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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. Describe the presentation tracheobronchitis
Folliculitis
Upper sternal area burning pain - associated with a productive cough
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Possibility of Ischemic colitis

2. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Nonulcer dyspepsia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

3. 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
Polymenorrhea
Fever with frontal or maxillary tenderness
Molluscum contagiosum- pox virus
Regular bleeding at intervals of more than 35 days

4. What are the features of nephrotic syndrome?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

5. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Diuretics -BB -CCB -ACEi
Viral gastroenteritis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

6. What are the secondly causes of glomerular disease?
Common problem that resolves spontaneously and is most often seen in children and young adults
>3.5g of protein per 24hrs
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

7. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cellulitis

8. 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.
Upper sternal area burning pain - associated with a productive cough
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Coag disorders

9. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
24 hour halter
These patients are associated with low renin states=less likely to respond to medication
Temporal arteritis-biopsy of the temporal artery

10. 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
Echocardiogram
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Less abrupt onset and cessation of palpitations

11. Describe the history and PE of patient presenting with common cold
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

12. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Common problem that resolves spontaneously and is most often seen in children and young adults
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
35 (exception for postmenopausal women who have recently been started on HRT)
PE - MI - aortic dissection - pneumothorax

13. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Medication or chemical esophagitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Cholelithiasis
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

14. How does CHF present on X-ray?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

15. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
ACEi - ARBS - thiazide diuretics
Pts with palpitations and dizziness - near syncope - or syncope
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

16. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
A central clear area
Furucnle
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

17. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Viral gastroenteritis
Cervical radiculopathy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

18. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Supraspinatus and bicipital tendons
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

19. What is benign transient proteinuria?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Common problem that resolves spontaneously and is most often seen in children and young adults
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

20. What is the goal of CHF treatment? What drugs should be used?
S. Aureus
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

21. What are the common causes for laryngitis?
Furucnle
Loop diuretics (Check serum K+ levels before drug admin)
Coronary artery disease/ angina
Influenza - Rhinovirus - Adenovirus - Parainfluenza

22. Where does the development of abnormal cervical cells begin?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Peptic ulcer disease or gastritis
Less abrupt onset and cessation of palpitations
Squamocolumnar junction=most common site of cervical cancer

23. What is the Epley maneuver?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Kids: Rotavirus Adults: Norwalk Virus
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.
Less abrupt onset and cessation of palpitations

24. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Peptic ulcer disease or gastritis
Scabies

25. What is the difference between a Holter monitor or an event monitor?
Less than 80 ml of blood
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

26. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
PVC or Premature atrial contraction (PAC)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

27. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
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

28. Lab testing for heart palpitation
Cellulitis
Peptic ulcer disease or gastritis
Hgb - Electrolytes - and TSH
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

29. Name types of laxatives
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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

30. Define the patient population typically affected by orthostatic or postural proteinuria
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
EGD
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

31. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Hgb - Electrolytes - and TSH
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

32. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Menorrhagia
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
True

33. When should invasive eletrophysiologic study should be considered?
True
Presence of proteinuria on at least two separate ocassion
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

34. What diagnosis does the 'worse headache of my life' suggest?
Increase; 200 g/day
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
ACEi
Subarachnoid hemorrhage

35. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Pleurisy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Repeat Pap after infection treated

36. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Pancreatitis
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
S. aureus- beta hemolytic streptococcus

37. 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.
Regular bleeding at intervals of more than 35 days
Repeat Pap after infection treated
Folliculitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

38. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Loop diuretics (Check serum K+ levels before drug admin)

39. Uterine bleeding between regular cycles
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
True
Intermenstrual bleeding
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

40. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Non-cardiac causes of palpitations
Rotator cuff tendonitis

41. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Chest pain during pneumonia or PE
Hypertension - CAD - valvular heart disease

42. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A central clear area
High blood pressure - focal neurologic defecit - or papilledema
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. History for Sinusitis

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44. Menometrorrhagia
Increase; 200 g/day
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Excessive bleeding in amount - duration - or both at irregular intervals

45. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

46. What drugs do you use to treat H.pylori + PUD?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
ACEi - ARBS - thiazide diuretics
Possibility of Ischemic colitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

47. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
DM - HTN - DVT - seizures - depression - or anxiety

48. Describe the presentation of angina?
100mg; means patient can be trace protein positive and not be detected
S. Aureus
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
Irregular bleeding between cycles

49. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
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
24 hour halter
Supraspinatus and bicipital tendons

50. Tx of chronic or intermittent afibs
With a KOH wet mount preparation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Anticoag with warfarin to prevent thromboembolism