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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 is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
PE - MI - aortic dissection - pneumothorax
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

2. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Rotator Cuff problem
Scleroderma/polymyositis with secondary gastroesophageal reflux
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

3. 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
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
Repeat Pap after infection treated
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

4. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
High blood pressure - focal neurologic defecit - or papilledema
ACEi - ARBS - thiazide diuretics
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

5. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

6. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Giardia

7. What are the primary glomerular diseases?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
ACEi - ARBS - thiazide diuretics
Colposcopy - Endocervical curettage - and directed cervical biopsy

8. What is the role of FSH in one's menstrual cycle
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Irregular bleeding between cycles
Hgb - Electrolytes - and TSH

9. What is the peripheral caUse of vertigo?
Staphylococcal scalded skin syndrome
Echocardiogram
True
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

10. Things that need to be included in history of shoulder pain
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
S. Aureus

11. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pain
Peptic ulcer disease or gastritis

12. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Adhesive capsulitis (frozen shoulder): most common in middle age women
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Polymenorrhea
Non-cardiac causes of palpitations

13. What should blood work include for suspected heart failure?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Rotator Cuff problem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

14. What are the consequences of diastolic dysfunction?
High blood pressure - focal neurologic defecit - or papilledema
Rotator cuff tendonitis
Furucnle
Higher filling presure - pulmonary congestion - and decreasd cardiac return

15. What are the physical exam signs of CHF?
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
Less abrupt onset and cessation of palpitations
True
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

16. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Scabies
Diuretics -BB -CCB -ACEi

17. patients with herpes zoster may experience what symptom before the rash appear?
>3.5g of protein per 24hrs
Pain
With a KOH wet mount preparation
Scabies

18. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Repeat Pap after infection treated

19. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Common problem that resolves spontaneously and is most often seen in children and young adults
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
>3.5g of protein per 24hrs
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

20. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Pancreatitis
Viral gastroenteritis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

21. Pain in shoulder when throwing - swimming - or serving a tennis ball
24 hour halter
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Rotator cuff tendonitis
Varicella virus

22. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Variability in the time for follicle development during the proliferative phase
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
35 (exception for postmenopausal women who have recently been started on HRT)
A 24hr urine protein collection and urine creatinine clearance determination

23. What type of imaging is need for chronic sinusitis?
Pleurisy
CT
Folliculitis
True

24. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Adhesive capsulitis (frozen shoulder): most common in middle age women
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Viral gastroenteritis

25. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

26. What is considered normal blood loss during a menstrual cycle?
Peptic ulcer disease or gastritis
EGD
Warts
Less than 80 ml of blood

27. Menometrorrhagia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Rotator Cuff tendonitis
Excessive bleeding in amount - duration - or both at irregular intervals
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

28. What are the secondly causes of glomerular disease?
PVC or Premature atrial contraction (PAC)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

29. name the 4 emergent causes of chest pain
Temporal arteritis-biopsy of the temporal artery
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
PE - MI - aortic dissection - pneumothorax
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

30. Name types of laxatives
Folliculitis
Dehydration - anemia - cardiac causes
Intermenstrual bleeding
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

31. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Furucnle
DM - HTN - DVT - seizures - depression - or anxiety
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

32. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Less than 3 stools per week
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Scleroderma/polymyositis with secondary gastroesophageal reflux
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

33. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
MSK - pulmonary - GI - or psychological
Impetigo

34. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Scabies
Coag disorders
Colposcopy - Endocervical curettage - and directed cervical biopsy
Rotator Cuff problem

35. Metrorrhagia
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Irregular bleeding between cycles
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

36. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
HPV
Possibility of Ischemic colitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

37. Regular bleeding at intervals of less than 21 days
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Squamocolumnar junction=most common site of cervical cancer
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Polymenorrhea

38. How are fungal infections diagnosed?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
>3.5g of protein per 24hrs
CBC
With a KOH wet mount preparation

39. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Repeat Pap after infection treated
Paroxysmal atrial fibrillation or supraventricular tachycardia
Chest pain during pneumonia or PE

40. Lab testing for heart palpitation
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Candida albicans
Hgb - Electrolytes - and TSH
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

41. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
GERD
Pleurisy

42. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Warts
Giardia
Upper sternal area burning pain - associated with a productive cough
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

43. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
Cervical radiculopathy
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

44. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Loop diuretics (Check serum K+ levels before drug admin)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
These patients are associated with low renin states=less likely to respond to medication

45. PE for a patient getting an abnormal vaginal bleeding work up
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Paroxysmal atrial fibrillation or supraventricular tachycardia
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Medication or chemical esophagitis

46. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
True
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

47. What is the Epley maneuver?
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
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
>3.5g of protein per 24hrs

48. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Wolff-Parkinson-White syndrome
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
Streptococci
Cholelithiasis

49. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Cholelithiasis
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
Fever with frontal or maxillary tenderness

50. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
35 (exception for postmenopausal women who have recently been started on HRT)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Menorrhagia
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