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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. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
S. aureus- beta hemolytic streptococcus
Menorrhagia
Viral gastroenteritis

2. Describes what occurs during squamous metaplasia of the cervix.
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
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.

3. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
S. Aureus
Paroxysmal atrial fibrillation or supraventricular tachycardia

4. What are symptoms are CHF?
Viral infection of the semicircular apparatus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

5. What are the signs of acute sinusitis?
With a KOH wet mount preparation
Fever with frontal or maxillary tenderness
ACEi
Pts with palpitations and dizziness - near syncope - or syncope

6. Prenatal visit schedule for low-risk pregnancies
These patients are associated with low renin states=less likely to respond to medication
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
Rotator Cuff problem
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

7. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

8. Pain in shoulder when throwing - swimming - or serving a tennis ball
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Rotator cuff tendonitis
PVC or Premature atrial contraction (PAC)
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

9. 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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Menorrhagia
Subarachnoid hemorrhage

10. Cycle length variabilty is primarily due to what?
Varicella virus
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
Variability in the time for follicle development during the proliferative phase
EGD

11. What does orthostatic positional changes that bring on dizziness suggest?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Colposcopy - Endocervical curettage - and directed cervical biopsy
Kids: Rotavirus Adults: Norwalk Virus
Dehydration - anemia - cardiac causes

12. Pneumonia tx: suitable for healthy adults less than 60
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
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.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

13. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bence-Jones
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Medication or chemical esophagitis

14. Why is the pap smear one of the most effective cancer screening tools?
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Slow progression of cervical cancer changes -Availability of effective early treatment

15. Name the skin lesion: pustule in association with a hair follice
Adhesive capsulitis (frozen shoulder): most common in middle age women
Streptococci
Folliculitis
Kids: Rotavirus Adults: Norwalk Virus

16. Metrorrhagia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Common problem that resolves spontaneously and is most often seen in children and young adults
Irregular bleeding between cycles

17. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Rotator Cuff tendonitis
Squamocolumnar junction=most common site of cervical cancer
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

18. After treatment of dysplasia - women need Pap smears every...
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
S. Aureus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

19. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Increase; 200 g/day
Medication or chemical esophagitis
CT
HIV and syphilis

20. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Warts
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
Coag disorders
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

21. What are the three major risk factors for heart failure?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Hypertension - CAD - valvular heart disease
Cholelithiasis
CT

22. PE for a patient getting an abnormal vaginal bleeding work up
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pancreatitis
A 24hr urine protein collection and urine creatinine clearance determination

23. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Repeat Pap after infection treated
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Acute headache - ataxia - profuse nausea - and vomiting
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

24. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Hypertension - CAD - valvular heart disease
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Nonulcer dyspepsia
Coag disorders

25. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Other brainstem or cranial nerve findings
Hypertension - CAD - valvular heart disease
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
24 hour halter

26. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
E. Coli O157:H7

27. Regular bleeding at intervals of less than 21 days
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Infectious esophagitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Polymenorrhea

28. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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.
Increase; 200 g/day
Pleurisy
HPV

29. Name the skin lesion: erythema - warmth - edema - pain - fever
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cellulitis
Polymenorrhea
Tension headache

30. Initial treatment for Rhinosinusitis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

31. When does troponin rise following myocardial injury or infarction?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
>3.5g of protein per 24hrs

32. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Subarachnoid hemorrhage
Repeat Pap after infection treated
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

33. Clinical Manifestations of HTN
35 (exception for postmenopausal women who have recently been started on HRT)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Bence-Jones
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

34. What are the most common viral causes of diarrhea in kids and adults?
Paroxysmal atrial fibrillation or supraventricular tachycardia
ACEi
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.
Kids: Rotavirus Adults: Norwalk Virus

35. What are the primary glomerular diseases?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
PVC or Premature atrial contraction (PAC)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Infectious esophagitis

36. Carcinoma in situ is generally referred to a gynecologist and requires ______
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
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
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

37. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Less abrupt onset and cessation of palpitations
Viral infection of the semicircular apparatus
Cluster headache
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

38. History and PE for Pneumonia
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

39. Tx of chronic or intermittent afibs
35 (exception for postmenopausal women who have recently been started on HRT)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Anticoag with warfarin to prevent thromboembolism

40. 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
Varicella virus
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
Repeat Pap after infection treated
Intermenstrual bleeding

41. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Bence-Jones
Temporal arteritis-biopsy of the temporal artery
Less than 80 ml of blood
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

42. 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
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
Peptic ulcer disease or gastritis
Giardia

43. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
PE - MI - aortic dissection - pneumothorax
Polymenorrhea
Paroxysmal atrial fibrillation or supraventricular tachycardia

44. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Generalized Anxiety disorder and panic disorder
Pleurisy
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

45. 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
Upper sternal area burning pain - associated with a productive cough
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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.

46. How are fungal infections diagnosed?
Lightheadedness - dizziness - syncope
With a KOH wet mount preparation
Repeat Pap after infection treated
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

47. Things that need to be included in history of shoulder pain
Less than 80 ml of blood
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
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

48. Describe the presentation of angina?
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

49. Diagnosis of HTN
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
Candida albicans
Hypertension - CAD - valvular heart disease
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

50. 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
HPV
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Scabies
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct