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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. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

2. 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)
HIV and syphilis
Rotator Cuff problem
Coronary artery disease/ angina

3. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Non-cardiac causes of palpitations
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Pleurisy
True

4. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
>150mg per 24hrs
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

5. How can GERD (or esophageal motility disorders) lead to chest pain?
Chest pain during pneumonia or PE
RBC casts and old to moderate HTN
LH surge triggers ovulation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

6. What are the secondly causes of glomerular disease?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
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

7. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

8. Shoulder pain with pain radiating to elbow
GERD
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Cervical radiculopathy
Supraspinatus and bicipital tendons

9. What does treatment for migrans include?
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Presence of proteinuria on at least two separate ocassion

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
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
BB or CCB - catheter ablation of identified bypass tract

11. What is the peripheral caUse of vertigo?
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

12. What is the mechanism of action for stimulant agents in treating constipation?
Excessive bleeding in amount - duration - or both at irregular intervals
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

13. Mainstay treatment for soft tissue inflammation (Shoulder)
A central clear area
Dehydration - anemia - cardiac causes
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

14. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Polymenorrhea
Increase; 200 g/day
Possibility of Ischemic colitis

15. Clinical Manifestations of HTN
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
EGD
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

16. What should blood work include for suspected heart failure?
E. Coli O157:H7
Rotator Cuff problem
Associated with hypotension
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

17. What is a markers of CNS vertigo?
Slow progression of cervical cancer changes -Availability of effective early treatment
Other brainstem or cranial nerve findings
ACEi
Cellulitis

18. 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
DM - HTN - DVT - seizures - depression - or anxiety
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
True
Less abrupt onset and cessation of palpitations

19. How do you define persistent protein uria?
A 24hr urine protein collection and urine creatinine clearance determination
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
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
Presence of proteinuria on at least two separate ocassion

20. Who should have Xray testing for shoulder pain?
Rotator Cuff tendonitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Acute headache - ataxia - profuse nausea - and vomiting

21. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Diuretics -BB -CCB -ACEi
Scleroderma/polymyositis with secondary gastroesophageal reflux

22. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Giardia
Echocardiogram
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Folliculitis

23. Discomfort with abducting the arm past 90 degress
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Rotator Cuff tendonitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Tension headache

24. Menometrorrhagia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Excessive bleeding in amount - duration - or both at irregular intervals
Paroxysmal atrial fibrillation or supraventricular tachycardia

25. Uterine bleeding between regular cycles
E. Coli O157:H7
Intermenstrual bleeding
Chest pain during pneumonia or PE
Menorrhagia

26. PE for a patient getting an abnormal vaginal bleeding work up
>3.5g of protein per 24hrs
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Acute headache - ataxia - profuse nausea - and vomiting
Loop diuretics (Check serum K+ levels before drug admin)

27. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Paroxysmal atrial fibrillation or supraventricular tachycardia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

28. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Coag disorders
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

29. Cycle length variabilty is primarily due to what?
Less abrupt onset and cessation of palpitations
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Variability in the time for follicle development during the proliferative phase
Albumin; low molecular weight proteins

30. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
DM - HTN - DVT - seizures - depression - or anxiety
GERD
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Albumin; low molecular weight proteins

31. What are the physical exam signs of CHF?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
LH surge triggers ovulation
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

32. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Cervical radiculopathy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Less than 3 stools per week

33. 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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
E. Coli O157:H7
Less abrupt onset and cessation of palpitations
Anticoag with warfarin to prevent thromboembolism

34. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
>3.5g of protein per 24hrs
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

35. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Furucnle
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.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
ACEi

36. When does troponin rise following myocardial injury or infarction?
Irregular bleeding between cycles
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

37. When should invasive eletrophysiologic study should be considered?
Staphylococcal scalded skin syndrome
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

38. What are the three major risk factors for heart failure?
Impetigo
Hypertension - CAD - valvular heart disease
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Nonulcer dyspepsia

39. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. Aureus
Medication or chemical esophagitis
PE - MI - aortic dissection - pneumothorax
S. aureus- beta hemolytic streptococcus

40. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Warts

41. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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.

42. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Less than 3 stools per week

43. Describe the presentation of pneumonia
Adhesive capsulitis (frozen shoulder): most common in middle age women
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

44. What does orthostatic positional changes that bring on dizziness suggest?
Wolff-Parkinson-White syndrome
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Dehydration - anemia - cardiac causes
>150mg per 24hrs

45. Difference between Pneumonia and Bronchitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

46. What diagnosis does the 'worse headache of my life' suggest?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Cervical radiculopathy
Colposcopy - Endocervical curettage - and directed cervical biopsy
Subarachnoid hemorrhage

47. What are the signs of malignant hypertension?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lightheadedness - dizziness - syncope
High blood pressure - focal neurologic defecit - or papilledema
Anticoag with warfarin to prevent thromboembolism

48. Name some medications that can cause proteinuria
Pain
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Diuretics -BB -CCB -ACEi
>3.5g of protein per 24hrs

49. What are the most common causes for the common cold?
PVC or Premature atrial contraction (PAC)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

50. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
PVC or Premature atrial contraction (PAC)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Varicella virus