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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 places women at higher risk of getting cervical cancer?
Generalized Anxiety disorder and panic disorder
Serotypes 16 - 18 - 31 -52 -58
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

2. What occurs after ovulation
Regular bleeding at intervals of more than 35 days
Non-cardiac causes of palpitations
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

3. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
ACEi - ARBS - thiazide diuretics
A central clear area

4. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
PVC or Premature atrial contraction (PAC)
Medication or chemical esophagitis

5. 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
Nonulcer dyspepsia
High blood pressure - focal neurologic defecit - or papilledema
Wolff-Parkinson-White syndrome

6. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Supraspinatus and bicipital tendons
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

7. Shoulder pain with pain radiating to elbow
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cervical radiculopathy
Analgesic headache
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

8. What is the role of LH in the menstrual cycle
Rotator cuff tendonitis
Anticoag with warfarin to prevent thromboembolism
LH surge triggers ovulation
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

9. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Temporal arteritis-biopsy of the temporal artery
Analgesic headache
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
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

10. 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
Cervical radiculopathy
RBC casts and old to moderate HTN
Folliculitis
Molluscum contagiosum- pox virus

11. Prenatal visit schedule for low-risk pregnancies
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
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

12. What is the role of FSH in one's menstrual cycle
Variability in the time for follicle development during the proliferative phase
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Anticoag with warfarin to prevent thromboembolism
Diuretics -BB -CCB -ACEi

13. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
DM - HTN - DVT - seizures - depression - or anxiety
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Rotator Cuff tendonitis

14. What are the most common viral causes of diarrhea in kids and adults?
Viral gastroenteritis
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
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
Kids: Rotavirus Adults: Norwalk Virus

15. Lab testing for heart palpitation
Polymenorrhea
Hgb - Electrolytes - and TSH
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

16. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Hypertension - CAD - valvular heart disease
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
S. aureus- beta hemolytic streptococcus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

17. What HPV serotypes are most commonly associated with cervical cancer?
EGD
Lightheadedness - dizziness - syncope
Coronary artery disease/ angina
Serotypes 16 - 18 - 31 -52 -58

18. Why is the pap smear one of the most effective cancer screening tools?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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.
Coag disorders
Slow progression of cervical cancer changes -Availability of effective early treatment

19. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Serotypes 16 - 18 - 31 -52 -58

20. What are the three major risk factors for heart failure?
Chest pain during pneumonia or PE
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Possibility of Ischemic colitis
Hypertension - CAD - valvular heart disease

21. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

22. Describe the presentation of pneumonia
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Common problem that resolves spontaneously and is most often seen in children and young adults
EGD
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

23. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Scabies
Albumin; low molecular weight proteins
Wolff-Parkinson-White syndrome
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. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

25. What are the indiciations for neuroimaging?
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
Cervical radiculopathy
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
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

26. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
A central clear area
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

27. What is the goal of CHF treatment? What drugs should be used?
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

28. What drugs do you use to treat H.pylori + PUD?
Viral infection of the semicircular apparatus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Bence-Jones

29. Define the patient population typically affected by orthostatic or postural proteinuria
Subarachnoid hemorrhage
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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

30. What are signs of pulmonary congestion?
Medication or chemical esophagitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

31. 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
Folliculitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Hgb - Electrolytes - and TSH

32. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Nonulcer dyspepsia
High blood pressure - focal neurologic defecit - or papilledema

33. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
PE - MI - aortic dissection - pneumothorax
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

34. Name 4 factors that predispose an individual to develop pneumonia.
ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Albumin; low molecular weight proteins
RBC casts and old to moderate HTN

35. What should preconception counseling include?
Genetic screening - medical assessment for chronic diseases - screening for infectious diseases - and updating of immunizations - advice on proper nutrition and exercise - help with quitting unhealthy habits - and advice on avoiding environmental haz
Supraspinatus and bicipital tendons
Fever with frontal or maxillary tenderness
Warts

36. Define nephrotic range proteinuria
BB or CCB - catheter ablation of identified bypass tract
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
>3.5g of protein per 24hrs
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

37. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Staphylococcal scalded skin syndrome
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
BB or CCB - catheter ablation of identified bypass tract

38. What test done in PE measures instability of shoulder?
Upper sternal area burning pain - associated with a productive cough
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Temporal arteritis-biopsy of the temporal artery
Genetic screening - medical assessment for chronic diseases - screening for infectious diseases - and updating of immunizations - advice on proper nutrition and exercise - help with quitting unhealthy habits - and advice on avoiding environmental haz

39. Regular bleeding at intervals of less than 21 days
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
Polymenorrhea
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Dehydration - anemia - cardiac causes

40. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Viral infection of the semicircular apparatus
Rotator cuff tendonitis
Subarachnoid hemorrhage

41. What does the classic ring worm lesion have?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Excessive bleeding in amount - duration - or both at irregular intervals
A central clear area

42. Metrorrhagia
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Irregular bleeding between cycles
Subarachnoid hemorrhage

43. What are the most common causes for the common cold?
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
E. Coli O157:H7
RBC casts and old to moderate HTN

44. What does orthostatic positional changes that bring on dizziness suggest?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
RBC casts and old to moderate HTN
Cellulitis
Dehydration - anemia - cardiac causes

45. At was quantity does urine dipstick test detect elevated protein?
Giardia
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
100mg; means patient can be trace protein positive and not be detected

46. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Albumin; low molecular weight proteins
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

47. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Kids: Rotavirus Adults: Norwalk Virus
ACEi
Tension headache

48. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Scabies
Slow progression of cervical cancer changes -Availability of effective early treatment
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

49. What are the consequences of diastolic dysfunction?
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
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
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

50. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)