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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. 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
Increase; 200 g/day
Analgesic headache
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.

2. 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
Albumin; low molecular weight proteins
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
E. Coli O157:H7
Warts

3. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
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
Supraspinatus and bicipital tendons
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
High blood pressure - focal neurologic defecit - or papilledema

4. Describe the presentation of myocardial pain?
>3.5g of protein per 24hrs
Upper sternal area burning pain - associated with a productive cough
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

5. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
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
Rotator Cuff tendonitis
Infectious esophagitis

6. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

7. What does the classic ring worm lesion have?
A central clear area
Possibility of Ischemic colitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults

8. patients with herpes zoster may experience what symptom before the rash appear?
Infectious esophagitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Pain
DM - HTN - DVT - seizures - depression - or anxiety

9. What is the difference between a Holter monitor or an event monitor?
Impetigo
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

10. Things that need to be included in history of shoulder pain
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
When the patient has symptoms in association with exercise or who describe chest pain or pressure

11. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
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
Possibility of Ischemic colitis
Other brainstem or cranial nerve findings

12. Name the skin lesion: erythema - warmth - edema - pain - fever
Folliculitis
Pancreatitis
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
Cellulitis

13. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
DM - HTN - DVT - seizures - depression - or anxiety
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.
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

14. What is benign transient proteinuria?
Fever with frontal or maxillary tenderness
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Common problem that resolves spontaneously and is most often seen in children and young adults
Coag disorders

15. HIgh risk pregnant patients should be evaluated for ____ and ____
Hypertension - CAD - valvular heart disease
HIV and syphilis
Pancreatitis
Candida albicans

16. Cycle length variabilty is primarily due to what?
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
Variability in the time for follicle development during the proliferative phase
MSK - pulmonary - GI - or psychological

17. What the consequences of decreased cardiac output?
Candida albicans
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

18. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Less than 3 stools per week
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

19. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Squamocolumnar junction=most common site of cervical cancer
Infectious esophagitis
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

20. History and PE for Pneumonia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

21. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Polymenorrhea
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

22. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Higher filling presure - pulmonary congestion - and decreasd cardiac return
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Folliculitis

23. Tx of chronic or intermittent afibs
Rotator cuff tendonitis
Anticoag with warfarin to prevent thromboembolism
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
Pancreatitis

24. What are the physical exam signs of CHF?
Infectious esophagitis
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

25. What are symptoms are CHF?
Less than 3 stools per week
100mg; means patient can be trace protein positive and not be detected
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
PVC or Premature atrial contraction (PAC)

26. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Excessive bleeding in amount - duration - or both at irregular intervals
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

27. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Fever with frontal or maxillary tenderness
Slow progression of cervical cancer changes -Availability of effective early treatment
Analgesic headache
Less abrupt onset and cessation of palpitations

28. Define the patient population typically affected by orthostatic or postural proteinuria
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
CT
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

29. 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
Varicella virus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

30. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
35 (exception for postmenopausal women who have recently been started on HRT)
CBC
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Less abrupt onset and cessation of palpitations

31. Diarrhea from custard filled pastries
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
S. Aureus
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.
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

32. What treatments are the cornerstone for treating cases of functional constipation?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pancreatitis

33. MI - pericardial tamponade - PE - GI bleed - are...
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Subarachnoid hemorrhage
Medication or chemical esophagitis
Associated with hypotension

34. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Staphylococcal scalded skin syndrome
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

35. What are the 2 psych disorders most commonly associated with palpitations?
E. Coli O157:H7
Generalized Anxiety disorder and panic disorder
MSK - pulmonary - GI - or psychological
Rotator Cuff problem

36. Complete the sentence: pericarditis can cause frictional rub and......
These patients are associated with low renin states=less likely to respond to medication
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Chest pain during pneumonia or PE

37. PE for a patient getting an abnormal vaginal bleeding work up
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

38. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Molluscum contagiosum- pox virus
Common problem that resolves spontaneously and is most often seen in children and young adults
Varicella virus

39. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Bence-Jones
Scabies
Variability in the time for follicle development during the proliferative phase
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

40. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Nonulcer dyspepsia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Albumin; low molecular weight proteins

41. What are the symptoms of palpitations?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Lightheadedness - dizziness - syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

42. How are fungal infections diagnosed?
With a KOH wet mount preparation
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
35 (exception for postmenopausal women who have recently been started on HRT)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

43. Initial treatment for Rhinosinusitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
24 hour halter

44. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Menorrhagia

45. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

46. How to NSAIDs contribute to gastritis and ulcer formation?
35 (exception for postmenopausal women who have recently been started on HRT)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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.
Cluster headache

47. How does CHF present on X-ray?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Cholelithiasis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
True

48. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Albumin; low molecular weight proteins
Candida albicans
Less abrupt onset and cessation of palpitations

49. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Bence-Jones
Pts with palpitations and dizziness - near syncope - or syncope

50. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
A central clear area