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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. patients with herpes zoster may experience what symptom before the rash appear?
Kids: Rotavirus Adults: Norwalk Virus
Anticoag with warfarin to prevent thromboembolism
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Pain

2. What does the classic ring worm lesion have?
A central clear area
Varicella 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
24 hour halter

3. Cycle length variabilty is primarily due to what?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A central clear area
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Variability in the time for follicle development during the proliferative phase

4. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Menorrhagia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

5. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV
Colposcopy - Endocervical curettage - and directed cervical biopsy
Molluscum contagiosum- pox virus

6. name the 4 emergent causes of chest pain
Rotator Cuff problem
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
PE - MI - aortic dissection - pneumothorax
Acute headache - ataxia - profuse nausea - and vomiting

7. 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
W/in 4hrs and peaks 24hrs; it is important to obtain serial markers since the first set of cardiac markers are negative in 25 - 50% of patients with an acute MI
Adhesive capsulitis (frozen shoulder): most common in middle age women
Varicella virus
CBC

8. At was quantity does urine dipstick test detect elevated protein?
S. Aureus
100mg; means patient can be trace protein positive and not be detected
Cluster headache
CT

9. What test done in PE measures instability of shoulder?
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
Associated with hypotension
Cervical radiculopathy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

10. Name the skin lesion: erythema - warmth - edema - pain - fever
HIV and syphilis
CT
Cellulitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber

11. 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
Excessive bleeding in amount - duration - or both at irregular intervals
Molluscum contagiosum- pox virus
Hgb - Electrolytes - and TSH
Cholelithiasis

12. How can GERD (or esophageal motility disorders) lead to chest pain?
24 hour halter
Non-cardiac causes of palpitations
Paroxysmal atrial fibrillation or supraventricular tachycardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

13. Natural history of cervical cancer
Infectious esophagitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

14. Name the skin lesion: pustule in association with a hair follice
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
Less than 80 ml of blood
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Folliculitis

15. What are the secondly causes of glomerular disease?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Slow progression of cervical cancer changes -Availability of effective early treatment

16. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Intermenstrual bleeding
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
Candida albicans
Cluster headache

17. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Rotator Cuff tendonitis
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days

18. What places women at higher risk of getting cervical cancer?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Varicella virus

19. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.
Variability in the time for follicle development during the proliferative phase

20. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Viral gastroenteritis
Impetigo
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

21. What are the signs of cerebral hemorrhage?
Supraspinatus and bicipital tendons
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Acute headache - ataxia - profuse nausea - and vomiting

22. Oligomenorrhea
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Regular bleeding at intervals of more than 35 days
Pts with palpitations and dizziness - near syncope - or syncope
Slow progression of cervical cancer changes -Availability of effective early treatment

23. Name the diagnosis of heartburn: severe constant mid abdominal pain
S. aureus- beta hemolytic streptococcus
Pancreatitis
PVC or Premature atrial contraction (PAC)
MSK - pulmonary - GI - or psychological

24. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Coronary artery disease/ angina
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
Polymenorrhea
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

25. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Colposcopy - Endocervical curettage - and directed cervical biopsy
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Possibility of Ischemic colitis
Wolff-Parkinson-White syndrome

26. Why is the pap smear one of the most effective cancer screening tools?
Excessive bleeding in amount - duration - or both at irregular intervals
Rotator cuff tendonitis
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
Slow progression of cervical cancer changes -Availability of effective early treatment

27. How do you define persistent protein uria?
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.
Presence of proteinuria on at least two separate ocassion
Staphylococcal scalded skin syndrome
Medication or chemical esophagitis

28. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

29. Four muscles of rotator cuff
Variability in the time for follicle development during the proliferative phase
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
>150mg per 24hrs
Coag disorders

30. Describe the presentation of pneumonia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

31. Where does the development of abnormal cervical cells begin?
Acute headache - ataxia - profuse nausea - and vomiting
Squamocolumnar junction=most common site of cervical cancer
Variability in the time for follicle development during the proliferative phase
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

32. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Dehydration - anemia - cardiac causes
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

33. Shoulder pain with pain radiating to elbow
Acute headache - ataxia - profuse nausea - and vomiting
Cervical radiculopathy
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
LH surge triggers ovulation

34. What type of imaging is need for chronic sinusitis?
CT
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Diuretics -BB -CCB -ACEi

35. What are the most common viral causes of diarrhea in kids and adults?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
PVC or Premature atrial contraction (PAC)
Kids: Rotavirus Adults: Norwalk Virus

36. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
A 24hr urine protein collection and urine creatinine clearance determination
Folliculitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
High blood pressure - focal neurologic defecit - or papilledema
S. Aureus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Bence-Jones

38. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
CBC
CT
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

39. What are the two common clinical presentations of acute diarrhea?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
High blood pressure - focal neurologic defecit - or papilledema
Cellulitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

40. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
GERD
Medication or chemical esophagitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
S. aureus- beta hemolytic streptococcus

41. What are symptoms are CHF?
Albumin; low molecular weight proteins
RBC casts and old to moderate HTN
These patients are associated with low renin states=less likely to respond to medication
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Pts with palpitations and dizziness - near syncope - or syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Staphylococcal scalded skin syndrome
Scleroderma/polymyositis with secondary gastroesophageal reflux

43. Prenatal visit schedule for low-risk pregnancies
Cellulitis
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

44. Diarrhea from custard filled pastries
Variability in the time for follicle development during the proliferative phase
S. Aureus
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

45. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

46. Describes what occurs during squamous metaplasia of the cervix.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Warts
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Fever with frontal or maxillary tenderness

47. What medications can cause heart palpitations?
Wolff-Parkinson-White syndrome
>3.5g of protein per 24hrs
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

48. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Peptic ulcer disease or gastritis
Squamocolumnar junction=most common site of cervical cancer
True

49. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Non-cardiac causes of palpitations
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

50. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Repeat Pap after infection treated
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Nonulcer dyspepsia