Test your basic knowledge |

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. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Slow progression of cervical cancer changes -Availability of effective early treatment

2. What is the role of LH in the menstrual cycle
Warts
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
LH surge triggers ovulation
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

3. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Varicella virus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HPV
Molluscum contagiosum- pox virus

4. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
EGD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

5. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pleurisy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

6. History for Acute bronchitis
Warts
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

7. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Cellulitis
Slow progression of cervical cancer changes -Availability of effective early treatment
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

8. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Candida albicans
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

9. What lab tests are recommended for newly diagnosed hypertensive patients?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. What treatments are the cornerstone for treating cases of functional constipation?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
>150mg per 24hrs

11. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Associated with hypotension
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
E. Coli O157:H7

12. Describe the presentation of angina?
High blood pressure - focal neurologic defecit - or papilledema
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
EGD

13. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

14. How does CHF present on X-ray?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

15. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Possibility of Ischemic colitis

16. 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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

17. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Analgesic headache
Generalized Anxiety disorder and panic disorder
These patients are associated with low renin states=less likely to respond to medication

18. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Associated with hypotension

19. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

20. What is the goal of CHF treatment? What drugs should be used?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
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
Increase; 200 g/day

21. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Lightheadedness - dizziness - syncope
HPV
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
Dehydration - anemia - cardiac causes

22. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
ACEi - ARBS - thiazide diuretics
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
35 (exception for postmenopausal women who have recently been started on HRT)

23. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Tension headache
Echocardiogram
35 (exception for postmenopausal women who have recently been started on HRT)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

24. What are the 2 psych disorders most commonly associated with palpitations?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Other brainstem or cranial nerve findings
Generalized Anxiety disorder and panic disorder

25. Regular bleeding at intervals of less than 21 days
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
Rotator Cuff problem
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Polymenorrhea

26. Where does the development of abnormal cervical cells begin?
Kids: Rotavirus Adults: Norwalk Virus
Squamocolumnar junction=most common site of cervical cancer
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
24 hour halter

27. Menometrorrhagia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Varicella virus
Excessive bleeding in amount - duration - or both at irregular intervals
Serotypes 16 - 18 - 31 -52 -58

28. Constipation: What are indications for lab testing?
Rotator Cuff tendonitis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Coronary artery disease/ angina
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

29. Define the patient population typically affected by orthostatic or postural proteinuria
RBC casts and old to moderate HTN
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
DM - HTN - DVT - seizures - depression - or anxiety
Fever with frontal or maxillary tenderness

30. Diarrhea from custard filled pastries
CT
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
Slow progression of cervical cancer changes -Availability of effective early treatment

31. 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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

32. What are the signs of cerebral hemorrhage?
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Acute headache - ataxia - profuse nausea - and vomiting
Regular bleeding at intervals of more than 35 days

33. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Giardia
Variability in the time for follicle development during the proliferative phase
Colposcopy - Endocervical curettage - and directed cervical biopsy

34. What does orthostatic positional changes that bring on dizziness suggest?
Scabies
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Dehydration - anemia - cardiac causes
GERD

35. What are the secondly causes of glomerular disease?
Less abrupt onset and cessation of palpitations
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

36. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Diuretics -BB -CCB -ACEi
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
Dehydration - anemia - cardiac causes

37. Predictors of cardiac etiology
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Peptic ulcer disease or gastritis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

38. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Serotypes 16 - 18 - 31 -52 -58
Cholelithiasis

39. Define nephrotic range proteinuria
Rotator Cuff tendonitis
>3.5g of protein per 24hrs
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

40. At was quantity does urine dipstick test detect elevated protein?
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.
100mg; means patient can be trace protein positive and not be detected
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

41. 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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Tension headache

42. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Excessive bleeding in amount - duration - or both at irregular intervals
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

43. How are fungal infections diagnosed?
Other brainstem or cranial nerve findings
Folliculitis
With a KOH wet mount preparation
Bence-Jones

44. Difference between Pneumonia and Bronchitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Presence of proteinuria on at least two separate ocassion

45. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Squamocolumnar junction=most common site of cervical cancer
Common problem that resolves spontaneously and is most often seen in children and young adults

46. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
CT
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
DM - HTN - DVT - seizures - depression - or anxiety
Analgesic headache

47. When should invasive eletrophysiologic study should be considered?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Repeat Pap after infection treated

48. 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.
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

49. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
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
Diuretics -BB -CCB -ACEi
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

50. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Fever with frontal or maxillary tenderness
Polymenorrhea
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
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