycle?
24 hour halter
Polymenorrhea
Less than 80 ml of blood
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

24. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
High blood pressure - focal neurologic defecit - or papilledema
100mg; means patient can be trace protein positive and not be detected
Medication or chemical esophagitis
Common problem that resolves spontaneously and is most often seen in children and young adults

25. What are the features of nephrotic syndrome?
Acute headache - ataxia - profuse nausea - and vomiting
Menorrhagia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

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
Rotator cuff tendonitis
Albumin; low molecular weight proteins
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

27. What are the features of glomerular nephritis
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
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
Hypertension - CAD - valvular heart disease

28. Clinical Manifestations of HTN
Rotator Cuff problem
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

29. Name the diagnosis of heartburn: severe constant mid abdominal pain
Infectious esophagitis
Pancreatitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Bence-Jones

30. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
HPV testing -Pos=colposcopy -Neg=repeat pap smear
HPV

31. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Associated with hypotension
Loop diuretics (Check serum K+ levels before drug admin)
Less abrupt onset and cessation of palpitations
100mg; means patient can be trace protein positive and not be detected

32. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

33. 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
Upper sternal area burning pain - associated with a productive cough
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

34. Cycle length variabilty is primarily due to what?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Variability in the time for follicle development during the proliferative phase
Rotator Cuff tendonitis

35. Tx of chronic or intermittent afibs
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Anticoag with warfarin to prevent thromboembolism
Cluster headache

36. 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
Variability in the time for follicle development during the proliferative phase
Pancreatitis
E. Coli O157:H7
Molluscum contagiosum- pox virus

37. What should blood work include for suspected heart failure?
Folliculitis
Upper sternal area burning pain - associated with a productive cough
Less abrupt onset and cessation of palpitations
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

38. How can GERD (or esophageal motility disorders) lead to chest pain?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

39. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Anticoag with warfarin to prevent thromboembolism
A 24hr urine protein collection and urine creatinine clearance determination
HIV and syphilis

40. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
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
HPV
Bulk forming: Psyllium - Methycellulose - Polycarbophil

41. Name some medications that can cause proteinuria
35 (exception for postmenopausal women who have recently been started on HRT)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
ACEi

42. How do you know if heart palpitations are due to stimulant or medication use?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Less abrupt onset and cessation of palpitations
Echocardiogram

43. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less than 3 stools per week
Furucnle
Other brainstem or cranial nerve findings

44. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Upper sternal area burning pain - associated with a productive cough
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

45. Predictors of cardiac etiology
Rotator Cuff tendonitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
GERD

46. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Less than 80 ml of blood

47. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Regular bleeding at intervals of more than 35 days
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

48. What HPV serotypes are most commonly associated with cervical cancer?
True
Serotypes 16 - 18 - 31 -52 -58
GERD
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

49. What are the signs of cerebral hemorrhage?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
LH surge triggers ovulation
Acute headache - ataxia - profuse nausea - and vomiting
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. Shoulder pain with pain radiating to elbow
Slow progression of cervical cancer changes -Availability of effective early treatment
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Increase; 200 g/day
Cervical radiculopathy