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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. Tx of chronic or intermittent afibs
S. aureus- beta hemolytic streptococcus
Anticoag with warfarin to prevent thromboembolism
BB or CCB - catheter ablation of identified bypass tract
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

2. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
HPV
>150mg per 24hrs

3. 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
Diuretics -BB -CCB -ACEi
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
S. aureus- beta hemolytic streptococcus

4. Name the diagnosis of heartburn: severe constant mid abdominal pain
Viral infection of the semicircular apparatus
Pancreatitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

5. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Colposcopy - Endocervical curettage - and directed cervical biopsy
Intermenstrual bleeding
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

6. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
EGD
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
Less than 3 stools per week

7. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Molluscum contagiosum- pox virus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

8. Oligomenorrhea
Albumin; low molecular weight proteins
Regular bleeding at intervals of more than 35 days
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
True

9. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Staphylococcal scalded skin syndrome
Cluster headache
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

10. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Rotator cuff tendonitis
Streptococci

11. What are the signs of acute sinusitis?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Slow progression of cervical cancer changes -Availability of effective early treatment
Fever with frontal or maxillary tenderness
Polymenorrhea

12. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Associated with hypotension
Menorrhagia
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

13. Initial treatment for Rhinosinusitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

14. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Warts
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

15. 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
ACEi - ARBS - thiazide diuretics
Scabies
With a KOH wet mount preparation
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

16. Define nephrotic range proteinuria
Pancreatitis
>3.5g of protein per 24hrs
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
HPV testing -Pos=colposcopy -Neg=repeat pap smear

17. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

18. Clinical Manifestations of HTN
EGD
>150mg per 24hrs
Anticoag with warfarin to prevent thromboembolism
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

19. Name the skin lesion: pustule in association with a hair follice
Excessive bleeding in amount - duration - or both at irregular intervals
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Folliculitis
>3.5g of protein per 24hrs

20. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Albumin; low molecular weight proteins
Viral gastroenteritis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Rotator Cuff tendonitis

21. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Excessive bleeding in amount - duration - or both at irregular intervals

22. Diagnosis of HTN
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pain
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

23. Name the skin lesion: honey colored crusts
Impetigo
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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.
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.

24. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Increase; 200 g/day
MSK - pulmonary - GI - or psychological
Candida albicans

25. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Analgesic headache

26. What are the physical exam signs of CHF?
Less than 80 ml of blood
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

27. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
ACEi
RBC casts and old to moderate HTN
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Giardia

28. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Colposcopy - Endocervical curettage - and directed cervical biopsy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

29. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

30. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Staphylococcal scalded skin syndrome

31. What is a markers of CNS vertigo?
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
Generalized Anxiety disorder and panic disorder
These patients are associated with low renin states=less likely to respond to medication
Other brainstem or cranial nerve findings

32. What are the indiciations for neuroimaging?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Presence of proteinuria on at least two separate ocassion
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
Cluster headache

33. When is a lumbar puncture contraindicated?
Pleurisy
100mg; means patient can be trace protein positive and not be detected
Dehydration - anemia - cardiac causes
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

34. What type of imaging is need for chronic sinusitis?
S. Aureus
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.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
CT

35. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
A central clear area
Serotypes 16 - 18 - 31 -52 -58
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Wolff-Parkinson-White syndrome

36. Diagnostic Evaluation of Abnoraml vaginal bleeding
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. Metrorrhagia
Fever with frontal or maxillary tenderness
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Irregular bleeding between cycles
Possibility of Ischemic colitis

38. History for Sinusitis

39. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Nonulcer dyspepsia
Giardia

40. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
EGD
Supraspinatus and bicipital tendons
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

41. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Genetic screening - medical assessment for chronic diseases - screening for infectious diseases - and updating of immunizations - advice on proper nutrition and exercise - help with quitting unhealthy habits - and advice on avoiding environmental haz
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
DM - HTN - DVT - seizures - depression - or anxiety

42. What is the goal of CHF treatment? What drugs should be used?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

43. Diarrhea from custard filled pastries
Kids: Rotavirus Adults: Norwalk Virus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
S. Aureus
Impetigo

44. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Folliculitis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
35 (exception for postmenopausal women who have recently been started on HRT)

45. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Non-cardiac causes of palpitations
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

46. 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.
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Less abrupt onset and cessation of palpitations
Supraspinatus and bicipital tendons
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

47. Difference between Pneumonia and Bronchitis
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
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
Irregular bleeding between cycles
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.

48. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Analgesic headache
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

49. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Fever with frontal or maxillary tenderness
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When the patient has symptoms in association with exercise or who describe chest pain or pressure

50. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
PE - MI - aortic dissection - pneumothorax
Less abrupt onset and cessation of palpitations
Candida albicans
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