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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. PE for a patient getting an abnormal vaginal bleeding work up
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

2. Why is the pap smear one of the most effective cancer screening tools?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Slow progression of cervical cancer changes -Availability of effective early treatment
Medication or chemical esophagitis
Wolff-Parkinson-White syndrome

3. What should be considered in younger patients with menorrhagia
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.
Molluscum contagiosum- pox virus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Coag disorders

4. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
24 hour halter
Folliculitis
High blood pressure - focal neurologic defecit - or papilledema
Analgesic headache

5. Name the skin lesion: erythema - warmth - edema - pain - fever
True
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Coag disorders
Cellulitis

6. What are symptoms are CHF?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Lightheadedness - dizziness - syncope
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Higher filling presure - pulmonary congestion - and decreasd cardiac return

7. Describe the presentation of angina?
CBC
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

8. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Analgesic headache
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
Coronary artery disease/ angina
These patients are associated with low renin states=less likely to respond to medication

9. Cycle length variabilty is primarily due to what?
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
High blood pressure - focal neurologic defecit - or papilledema
Variability in the time for follicle development during the proliferative phase
HPV

10. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Cellulitis
Excessive bleeding in amount - duration - or both at irregular intervals
Diuretics -BB -CCB -ACEi

11. What are the symptoms of palpitations?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Lightheadedness - dizziness - syncope
CT
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

12. Uterine bleeding between regular cycles
Menorrhagia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Intermenstrual bleeding
Dehydration - anemia - cardiac causes

13. 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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Adhesive capsulitis (frozen shoulder): most common in middle age women
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Varicella virus

14. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
DM - HTN - DVT - seizures - depression - or anxiety
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

15. Name 4 factors that predispose an individual to develop pneumonia.
Peptic ulcer disease or gastritis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

16. Pneumonia tx: suitable for healthy adults less than 60
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cholelithiasis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

17. What are the two common clinical presentations of acute diarrhea?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Albumin; low molecular weight proteins
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

18. How do you know if heart palpitations are due to stimulant or medication use?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Less abrupt onset and cessation of palpitations
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Bence-Jones

19. What HPV serotypes are most commonly associated with cervical cancer?
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.
Polymenorrhea
Serotypes 16 - 18 - 31 -52 -58
Echocardiogram

20. What is the role of FSH in one's menstrual cycle
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

21. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Irregular bleeding between cycles
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

22. Describe the presentation of pneumonia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

23. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
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
Diuretics -BB -CCB -ACEi
Non-cardiac causes of palpitations

24. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Slow progression of cervical cancer changes -Availability of effective early treatment
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

25. Diarrhea from custard filled pastries
S. Aureus
Repeat Pap after infection treated
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bulk forming: Psyllium - Methycellulose - Polycarbophil

26. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Giardia
Streptococci
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.

27. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Peptic ulcer disease or gastritis

28. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Squamocolumnar junction=most common site of cervical cancer
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
Generalized Anxiety disorder and panic disorder

29. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Warts
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
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

30. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
A 24hr urine protein collection and urine creatinine clearance determination
Furucnle

31. Difference between Pneumonia and Bronchitis
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
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

32. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Albumin; low molecular weight proteins

33. What diagnosis does the 'worse headache of my life' suggest?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Analgesic headache
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Subarachnoid hemorrhage

34. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Rotator Cuff tendonitis
Cholelithiasis
BB or CCB - catheter ablation of identified bypass tract
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

35. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Fever with frontal or maxillary tenderness
Medication or chemical esophagitis
EGD

36. What is afterload?
S. aureus- beta hemolytic streptococcus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

37. Describe the presentation of myocardial pain?
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.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Scabies

38. What occurs after ovulation
Adhesive capsulitis (frozen shoulder): most common in middle age women
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
High blood pressure - focal neurologic defecit - or papilledema
Warts

39. What are signs of pulmonary congestion?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Molluscum contagiosum- pox virus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

40. Regular bleeding at intervals of less than 21 days
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Polymenorrhea
Menorrhagia
Hgb - Electrolytes - and TSH

41. Pneumothorax - sudden sharp chest pain - preceded by viral illness
S. Aureus
Candida albicans
Pleurisy
Kids: Rotavirus Adults: Norwalk Virus

42. Define proteinuria
Hypertension - CAD - valvular heart disease
>150mg per 24hrs
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
ACEi - ARBS - thiazide diuretics

43. 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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

44. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Scabies
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
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

45. How does systolic vs. diastolic heart failure present on the echocardiogram?
Less than 3 stools per week
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
RBC casts and old to moderate HTN

46. Chronic pain and shoulder stiffness with limited motion
Upper sternal area burning pain - associated with a productive cough
Adhesive capsulitis (frozen shoulder): most common in middle age women
Rotator Cuff problem
Cluster headache

47. What is the preload?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.
Common problem that resolves spontaneously and is most often seen in children and young adults

48. What test done in PE measures instability of shoulder?
Repeat Pap after infection treated
Molluscum contagiosum- pox virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

49. 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
E. Coli O157:H7
Echocardiogram
Infectious esophagitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

50. What are the primary glomerular diseases?
E. Coli O157:H7
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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.
35 (exception for postmenopausal women who have recently been started on HRT)