Test your basic knowledge |

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. How do you know if heart palpitations are due to stimulant or medication use?
Giardia
Less abrupt onset and cessation of palpitations
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Intermenstrual bleeding

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Varicella virus
24 hour halter
EGD
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

3. What is the mechanism of action for stimulant agents in treating constipation?
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)
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

4. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Polymenorrhea

5. Irregular cycles with excessive flow - duration - or both
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Menorrhagia
35 (exception for postmenopausal women who have recently been started on HRT)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

6. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Coag disorders
Kids: Rotavirus Adults: Norwalk Virus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

7. Diagnosis of HTN
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
HPV testing -Pos=colposcopy -Neg=repeat pap smear

8. Prenatal visit schedule for low-risk pregnancies
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

9. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Generalized Anxiety disorder and panic disorder
EGD

10. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
Bence-Jones
Cellulitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

11. What is the caUse of Meniere disease? What are the cardinal symptoms?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

12. Name types of laxatives
Less than 3 stools per week
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
Menorrhagia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

13. Define nephrotic range proteinuria
PVC or Premature atrial contraction (PAC)
Pancreatitis
>3.5g of protein per 24hrs
Albumin; low molecular weight proteins

14. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Pain
Varicella virus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Chest pain during pneumonia or PE

15. What are the signs of cerebral hemorrhage?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Acute headache - ataxia - profuse nausea - and vomiting
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Infectious esophagitis

16. Regular bleeding at intervals of less than 21 days
Giardia
Nonulcer dyspepsia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Polymenorrhea

17. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
RBC casts and old to moderate HTN

18. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Other brainstem or cranial nerve findings
DM - HTN - DVT - seizures - depression - or anxiety

19. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Less than 80 ml of blood
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Temporal arteritis-biopsy of the temporal artery
Cervical radiculopathy

20. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
RBC casts and old to moderate HTN
Subarachnoid hemorrhage
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

21. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Staphylococcal scalded skin syndrome
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Molluscum contagiosum- pox virus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

22. What are the signs of malignant hypertension?
Presence of proteinuria on at least two separate ocassion
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
High blood pressure - focal neurologic defecit - or papilledema
Hypertension - CAD - valvular heart disease

23. Diarrhea is defined as an ____ in stool weight to more than ____g per day
A 24hr urine protein collection and urine creatinine clearance determination
Increase; 200 g/day
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
Impetigo

24. Why don't ACEi work well for the elderly and African Americans when treating HTN?
PE - MI - aortic dissection - pneumothorax
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
These patients are associated with low renin states=less likely to respond to medication
Scleroderma/polymyositis with secondary gastroesophageal reflux

25. What lab tests are recommended for newly diagnosed hypertensive patients?
Tension headache
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

26. patients with herpes zoster may experience what symptom before the rash appear?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Pain

27. Name the skin lesion: honey colored crusts
Scabies
Impetigo
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Infectious esophagitis

28. Difference between Pneumonia and Bronchitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
>3.5g of protein per 24hrs
Rotator cuff tendonitis

29. Oligomenorrhea
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Irregular bleeding between cycles
Regular bleeding at intervals of more than 35 days
Scleroderma/polymyositis with secondary gastroesophageal reflux

30. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

31. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Upper sternal area burning pain - associated with a productive cough
Coronary artery disease/ angina
Increasing fluid (8 - 8oz glasses of water/day) -fiber

32. Mainstay treatment for soft tissue inflammation (Shoulder)
Staphylococcal scalded skin syndrome
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

33. 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
S. Aureus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Molluscum contagiosum- pox virus
Rotator cuff tendonitis

34. History and PE for Pneumonia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Variability in the time for follicle development during the proliferative phase

35. What are the three major risk factors for heart failure?
LH surge triggers ovulation
Bence-Jones
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
Hypertension - CAD - valvular heart disease

36. Define the patient population typically affected by orthostatic or postural proteinuria
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Presence of proteinuria on at least two separate ocassion

37. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Candida albicans
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

38. What the consequences of decreased cardiac output?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Lightheadedness - dizziness - syncope
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

39. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Loop diuretics (Check serum K+ levels before drug admin)
Coronary artery disease/ angina
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

40. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Viral infection of the semicircular apparatus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

41. What are the most common viral causes of diarrhea in kids and adults?
Cholelithiasis
35 (exception for postmenopausal women who have recently been started on HRT)
CT
Kids: Rotavirus Adults: Norwalk Virus

42. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
35 (exception for postmenopausal women who have recently been started on HRT)
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
Wolff-Parkinson-White syndrome

43. What type of imaging is need for chronic sinusitis?
Paroxysmal atrial fibrillation or supraventricular tachycardia
CT
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pain

44. What is the Barany maneuver?
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
100mg; means patient can be trace protein positive and not be detected

45. What treatments are the cornerstone for treating cases of functional constipation?
Intermenstrual bleeding
Other brainstem or cranial nerve findings
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

46. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
MSK - pulmonary - GI - or psychological
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
Other brainstem or cranial nerve findings
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

47. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Associated with hypotension
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Echocardiogram

48. What does treatment for migrans include?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Molluscum contagiosum- pox virus
Bence-Jones
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

49. Why is the pap smear one of the most effective cancer screening tools?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Slow progression of cervical cancer changes -Availability of effective early treatment
Presence of proteinuria on at least two separate ocassion
Warts

50. How are fungal infections diagnosed?
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
Dehydration - anemia - cardiac causes
With a KOH wet mount preparation
Less than 80 ml of blood