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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. Constipation: What are indications for lab testing?
Associated with hypotension
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

2. patients with herpes zoster may experience what symptom before the rash appear?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

3. What is the difference between a Holter monitor or an event monitor?
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Intermenstrual bleeding
Cholelithiasis

4. What are the indiciations for neuroimaging?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
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
Less than 80 ml of blood

5. Name the diagnosis of heartburn: severe constant mid abdominal pain
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pancreatitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

6. Define nephrotic range proteinuria
Rotator cuff tendonitis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Dehydration - anemia - cardiac causes
>3.5g of protein per 24hrs

7. 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)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

8. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
CBC
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

9. HIgh risk pregnant patients should be evaluated for ____ and ____
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
GERD
HIV and syphilis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

10. What lab tests are recommended for newly diagnosed hypertensive patients?
Cluster headache
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
GERD

11. Describes what occurs during squamous metaplasia of the cervix.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Particulate matter or otoliths may form in the semicircular canal. The otoliths become dislodged and stimulate the sensory hair cells in the semicircular canals - leading to vertigo.

12. What the consequences of decreased cardiac output?
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
CBC
Kids: Rotavirus Adults: Norwalk Virus
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

13. Natural history of cervical cancer
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
MSK - pulmonary - GI - or psychological

14. Describe the presentation of pericardial pain
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

15. Describe the presentation tracheobronchitis
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
Candida albicans
Upper sternal area burning pain - associated with a productive cough
Serotypes 16 - 18 - 31 -52 -58

16. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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
S. aureus- beta hemolytic streptococcus
Squamocolumnar junction=most common site of cervical cancer
Infectious esophagitis

17. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

18. What are the primary glomerular diseases?
Colposcopy - Endocervical curettage - and directed cervical biopsy
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Variability in the time for follicle development during the proliferative phase

19. 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.
Supraspinatus and bicipital tendons
Impetigo
Repeat Pap after infection treated
Infectious esophagitis

20. Describe the presentation of angina?
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

21. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Scleroderma/polymyositis with secondary gastroesophageal reflux
Varicella virus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

22. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Streptococci
Adhesive capsulitis (frozen shoulder): most common in middle age women
Dehydration - anemia - cardiac causes

23. What is the next best step if a patient has two or more positive dipstick tests?
Cervical radiculopathy
A 24hr urine protein collection and urine creatinine clearance determination
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

24. After treatment of dysplasia - women need Pap smears every...
Serotypes 16 - 18 - 31 -52 -58
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral infection of the semicircular apparatus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

25. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Temporal arteritis-biopsy of the temporal artery
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

26. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Medication or chemical esophagitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Peptic ulcer disease or gastritis
Fever with frontal or maxillary tenderness

27. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Possibility of Ischemic colitis
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.
CT

28. Name the skin lesion: pustule in association with a hair follice
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Folliculitis
Nonulcer dyspepsia

29. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
Supraspinatus and bicipital tendons
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

30. Carcinoma in situ is generally referred to a gynecologist and requires ______
MSK - pulmonary - GI - or psychological
Repeat Pap after infection treated
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

31. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Colposcopy - Endocervical curettage - and directed cervical biopsy

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

33. What are the signs of cerebral hemorrhage?
ACEi
E. Coli O157:H7
Acute headache - ataxia - profuse nausea - and vomiting
Colposcopy - Endocervical curettage - and directed cervical biopsy

34. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
>150mg per 24hrs
Associated with hypotension
Staphylococcal scalded skin syndrome
Regular bleeding at intervals of more than 35 days

35. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV testing -Pos=colposcopy -Neg=repeat pap smear

36. Define proteinuria
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Rotator cuff tendonitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
>150mg per 24hrs

37. How does CHF present on X-ray?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

38. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Varicella virus
These patients are associated with low renin states=less likely to respond to medication
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

39. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
Subarachnoid hemorrhage
BB or CCB - catheter ablation of identified bypass tract
ACEi

40. How to NSAIDs contribute to gastritis and ulcer formation?
Coronary artery disease/ angina
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.
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral infection of the semicircular apparatus

41. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Chest pain during pneumonia or PE
Slow progression of cervical cancer changes -Availability of effective early treatment
Lightheadedness - dizziness - syncope

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
>3.5g of protein per 24hrs
PVC or Premature atrial contraction (PAC)
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. Shoulder pain with pain radiating to elbow
RBC casts and old to moderate HTN
Temporal arteritis-biopsy of the temporal artery
Cervical radiculopathy
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

44. What are the features of nephrotic syndrome?
Cholelithiasis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
ACEi
Dehydration - anemia - cardiac causes

45. What are the physical exam signs of CHF?
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
Peptic ulcer disease or gastritis
24 hour halter
Temporal arteritis-biopsy of the temporal artery

46. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Pts with palpitations and dizziness - near syncope - or syncope
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

47. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Pleurisy
Supraspinatus and bicipital tendons
DM - HTN - DVT - seizures - depression - or anxiety
Molluscum contagiosum- pox virus

48. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
GERD
DM - HTN - DVT - seizures - depression - or anxiety
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Intermenstrual bleeding

49. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Analgesic headache
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

50. Name 4 factors that predispose an individual to develop pneumonia.
EGD
ACEi
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport