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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. What is the mechanism of action for stimulant agents in treating constipation?
S. aureus- beta hemolytic streptococcus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

2. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Impetigo
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
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
Common problem that resolves spontaneously and is most often seen in children and young adults

3. Things that need to be included in history of shoulder pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Pancreatitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

4. What occurs after ovulation
LH surge triggers ovulation
Chest pain during pneumonia or PE
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

5. 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)
Wolff-Parkinson-White syndrome
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Subarachnoid hemorrhage

6. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Cluster headache
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

7. What are the most common viral causes of diarrhea in kids and adults?
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
Tension headache
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
Kids: Rotavirus Adults: Norwalk Virus

8. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

9. What are the physical exam signs of CHF?
Analgesic headache
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
A central clear area

10. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Analgesic headache
Peptic ulcer disease or gastritis
Cluster headache

11. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
LH surge triggers ovulation
A 24hr urine protein collection and urine creatinine clearance determination

12. Name the diagnosis of heartburn: severe constant mid abdominal pain
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pancreatitis
These patients are associated with low renin states=less likely to respond to medication
Less than 80 ml of blood

13. What are the consequences of diastolic dysfunction?
Analgesic headache
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator cuff tendonitis

14. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Echocardiogram
Pts with palpitations and dizziness - near syncope - or syncope
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Polymenorrhea

15. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Temporal arteritis-biopsy of the temporal artery
S. aureus- beta hemolytic streptococcus
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

16. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Analgesic headache
35 (exception for postmenopausal women who have recently been started on HRT)

17. History and PE for Pneumonia
Diuretics -BB -CCB -ACEi
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

18. Diagnostic Evaluation of Abnoraml vaginal bleeding
Folliculitis
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
Cluster headache
S. Aureus

19. What are the two common clinical presentations of acute diarrhea?
RBC casts and old to moderate HTN
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Associated with hypotension

20. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Lightheadedness - dizziness - syncope
Possibility of Ischemic colitis
Streptococci

21. Oligomenorrhea
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Regular bleeding at intervals of more than 35 days
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
Giardia

22. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Pts with palpitations and dizziness - near syncope - or syncope
EGD
PVC or Premature atrial contraction (PAC)
Staphylococcal scalded skin syndrome

23. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Fever with frontal or maxillary tenderness
Irregular bleeding between cycles
Bulk forming: Psyllium - Methycellulose - Polycarbophil
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

24. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
HPV testing -Pos=colposcopy -Neg=repeat pap smear

25. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Furucnle
Generalized Anxiety disorder and panic disorder
S. aureus- beta hemolytic streptococcus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

26. Predictors of cardiac etiology
Scleroderma/polymyositis with secondary gastroesophageal reflux
35 (exception for postmenopausal women who have recently been started on HRT)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
MSK - pulmonary - GI - or psychological

27. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Excessive bleeding in amount - duration - or both at irregular intervals

28. Pain in shoulder when throwing - swimming - or serving a tennis ball
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Scabies
Rotator cuff tendonitis

29. Name the diagnosis of heartburn: regurgitation - dysphagia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
GERD
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

30. What are the signs of acute sinusitis?
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Fever with frontal or maxillary tenderness
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

31. Initial treatment for Rhinosinusitis
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.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

32. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
Scabies
Giardia
Intermenstrual bleeding

33. What treatments are the cornerstone for treating cases of functional constipation?
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
A central clear area
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Subarachnoid hemorrhage

34. How can GERD (or esophageal motility disorders) lead to chest pain?
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.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Diuretics -BB -CCB -ACEi

35. Who should have Xray testing for shoulder pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Adhesive capsulitis (frozen shoulder): most common in middle age women
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.
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

36. What is afterload?
Analgesic headache
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

37. Describe the presentation of pericardial pain
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Serotypes 16 - 18 - 31 -52 -58
Loop diuretics (Check serum K+ levels before drug admin)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

38. What are the signs of cerebral hemorrhage?
E. Coli O157:H7
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Acute headache - ataxia - profuse nausea - and vomiting
Increasing fluid (8 - 8oz glasses of water/day) -fiber

39. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Squamocolumnar junction=most common site of cervical cancer
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
These patients are associated with low renin states=less likely to respond to medication
A 24hr urine protein collection and urine creatinine clearance determination

40. What test done in PE measures instability of shoulder?
These patients are associated with low renin states=less likely to respond to medication
Less than 3 stools per week
Viral gastroenteritis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

41. What the consequences of decreased cardiac output?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
PE - MI - aortic dissection - pneumothorax
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

42. Vaccines that should be updated before planned pregnancy
Other brainstem or cranial nerve findings
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
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

43. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
24 hour halter

44. At was quantity does urine dipstick test detect elevated protein?
Possibility of Ischemic colitis
Pleurisy
Bence-Jones
100mg; means patient can be trace protein positive and not be detected

45. What are the features of nephrotic syndrome?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Acute headache - ataxia - profuse nausea - and vomiting
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

46. Describe the presentation of angina?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pts with palpitations and dizziness - near syncope - or syncope
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

47. Shoulder pain with pain radiating to elbow
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Cervical radiculopathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
CT

48. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
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

49. What medications can cause heart palpitations?
MSK - pulmonary - GI - or psychological
Cervical radiculopathy
Streptococci
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

50. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
35 (exception for postmenopausal women who have recently been started on HRT)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus