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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 does orthostatic positional changes that bring on dizziness suggest?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Dehydration - anemia - cardiac causes
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

2. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Kids: Rotavirus Adults: Norwalk Virus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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

3. Uterine bleeding between regular cycles
Viral gastroenteritis
Presence of proteinuria on at least two separate ocassion
True
Intermenstrual bleeding

4. What are the signs of malignant hypertension?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
High blood pressure - focal neurologic defecit - or papilledema

5. Isolated - extra pounding beats
ACEi
PVC or Premature atrial contraction (PAC)
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
Intermenstrual bleeding

6. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Staphylococcal scalded skin syndrome
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
Cellulitis

7. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Non-cardiac causes of palpitations
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

8. When should invasive eletrophysiologic study should be considered?
Serotypes 16 - 18 - 31 -52 -58
Peptic ulcer disease or gastritis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Colposcopy - Endocervical curettage - and directed cervical biopsy

9. PE for a patient getting an abnormal vaginal bleeding work up
100mg; means patient can be trace protein positive and not be detected
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

10. Prenatal visit schedule for low-risk pregnancies
Generalized Anxiety disorder and panic disorder
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Molluscum contagiosum- pox virus
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

11. What medications can cause heart palpitations?
Hgb - Electrolytes - and TSH
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Albumin; low molecular weight proteins
Pleurisy

12. How can GERD (or esophageal motility disorders) lead to chest pain?
Paroxysmal atrial fibrillation or supraventricular tachycardia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Supraspinatus and bicipital tendons

13. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
ACEi
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Staphylococcal scalded skin syndrome

14. Initial treatment for Rhinosinusitis
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.
A 24hr urine protein collection and urine creatinine clearance determination
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

15. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
CBC
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Furucnle

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Repeat Pap after infection treated
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

17. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Albumin; low molecular weight proteins
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Non-cardiac causes of palpitations

18. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

19. What is the preload?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Increasing fluid (8 - 8oz glasses of water/day) -fiber
HIV and syphilis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

20. What are symptoms are CHF?
Coag disorders
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Generalized Anxiety disorder and panic disorder
Tension headache

21. Metrorrhagia
Varicella virus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Irregular bleeding between cycles
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

22. Describe the presentation tracheobronchitis
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
Upper sternal area burning pain - associated with a productive cough
These patients are associated with low renin states=less likely to respond to medication
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

23. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Streptococci
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

24. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Excessive bleeding in amount - duration - or both at irregular intervals
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Medication or chemical esophagitis

25. What is a markers of CNS vertigo?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Other brainstem or cranial nerve findings

26. What are the indiciations for neuroimaging?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Increase; 200 g/day
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

27. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Bulk forming: Psyllium - Methycellulose - Polycarbophil

28. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Bence-Jones
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
Temporal arteritis-biopsy of the temporal artery
RBC casts and old to moderate HTN

29. Describe the presentation of angina?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Varicella virus
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
High blood pressure - focal neurologic defecit - or papilledema

30. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Bence-Jones
MSK - pulmonary - GI - or psychological
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Repeat Pap after infection treated

31. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Increase; 200 g/day
HPV testing -Pos=colposcopy -Neg=repeat pap smear
CBC

32. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Medication or chemical esophagitis
LH surge triggers ovulation
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

33. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

34. What does treatment for migrans include?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
True
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
Non-cardiac causes of palpitations

35. patients with herpes zoster may experience what symptom before the rash appear?
Folliculitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pain

36. What are signs of pulmonary congestion?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
High blood pressure - focal neurologic defecit - or papilledema

37. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Streptococci
Paroxysmal atrial fibrillation or supraventricular tachycardia
Intermenstrual bleeding
Echocardiogram

38. Irregular cycles with excessive flow - duration - or both
Candida albicans
Coag disorders
>150mg per 24hrs
Menorrhagia

39. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Acute headache - ataxia - profuse nausea - and vomiting
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Coronary artery disease/ angina
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

40. What should be considered in younger patients with menorrhagia
35 (exception for postmenopausal women who have recently been started on HRT)
Coag disorders
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

41. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Acute headache - ataxia - profuse nausea - and vomiting
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
DM - HTN - DVT - seizures - depression - or anxiety

42. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Pts with palpitations and dizziness - near syncope - or syncope
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

43. What is the role of LH in the menstrual cycle
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Other brainstem or cranial nerve findings
LH surge triggers ovulation

44. What are the symptoms of palpitations?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Variability in the time for follicle development during the proliferative phase
Lightheadedness - dizziness - syncope
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

45. SE Of Beta blockers?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

46. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Pancreatitis
Pts with palpitations and dizziness - near syncope - or syncope
PVC or Premature atrial contraction (PAC)

47. When is a lumbar puncture contraindicated?
Less than 3 stools per week
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
A 24hr urine protein collection and urine creatinine clearance determination
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

48. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Upper sternal area burning pain - associated with a productive cough
Adhesive capsulitis (frozen shoulder): most common in middle age women
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

49. History for Acute bronchitis
Bence-Jones
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Medication or chemical esophagitis

50. What drugs do you use to treat H.pylori + PUD?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Candida albicans