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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 are the symptoms of palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Lightheadedness - dizziness - syncope
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Warts

2. How to NSAIDs contribute to gastritis and ulcer formation?
Folliculitis
Cholelithiasis
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.
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

3. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Chest pain during pneumonia or PE
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

4. Predictors of cardiac etiology
Cellulitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
GERD

5. Name the diagnosis of heartburn: severe constant mid abdominal pain
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Pancreatitis

6. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Viral infection of the semicircular apparatus
24 hour halter

7. Shoulder pain with pain radiating to elbow
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Echocardiogram
Cervical radiculopathy
Rotator Cuff tendonitis

8. Uterine bleeding between regular cycles
Non-cardiac causes of palpitations
RBC casts and old to moderate HTN
Bence-Jones
Intermenstrual bleeding

9. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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.
Nonulcer dyspepsia
Bulk forming: Psyllium - Methycellulose - Polycarbophil

10. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Cluster headache
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
True

11. What is considered normal blood loss during a menstrual cycle?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected
Less than 80 ml of blood

12. Where does the development of abnormal cervical cells begin?
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
Squamocolumnar junction=most common site of cervical cancer
Diuretics -BB -CCB -ACEi
Coronary artery disease/ angina

13. What is the goal of CHF treatment? What drugs should be used?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Increase; 200 g/day
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

14. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

15. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

16. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
>3.5g of protein per 24hrs
Scleroderma/polymyositis with secondary gastroesophageal reflux
Viral gastroenteritis

17. Irregular cycles with excessive flow - duration - or both
S. aureus- beta hemolytic streptococcus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Menorrhagia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

18. What are the consequences of diastolic dysfunction?
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
Menorrhagia
Higher filling presure - pulmonary congestion - and decreasd cardiac return
EGD

19. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Peptic ulcer disease or gastritis
Bence-Jones
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

20. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Wolff-Parkinson-White syndrome
PVC or Premature atrial contraction (PAC)

21. What is a markers of CNS vertigo?
S. aureus- beta hemolytic streptococcus
Medication or chemical esophagitis
Other brainstem or cranial nerve findings
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

22. Diarrhea from custard filled pastries
S. Aureus
Rotator Cuff problem
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

23. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Paroxysmal atrial fibrillation or supraventricular tachycardia
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

24. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
PVC or Premature atrial contraction (PAC)
ACEi
Generalized Anxiety disorder and panic disorder
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

25. Describe the presentation tracheobronchitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
CT
Upper sternal area burning pain - associated with a productive cough
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

26. 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
Scabies
Kids: Rotavirus Adults: Norwalk Virus
S. aureus- beta hemolytic streptococcus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

27. What is benign transient proteinuria?
True
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Cervical radiculopathy

28. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
With a KOH wet mount preparation
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
Pleurisy

29. What are the features of glomerular nephritis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
RBC casts and old to moderate HTN
Serotypes 16 - 18 - 31 -52 -58

30. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
RBC casts and old to moderate HTN
Candida albicans
S. aureus- beta hemolytic streptococcus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

31. When is a lumbar puncture contraindicated?
Varicella virus
Pts with palpitations and dizziness - near syncope - or syncope
ACEi - ARBS - thiazide diuretics
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

32. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Common problem that resolves spontaneously and is most often seen in children and young adults
LH surge triggers ovulation
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
Medication or chemical esophagitis

33. Diagnostic Evaluation of Abnoraml vaginal bleeding
Increase; 200 g/day
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
MSK - pulmonary - GI - or psychological

34. What are the most common viral causes of diarrhea in kids and adults?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Kids: Rotavirus Adults: Norwalk Virus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

35. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Pleurisy
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
>3.5g of protein per 24hrs

36. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
S. aureus- beta hemolytic streptococcus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Acute headache - ataxia - profuse nausea - and vomiting

37. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
24 hour halter
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increase; 200 g/day
Nonulcer dyspepsia

38. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hypertension - CAD - valvular heart disease
HPV

39. What are the three types of lice?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

40. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
24 hour halter
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
Warts
Viral infection of the semicircular apparatus

41. Vaccines that should be updated before planned pregnancy
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
Regular bleeding at intervals of more than 35 days
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

42. 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
Warts
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.
Cervical radiculopathy
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

43. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
CT
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Other brainstem or cranial nerve findings

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
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.
Temporal arteritis-biopsy of the temporal artery
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

45. What are the 2 psych disorders most commonly associated with palpitations?
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
Generalized Anxiety disorder and panic disorder
Nonulcer dyspepsia
Albumin; low molecular weight proteins

46. What are signs of pulmonary congestion?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

47. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Molluscum contagiosum- pox virus
Staphylococcal scalded skin syndrome
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Possibility of Ischemic colitis

48. Describe the presentation of myocardial pain?
Rotator cuff tendonitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
When the patient has symptoms in association with exercise or who describe chest pain or pressure

49. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Hypertension - CAD - valvular heart disease
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

50. Metrorrhagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Irregular bleeding between cycles
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