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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. What is the difference between a Holter monitor or an event monitor?
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
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
True

2. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Hgb - Electrolytes - and TSH
Menorrhagia
Peptic ulcer disease or gastritis

3. Carcinoma in situ is generally referred to a gynecologist and requires ______
Serotypes 16 - 18 - 31 -52 -58
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Less abrupt onset and cessation of palpitations

4. What are the 2 psych disorders most commonly associated with palpitations?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Fever with frontal or maxillary tenderness
Generalized Anxiety disorder and panic disorder
Nonulcer dyspepsia

5. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
HPV

6. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Cholelithiasis
Increase; 200 g/day
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
>3.5g of protein per 24hrs

7. When is a lumbar puncture contraindicated?
Lightheadedness - dizziness - syncope
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Rotator cuff tendonitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

8. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Common problem that resolves spontaneously and is most often seen in children and young adults
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

9. What are the most common causes for the common cold?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

10. PE for a patient getting an abnormal vaginal bleeding work up
Upper sternal area burning pain - associated with a productive cough
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Chest pain during pneumonia or PE

11. History for Acute bronchitis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

12. What is the next best step if a patient has two or more positive dipstick tests?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Higher filling presure - pulmonary congestion - and decreasd cardiac return
A 24hr urine protein collection and urine creatinine clearance determination
Hgb - Electrolytes - and TSH

13. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

14. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Adhesive capsulitis (frozen shoulder): most common in middle age women
S. Aureus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

15. How do you define persistent protein uria?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Temporal arteritis-biopsy of the temporal artery
Presence of proteinuria on at least two separate ocassion
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

16. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Kids: Rotavirus Adults: Norwalk Virus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Less abrupt onset and cessation of palpitations
Variability in the time for follicle development during the proliferative phase

17. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

18. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Staphylococcal scalded skin syndrome
DM - HTN - DVT - seizures - depression - or anxiety
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
Pancreatitis

19. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
100mg; means patient can be trace protein positive and not be detected
35 (exception for postmenopausal women who have recently been started on HRT)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Medication or chemical esophagitis

20. Constipation: What are indications for lab testing?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Squamocolumnar junction=most common site of cervical cancer
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
True
Coronary artery disease/ angina

22. Metrorrhagia
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Irregular bleeding between cycles
Other brainstem or cranial nerve findings
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

23. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Associated with hypotension
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

24. What is the mechanism of action for stimulant agents in treating constipation?
Intermenstrual bleeding
Diuretics -BB -CCB -ACEi
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
ACEi

25. What is an acoustic neuroma?
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
Pancreatitis
Candida albicans
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

26. Clinical Manifestations of HTN
CBC
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
PE - MI - aortic dissection - pneumothorax

27. What are the physical exam signs of CHF?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pleurisy
When the patient has symptoms in association with exercise or who describe chest pain or pressure

28. 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
E. Coli O157:H7
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
CBC

29. 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.
Tension headache
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HPV testing -Pos=colposcopy -Neg=repeat pap smear

30. Difference between Pneumonia and Bronchitis
Hypertension - CAD - valvular heart disease
CBC
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

31. What is the Barany maneuver?
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
Coag disorders
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

32. Pneumonia tx: suitable for healthy adults less than 60
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Fever with frontal or maxillary tenderness
>150mg per 24hrs

33. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Bence-Jones

34. Predictors of cardiac etiology
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pain
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Loop diuretics (Check serum K+ levels before drug admin)

35. Describe the presentation of myocardial pain?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Acute headache - ataxia - profuse nausea - and vomiting

36. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Irregular bleeding between cycles
Streptococci
Adhesive capsulitis (frozen shoulder): most common in middle age women
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

37. Menometrorrhagia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Excessive bleeding in amount - duration - or both at irregular intervals

38. What is benign transient proteinuria?
HPV
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Common problem that resolves spontaneously and is most often seen in children and young adults

39. 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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
With a KOH wet mount preparation
Cellulitis
Scabies

40. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
100mg; means patient can be trace protein positive and not be detected
Possibility of Ischemic colitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Diuretics -BB -CCB -ACEi

41. What are the consequences of diastolic dysfunction?
Fever with frontal or maxillary tenderness
A central clear area
Streptococci
Higher filling presure - pulmonary congestion - and decreasd cardiac return

42. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Menorrhagia
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

43. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Non-cardiac causes of palpitations
Paroxysmal atrial fibrillation or supraventricular tachycardia

44. Who should have Xray testing for shoulder pain?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

45. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Rotator Cuff tendonitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
PE - MI - aortic dissection - pneumothorax

46. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Rotator cuff tendonitis
Rotator Cuff tendonitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

47. History and PE for Pneumonia
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Presence of proteinuria on at least two separate ocassion

48. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
ACEi - ARBS - thiazide diuretics

49. Vaccines that should be updated before planned pregnancy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Chest pain during pneumonia or PE
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Paroxysmal atrial fibrillation or supraventricular tachycardia

50. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Anticoag with warfarin to prevent thromboembolism
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma