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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 are the indiciations for neuroimaging?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
E. Coli O157:H7

2. What are the primary glomerular diseases?
Cholelithiasis
High blood pressure - focal neurologic defecit - or papilledema
Pleurisy
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

3. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Wolff-Parkinson-White syndrome
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

4. How do you know if heart palpitations are due to stimulant or medication use?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Less abrupt onset and cessation of palpitations

5. Where does the development of abnormal cervical cells begin?
GERD
Squamocolumnar junction=most common site of cervical cancer
True
CBC

6. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
HPV
ACEi
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

7. When is a lumbar puncture contraindicated?
Pain
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Colposcopy - Endocervical curettage - and directed cervical biopsy
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

8. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
High blood pressure - focal neurologic defecit - or papilledema
Albumin; low molecular weight proteins

9. Tx of chronic or intermittent afibs
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
Viral infection of the semicircular apparatus
Anticoag with warfarin to prevent thromboembolism
Infectious esophagitis

10. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
DM - HTN - DVT - seizures - depression - or anxiety
Subarachnoid hemorrhage
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

11. Name the skin lesion: pustule in association with a hair follice
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Folliculitis
Fever with frontal or maxillary tenderness
Loop diuretics (Check serum K+ levels before drug admin)

12. Describe the presentation of pericardial pain
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
E. Coli O157:H7
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

13. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Nonulcer dyspepsia
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Repeat Pap after infection treated

14. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
Hgb - Electrolytes - and TSH
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

15. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
High blood pressure - focal neurologic defecit - or papilledema
Furucnle
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

16. What are signs of pulmonary congestion?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Peptic ulcer disease or gastritis
ACEi - ARBS - thiazide diuretics
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

17. History for Sinusitis

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18. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Serotypes 16 - 18 - 31 -52 -58
ACEi - ARBS - thiazide diuretics
Less than 3 stools per week
Viral infection of the semicircular apparatus

19. How to NSAIDs contribute to gastritis and ulcer formation?
Coag disorders
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.
Streptococci
Staphylococcal scalded skin syndrome

20. When should a patient get a stress test?
These patients are associated with low renin states=less likely to respond to medication
EGD
Cellulitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

21. What is the peripheral caUse of vertigo?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Paroxysmal atrial fibrillation or supraventricular tachycardia
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

22. Metrorrhagia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Irregular bleeding between cycles
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

23. What is the role of FSH in one's menstrual cycle
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

24. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Giardia
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
Less than 80 ml of blood
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

25. What are the signs of malignant hypertension?
Candida albicans
Bence-Jones
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
High blood pressure - focal neurologic defecit - or papilledema

26. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Staphylococcal scalded skin syndrome
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
Chest pain during pneumonia or PE

27. Diarrhea from custard filled pastries
S. Aureus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

28. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Colposcopy - Endocervical curettage - and directed cervical biopsy
HPV
Irregular bleeding between cycles

29. MI - pericardial tamponade - PE - GI bleed - are...
ACEi
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Associated with hypotension

30. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
LH surge triggers ovulation
High blood pressure - focal neurologic defecit - or papilledema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

31. What the consequences of decreased cardiac output?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Rotator Cuff tendonitis
True

32. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

33. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Acute headache - ataxia - profuse nausea - and vomiting
Rotator Cuff tendonitis
A 24hr urine protein collection and urine creatinine clearance determination

34. How is constipation clinically defined?
Generalized Anxiety disorder and panic disorder
Less than 3 stools per week
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Less than 80 ml of blood

35. 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
Fever with frontal or maxillary tenderness
Polymenorrhea
Molluscum contagiosum- pox virus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

36. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Echocardiogram
Other brainstem or cranial nerve findings
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

37. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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.

38. After treatment of dysplasia - women need Pap smears every...
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: 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
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

39. What is a markers of CNS vertigo?
With a KOH wet mount preparation
Other brainstem or cranial nerve findings
Tension headache
Repeat Pap after infection treated

40. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Associated with hypotension

41. Pain in shoulder when throwing - swimming - or serving a tennis ball
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Rotator cuff tendonitis

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Albumin; low molecular weight proteins
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CBC
Generalized Anxiety disorder and panic disorder

43. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Less than 80 ml of blood
Albumin; low molecular weight proteins
Cluster headache

44. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Less than 80 ml of blood
Staphylococcal scalded skin syndrome
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Temporal arteritis-biopsy of the temporal artery

45. Pneumonia tx: suitable for healthy adults less than 60
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Less abrupt onset and cessation of palpitations
Scleroderma/polymyositis with secondary gastroesophageal reflux

46. 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
True
Albumin; low molecular weight proteins
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pleurisy

47. Initial treatment for Rhinosinusitis
Infectious esophagitis
Kids: Rotavirus Adults: Norwalk Virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Variability in the time for follicle development during the proliferative phase

48. Predictors of cardiac etiology
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
Bence-Jones
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

49. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
ACEi
Adhesive capsulitis (frozen shoulder): most common in middle age women
Rotator cuff tendonitis

50. Name types of laxatives
Subarachnoid hemorrhage
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 80 ml of blood
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas