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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. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Rotator Cuff problem
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

2. Pneumonia tx: suitable for healthy adults less than 60
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Repeat Pap after infection treated
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

3. Tx of chronic or intermittent afibs
Molluscum contagiosum- pox virus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Anticoag with warfarin to prevent thromboembolism
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

4. What is the peripheral caUse of vertigo?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

5. What are the signs of acute sinusitis?
Slow progression of cervical cancer changes -Availability of effective early treatment
Fever with frontal or maxillary tenderness
RBC casts and old to moderate HTN
With a KOH wet mount preparation

6. How is constipation clinically defined?
Less than 3 stools per week
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
Pancreatitis
S. Aureus

7. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

8. What is the difference between a Holter monitor or an event monitor?
>150mg per 24hrs
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Common problem that resolves spontaneously and is most often seen in children and young adults
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

9. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

10. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Impetigo
A 24hr urine protein collection and urine creatinine clearance determination

11. Diarrhea from custard filled pastries
S. Aureus
Nonulcer dyspepsia
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
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

12. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Folliculitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

13. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Possibility of Ischemic colitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

14. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Diuretics -BB -CCB -ACEi
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

15. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Infectious esophagitis
CT
100mg; means patient can be trace protein positive and not be detected

16. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
A central clear area
Pts with palpitations and dizziness - near syncope - or syncope
Slow progression of cervical cancer changes -Availability of effective early treatment
Temporal arteritis-biopsy of the temporal artery

17. What is the goal of CHF treatment? What drugs should be used?
Tension headache
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

18. Describe the history and PE of patient presenting with common cold
Polymenorrhea
24 hour halter
Rotator cuff tendonitis
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

19. Prenatal visit schedule for low-risk pregnancies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Rotator cuff tendonitis
Pain
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

20. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Fever with frontal or maxillary tenderness
Cholelithiasis
Cluster headache
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

21. Vaccines that should be updated before planned pregnancy
>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
Less abrupt onset and cessation of palpitations
Coronary artery disease/ angina

22. MI - pericardial tamponade - PE - GI bleed - are...
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
Associated with hypotension
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
Presence of proteinuria on at least two separate ocassion

23. Complete the sentence: pericarditis can cause frictional rub and......
Increase; 200 g/day
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

24. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Varicella virus
CBC
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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.

25. What is the mechanism of action for stimulant agents in treating constipation?
>3.5g of protein per 24hrs
DM - HTN - DVT - seizures - depression - or anxiety
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

26. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
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
PVC or Premature atrial contraction (PAC)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Viral infection of the semicircular apparatus

27. Regular bleeding at intervals of less than 21 days
Polymenorrhea
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

28. Diagnosis of HTN
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Warts
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

29. 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.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Rotator Cuff problem

30. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
A 24hr urine protein collection and urine creatinine clearance determination
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

31. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Staphylococcal scalded skin syndrome
S. aureus- beta hemolytic streptococcus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

32. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
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
RBC casts and old to moderate HTN
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral gastroenteritis

33. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Rotator Cuff problem
Tension headache

34. What are the signs of cerebral hemorrhage?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CT
Acute headache - ataxia - profuse nausea - and vomiting
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

35. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Coronary artery disease/ angina
Less abrupt onset and cessation of palpitations

36. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Adhesive capsulitis (frozen shoulder): most common in middle age women
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

37. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
>3.5g of protein per 24hrs
CBC
100mg; means patient can be trace protein positive and not be detected
DM - HTN - DVT - seizures - depression - or anxiety

38. How can GERD (or esophageal motility disorders) lead to chest pain?
Viral gastroenteritis
Kids: Rotavirus Adults: Norwalk Virus
DM - HTN - DVT - seizures - depression - or anxiety
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

39. What is the standard tool used for diagnosis of GERD?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Associated with hypotension
EGD
24 hour halter

40. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Common problem that resolves spontaneously and is most often seen in children and young adults
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

41. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Rotator Cuff problem
ACEi
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
>3.5g of protein per 24hrs

42. 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
Rotator cuff tendonitis
Lightheadedness - dizziness - syncope
MSK - pulmonary - GI - or psychological
Scabies

43. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
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
Non-cardiac causes of palpitations
Polymenorrhea

44. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Rotator Cuff tendonitis

45. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Medication or chemical esophagitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Increase; 200 g/day
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

46. What is considered normal blood loss during a menstrual cycle?
RBC casts and old to moderate HTN
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Less than 80 ml of blood

47. Name the diagnosis of heartburn: severe constant mid abdominal pain
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Rotator cuff tendonitis
Pancreatitis

48. When does troponin rise following myocardial injury or infarction?
ACEi
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Non-cardiac causes of palpitations

49. Define the patient population typically affected by orthostatic or postural proteinuria
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Variability in the time for follicle development during the proliferative phase
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
Echocardiogram

50. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Squamocolumnar junction=most common site of cervical cancer
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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