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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. 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
Candida albicans
Warts
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

2. What are the indiciations for neuroimaging?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Repeat Pap after infection treated
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Headache of recent onset (<6 months) -headache beginning after 50 years of age -worsening headaches -headache that does not fit primary headache pattern -associated seizure -focal neurologic signs or symptoms -personality change-severe headaches unre

3. 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.
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
Squamocolumnar junction=most common site of cervical cancer
MSK - pulmonary - GI - or psychological

4. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Other brainstem or cranial nerve findings

5. What are symptoms are CHF?
True
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

6. What type of imaging is need for chronic sinusitis?
CT
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
Echocardiogram
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

7. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
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
Less abrupt onset and cessation of palpitations

8. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator Cuff problem
Rotator cuff tendonitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
These patients are associated with low renin states=less likely to respond to medication

9. How does systolic vs. diastolic heart failure present on the echocardiogram?
DM - HTN - DVT - seizures - depression - or anxiety
Kids: Rotavirus Adults: Norwalk Virus
LH surge triggers ovulation
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

10. Pneumonia tx: suitable for healthy adults older than 60
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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.

11. Define proteinuria
With a KOH wet mount preparation
>150mg per 24hrs
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
Regular bleeding at intervals of more than 35 days

12. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
35 (exception for postmenopausal women who have recently been started on HRT)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

13. 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
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
PE - MI - aortic dissection - pneumothorax
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

14. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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.
Giardia
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
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

15. Name types of laxatives
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

16. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

17. What is the caUse of benign positional vertigo?
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.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Irregular bleeding between cycles

18. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Wolff-Parkinson-White syndrome
Infectious esophagitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Variability in the time for follicle development during the proliferative phase

19. What should be considered in younger patients with menorrhagia
Coag disorders
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cluster headache
Adhesive capsulitis (frozen shoulder): most common in middle age women

20. Discomfort with abducting the arm past 90 degress
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
Squamocolumnar junction=most common site of cervical cancer
Rotator Cuff tendonitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

21. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Slow progression of cervical cancer changes -Availability of effective early treatment
Bulk forming: Psyllium - Methycellulose - Polycarbophil

22. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Hgb - Electrolytes - and TSH

23. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Hypertension - CAD - valvular heart disease
Molluscum contagiosum- pox virus

24. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Streptococci
Scabies
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

25. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Generalized Anxiety disorder and panic disorder
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Furucnle

26. HIgh risk pregnant patients should be evaluated for ____ and ____
Candida albicans
HIV and syphilis
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
Subarachnoid hemorrhage

27. What diagnosis does the 'worse headache of my life' suggest?
Lightheadedness - dizziness - syncope
Subarachnoid hemorrhage
With a KOH wet mount preparation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

28. 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
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
Nonulcer dyspepsia
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

29. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Varicella virus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

30. 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)
Kids: Rotavirus Adults: Norwalk Virus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

31. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Colposcopy - Endocervical curettage - and directed cervical biopsy
Headache of recent onset (<6 months) -headache beginning after 50 years of age -worsening headaches -headache that does not fit primary headache pattern -associated seizure -focal neurologic signs or symptoms -personality change-severe headaches unre
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

32. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Pleurisy
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Diuretics -BB -CCB -ACEi
Regular bleeding at intervals of more than 35 days

33. History for Acute bronchitis
Folliculitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Less than 3 stools per week
Regular bleeding at intervals of more than 35 days

34. What are the primary glomerular diseases?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Squamocolumnar junction=most common site of cervical cancer
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

35. 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
Other brainstem or cranial nerve findings
DM - HTN - DVT - seizures - depression - or anxiety
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
E. Coli O157:H7

36. What is benign transient proteinuria?
24 hour halter
Common problem that resolves spontaneously and is most often seen in children and young adults
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
A 24hr urine protein collection and urine creatinine clearance determination

37. What is the caUse of Meniere disease? What are the cardinal symptoms?
Fever with frontal or maxillary tenderness
Pleurisy
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
With a KOH wet mount preparation

38. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Less than 80 ml of blood
Medication or chemical esophagitis
A 24hr urine protein collection and urine creatinine clearance determination
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

39. What should preconception counseling include?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less than 3 stools per week
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
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

40. Where does the development of abnormal cervical cells begin?
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Scleroderma/polymyositis with secondary gastroesophageal reflux
Squamocolumnar junction=most common site of cervical cancer

41. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Tension headache
MSK - pulmonary - GI - or psychological
Adhesive capsulitis (frozen shoulder): most common in middle age women
Temporal arteritis-biopsy of the temporal artery

42. History for Sinusitis

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43. History and PE for Pneumonia
PVC or Premature atrial contraction (PAC)
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
Albumin; low molecular weight proteins
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

44. Things that need to be included in history of shoulder pain
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
Pts with palpitations and dizziness - near syncope - or syncope
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

45. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Fever with frontal or maxillary tenderness
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

46. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Regular bleeding at intervals of more than 35 days
Paroxysmal atrial fibrillation or supraventricular tachycardia
High blood pressure - focal neurologic defecit - or papilledema

47. How can GERD (or esophageal motility disorders) lead to chest pain?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Scleroderma/polymyositis with secondary gastroesophageal reflux
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Candida albicans

48. How are fungal infections diagnosed?
Pts with palpitations and dizziness - near syncope - or syncope
Lightheadedness - dizziness - syncope
Increasing fluid (8 - 8oz glasses of water/day) -fiber
With a KOH wet mount preparation

49. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Viral infection of the semicircular apparatus
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Analgesic headache

50. SE Of Beta blockers?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Repeat Pap after infection treated
HPV
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile