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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 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.
Tension headache
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Streptococci

2. What are the features of nephrotic syndrome?
Streptococci
Varicella virus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Colposcopy - Endocervical curettage - and directed cervical biopsy

3. When is a lumbar puncture contraindicated?
Peptic ulcer disease or gastritis
Rotator Cuff tendonitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Increase; 200 g/day

4. What does treatment for migrans include?
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

5. What is the standard tool used for diagnosis of GERD?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
EGD
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

6. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Candida albicans
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
Coronary artery disease/ angina
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

7. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Bence-Jones
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Colposcopy - Endocervical curettage - and directed cervical biopsy
Candida albicans

8. Metrorrhagia
Irregular bleeding between cycles
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Less abrupt onset and cessation of palpitations
Cervical radiculopathy

9. What are the most common viral causes of diarrhea in kids and adults?
Diuretics -BB -CCB -ACEi
Acute headache - ataxia - profuse nausea - and vomiting
Kids: Rotavirus Adults: Norwalk Virus
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

10. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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
Streptococci
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Fever with frontal or maxillary tenderness

11. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Polymenorrhea
With a KOH wet mount preparation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

12. Where does the development of abnormal cervical cells begin?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
RBC casts and old to moderate HTN
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Squamocolumnar junction=most common site of cervical cancer

13. What should blood work include for suspected heart failure?
ACEi - ARBS - thiazide diuretics
Molluscum contagiosum- pox virus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Slow progression of cervical cancer changes -Availability of effective early treatment

14. Diarrhea from custard filled pastries
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Common problem that resolves spontaneously and is most often seen in children and young adults
Generalized Anxiety disorder and panic disorder
S. Aureus

15. What is the preload?
DM - HTN - DVT - seizures - depression - or anxiety
Temporal arteritis-biopsy of the temporal artery
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

16. Uterine bleeding between regular cycles
Intermenstrual bleeding
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

17. What are the indiciations for neuroimaging?
Rotator Cuff tendonitis
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

18. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Rotator Cuff problem
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

19. What are the consequences of diastolic dysfunction?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Higher filling presure - pulmonary congestion - and decreasd cardiac return

20. What is a markers of CNS vertigo?
Viral infection of the semicircular apparatus
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
Other brainstem or cranial nerve findings
Streptococci

21. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

22. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Hgb - Electrolytes - and TSH
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
S. aureus- beta hemolytic streptococcus
Streptococci

23. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Giardia
Regular bleeding at intervals of more than 35 days
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

24. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Diuretics -BB -CCB -ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
E. Coli O157:H7
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

25. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
DM - HTN - DVT - seizures - depression - or anxiety
Molluscum contagiosum- pox virus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Regular bleeding at intervals of more than 35 days

26. Complete the sentence: pericarditis can cause frictional rub and......
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
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
A 24hr urine protein collection and urine creatinine clearance determination
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

27. What should be considered in younger patients with menorrhagia
Menorrhagia
Lightheadedness - dizziness - syncope
EGD
Coag disorders

28. 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)
Rotator Cuff problem
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
Molluscum contagiosum- pox virus

29. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Pts with palpitations and dizziness - near syncope - or syncope
Supraspinatus and bicipital tendons
24 hour halter
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

30. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Less than 3 stools per week
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
S. Aureus
GERD

31. Things that need to be included in history of shoulder pain
Excessive bleeding in amount - duration - or both at irregular intervals
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pts with palpitations and dizziness - near syncope - or syncope

32. What occurs after ovulation
Tension headache
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

33. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

34. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
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
Viral gastroenteritis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

35. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Peptic ulcer disease or gastritis
Analgesic headache

36. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Hgb - Electrolytes - and TSH
Increase; 200 g/day
Increasing fluid (8 - 8oz glasses of water/day) -fiber

37. When should invasive eletrophysiologic study should be considered?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Generalized Anxiety disorder and panic disorder
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

38. What are the most common causes for the common cold?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

39. What diagnosis does the 'worse headache of my life' suggest?
Infectious esophagitis
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
Subarachnoid hemorrhage
HPV

40. What are the secondly causes of glomerular disease?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Tension headache

41. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Cholelithiasis
Increase; 200 g/day
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Albumin; low molecular weight proteins

42. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Scleroderma/polymyositis with secondary gastroesophageal reflux
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Bence-Jones

43. What are the common causes for laryngitis?
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
Temporal arteritis-biopsy of the temporal artery
Tension headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza

44. What are the two common clinical presentations of acute diarrhea?
Less than 3 stools per week
High blood pressure - focal neurologic defecit - or papilledema
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
A central clear area

45. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
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
Common problem that resolves spontaneously and is most often seen in children and young adults

46. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
True
Upper sternal area burning pain - associated with a productive cough
HPV

47. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
E. Coli O157:H7
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

48. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
A 24hr urine protein collection and urine creatinine clearance determination
Diuretics -BB -CCB -ACEi

49. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Tension headache
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

50. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
100mg; means patient can be trace protein positive and not be detected
Loop diuretics (Check serum K+ levels before drug admin)
Temporal arteritis-biopsy of the temporal artery
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus