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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. How do you know if heart palpitations are due to stimulant or medication use?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
True
Irregular bleeding between cycles
Less abrupt onset and cessation of palpitations

2. Mainstay treatment for soft tissue inflammation (Shoulder)
Pts with palpitations and dizziness - near syncope - or syncope
Irregular bleeding between cycles
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

3. Pneumonia tx: suitable for healthy adults less than 60
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
>150mg per 24hrs
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

4. Natural history of cervical cancer
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

5. What are the physical exam signs of CHF?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
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
ACEi

6. What is the preload?
GERD
A 24hr urine protein collection and urine creatinine clearance determination
Bence-Jones
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

7. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Upper sternal area burning pain - associated with a productive cough
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

8. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Viral gastroenteritis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

9. MI - pericardial tamponade - PE - GI bleed - are...
Streptococci
Associated with hypotension
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.
PVC or Premature atrial contraction (PAC)

10. What are the features of nephrotic syndrome?
PVC or Premature atrial contraction (PAC)
Peptic ulcer disease or gastritis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
RBC casts and old to moderate HTN

11. Pneumothorax - sudden sharp chest pain - preceded by viral illness
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pleurisy
Acute headache - ataxia - profuse nausea - and vomiting
GERD

12. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Echocardiogram
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Temporal arteritis-biopsy of the temporal artery
Scleroderma/polymyositis with secondary gastroesophageal reflux

13. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Serotypes 16 - 18 - 31 -52 -58
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Kids: Rotavirus Adults: Norwalk Virus

14. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Acute headache - ataxia - profuse nausea - and vomiting
Molluscum contagiosum- pox virus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

15. What is the goal of CHF treatment? What drugs should be used?
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
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Slow progression of cervical cancer changes -Availability of effective early treatment

16. What is benign transient proteinuria?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pancreatitis
Common problem that resolves spontaneously and is most often seen in children and young adults

17. What are signs of pulmonary congestion?
CBC
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Paroxysmal atrial fibrillation or supraventricular tachycardia

18. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
>150mg per 24hrs
Paroxysmal atrial fibrillation or supraventricular tachycardia
LH surge triggers ovulation
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

19. Treatment for supraventricular tachycardias
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
BB or CCB - catheter ablation of identified bypass tract
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
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

20. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Temporal arteritis-biopsy of the temporal artery
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Giardia

21. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Infectious esophagitis
Repeat Pap after infection treated
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
Peptic ulcer disease or gastritis

22. Complete the sentence: pericarditis can cause frictional rub and......
Anticoag with warfarin to prevent thromboembolism
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Supraspinatus and bicipital tendons
Increasing fluid (8 - 8oz glasses of water/day) -fiber

23. Why is the pap smear one of the most effective cancer screening tools?
BB or CCB - catheter ablation of identified bypass tract
Slow progression of cervical cancer changes -Availability of effective early treatment
Increasing fluid (8 - 8oz glasses of water/day) -fiber
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

24. What is the role of LH in the menstrual cycle
ACEi
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
Rotator cuff tendonitis
LH surge triggers ovulation

25. 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
Anticoag with warfarin to prevent thromboembolism
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Warts
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

26. What is the mechanism of action for stimulant agents in treating constipation?
HPV
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Regular bleeding at intervals of more than 35 days
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

27. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
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
Presence of proteinuria on at least two separate ocassion
Subarachnoid hemorrhage

28. What should preconception counseling include?
Infectious esophagitis
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
35 (exception for postmenopausal women who have recently been started on HRT)
Pts with palpitations and dizziness - near syncope - or syncope

29. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

30. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
RBC casts and old to moderate HTN
Pancreatitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil

31. What occurs after ovulation
MSK - pulmonary - GI - or psychological
CBC
Anticoag with warfarin to prevent thromboembolism
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

32. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Hypertension - CAD - valvular heart disease
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

33. What does treatment for migrans include?
Hypertension - CAD - valvular heart disease
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
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
Viral gastroenteritis

34. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
With a KOH wet mount preparation
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pleurisy

35. What are the three major risk factors for heart failure?
S. Aureus
ACEi - ARBS - thiazide diuretics
Hypertension - CAD - valvular heart disease
LH surge triggers ovulation

36. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

37. History and PE for Pneumonia
Chest pain during pneumonia or PE
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
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.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

38. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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.
Diuretics -BB -CCB -ACEi

39. Diagnosis of HTN
Hypertension - CAD - valvular heart disease
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
PE - MI - aortic dissection - pneumothorax
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

40. 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
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
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
Cluster headache
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

41. 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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Scabies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

42. Describe the presentation of angina?
Presence of proteinuria on at least two separate ocassion
BB or CCB - catheter ablation of identified bypass tract
Furucnle
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

43. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
35 (exception for postmenopausal women who have recently been started on HRT)
Staphylococcal scalded skin syndrome
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

44. How are fungal infections diagnosed?
Fever with frontal or maxillary tenderness
Associated with hypotension
E. Coli O157:H7
With a KOH wet mount preparation

45. What are the signs of malignant hypertension?
Polymenorrhea
High blood pressure - focal neurologic defecit - or papilledema
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Varicella virus

46. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
Rotator Cuff tendonitis

47. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Medication or chemical esophagitis
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
Wolff-Parkinson-White syndrome
Pain

48. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
PE - MI - aortic dissection - pneumothorax
24 hour halter
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

49. Who should have Xray testing for shoulder pain?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

50. At was quantity does urine dipstick test detect elevated protein?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Colposcopy - Endocervical curettage - and directed cervical biopsy
100mg; means patient can be trace protein positive and not be detected
These patients are associated with low renin states=less likely to respond to medication