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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: pustule in association with a hair follice
Folliculitis
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
Excessive bleeding in amount - duration - or both at irregular intervals
Cluster headache

2. Shoulder pain with pain radiating to elbow
Coronary artery disease/ angina
Cervical radiculopathy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

3. Diagnostic Evaluation of Abnoraml vaginal bleeding
Candida albicans
Intermenstrual bleeding
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

4. Vaccines that should be updated before planned pregnancy
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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
>150mg per 24hrs

5. At was quantity does urine dipstick test detect elevated protein?
PE - MI - aortic dissection - pneumothorax
Rotator Cuff tendonitis
100mg; means patient can be trace protein positive and not be detected
24 hour halter

6. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Paroxysmal atrial fibrillation or supraventricular tachycardia

7. 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
24 hour halter
Analgesic headache
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

8. What is the role of FSH in one's menstrual cycle
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Viral gastroenteritis

9. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Hypertension - CAD - valvular heart disease
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

10. Initial treatment for Rhinosinusitis
S. aureus- beta hemolytic streptococcus
Analgesic headache
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

11. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Tension headache
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
Viral infection of the semicircular apparatus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

12. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Infectious esophagitis
Loop diuretics (Check serum K+ levels before drug admin)
Squamocolumnar junction=most common site of cervical cancer

13. Predictors of cardiac etiology
CT
Upper sternal area burning pain - associated with a productive cough
Peptic ulcer disease or gastritis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

14. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
S. aureus- beta hemolytic streptococcus
E. Coli O157:H7
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

15. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Staphylococcal scalded skin syndrome
Giardia
Higher filling presure - pulmonary congestion - and decreasd cardiac return

16. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Cellulitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
MSK - pulmonary - GI - or psychological

17. Name the skin lesion: erythema - warmth - edema - pain - fever
Acute headache - ataxia - profuse nausea - and vomiting
Non-cardiac causes of palpitations
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cellulitis

18. 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
Upper sternal area burning pain - associated with a productive cough
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

19. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Giardia

20. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Nonulcer dyspepsia
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
Anticoag with warfarin to prevent thromboembolism

21. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
A central clear area
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
GERD
Possibility of Ischemic colitis

22. PE for a patient getting an abnormal vaginal bleeding work up
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
Furucnle
Non-cardiac causes of palpitations

23. What type of imaging is need for chronic sinusitis?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
CT
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

24. What is the standard tool used for diagnosis of GERD?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
High blood pressure - focal neurologic defecit - or papilledema
Non-cardiac causes of palpitations
EGD

25. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
These patients are associated with low renin states=less likely to respond to medication
MSK - pulmonary - GI - or psychological
Scleroderma/polymyositis with secondary gastroesophageal reflux

26. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
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
Hypertension - CAD - valvular heart disease
Anticoag with warfarin to prevent thromboembolism

27. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Anticoag with warfarin to prevent thromboembolism
Varicella virus

28. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Supraspinatus and bicipital tendons

29. How are fungal infections diagnosed?
Generalized Anxiety disorder and panic disorder
With a KOH wet mount preparation
Intermenstrual bleeding
Adhesive capsulitis (frozen shoulder): most common in middle age women

30. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
MSK - pulmonary - GI - or psychological
Fever with frontal or maxillary tenderness
Hypertension - CAD - valvular heart disease

31. How do you know if heart palpitations are due to stimulant or medication use?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Varicella virus
Less abrupt onset and cessation of palpitations
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

32. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Kids: Rotavirus Adults: Norwalk Virus
Streptococci
Peptic ulcer disease or gastritis
Folliculitis

33. History for Sinusitis

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34. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Warts
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

35. Metrorrhagia
Rotator Cuff problem
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Chest pain during pneumonia or PE
Irregular bleeding between cycles

36. What is the mechanism of action for stimulant agents in treating constipation?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Rotator Cuff problem
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

37. What does orthostatic positional changes that bring on dizziness suggest?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dehydration - anemia - cardiac causes
HPV
PE - MI - aortic dissection - pneumothorax

38. What are the signs of acute sinusitis?
35 (exception for postmenopausal women who have recently been started on HRT)
Fever with frontal or maxillary tenderness
Medication or chemical esophagitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

39. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

40. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Bence-Jones
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.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

41. SE Of Beta blockers?
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
Anticoag with warfarin to prevent thromboembolism
Echocardiogram
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

42. What does treatment for migrans include?
CBC
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
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
Lightheadedness - dizziness - syncope

43. When is a lumbar puncture contraindicated?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Anticoag with warfarin to prevent thromboembolism

44. Name the diagnosis of heartburn: severe constant mid abdominal pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pancreatitis
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
>150mg per 24hrs

45. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Less than 3 stools per week
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

46. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
HIV and syphilis
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

47. Name the diagnosis of heartburn: regurgitation - dysphagia
Regular bleeding at intervals of more than 35 days
GERD
High blood pressure - focal neurologic defecit - or papilledema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

48. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
These patients are associated with low renin states=less likely to respond to medication
Infectious esophagitis
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

49. What diagnosis does the 'worse headache of my life' suggest?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Increase; 200 g/day
Subarachnoid hemorrhage

50. What are the secondly causes of glomerular disease?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV