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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. When should a patient get a stress test?
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.
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.
Polymenorrhea
When the patient has symptoms in association with exercise or who describe chest pain or pressure

2. What are the consequences of diastolic dysfunction?
Scabies
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Adhesive capsulitis (frozen shoulder): most common in middle age women

3. What diagnosis does the 'worse headache of my life' suggest?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
PE - MI - aortic dissection - pneumothorax
Pancreatitis
Subarachnoid hemorrhage

4. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Pts with palpitations and dizziness - near syncope - or syncope
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Rotator cuff tendonitis

5. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Analgesic headache
ACEi

6. What is the caUse of benign positional vertigo?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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.
Coronary artery disease/ angina

7. What are the common causes for laryngitis?
Dehydration - anemia - cardiac causes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Influenza - Rhinovirus - Adenovirus - Parainfluenza

8. Describe the presentation of myocardial pain?
True
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
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

9. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Coag disorders
Echocardiogram
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
ACEi - ARBS - thiazide diuretics

10. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Loop diuretics (Check serum K+ levels before drug admin)
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

11. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Coronary artery disease/ angina
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Increase; 200 g/day
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

12. Who should have Xray testing for shoulder pain?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Repeat Pap after infection treated
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

13. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.
Nonulcer dyspepsia
Pleurisy

14. What is a markers of CNS vertigo?
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
Cervical radiculopathy
Other brainstem or cranial nerve findings
Less than 80 ml of blood

15. How to NSAIDs contribute to gastritis and ulcer formation?
Analgesic headache
Generalized Anxiety disorder and panic disorder
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.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

16. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Pain
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

17. 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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

18. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

19. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Chest pain during pneumonia or PE
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
CBC

20. Name the skin lesion: honey colored crusts
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
Impetigo
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
PE - MI - aortic dissection - pneumothorax

21. What is the difference between a Holter monitor or an event monitor?
Loop diuretics (Check serum K+ levels before drug admin)
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Menorrhagia

22. Diagnosis of HTN
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

23. What is the peripheral caUse of vertigo?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Kids: Rotavirus Adults: Norwalk Virus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

24. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
High blood pressure - focal neurologic defecit - or papilledema
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
Associated with hypotension
Paroxysmal atrial fibrillation or supraventricular tachycardia

25. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Echocardiogram
Increase; 200 g/day
Cholelithiasis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

26. 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.
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
Analgesic headache
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Supraspinatus and bicipital tendons

27. Describes what occurs during squamous metaplasia of the cervix.
Varicella virus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
MSK - pulmonary - GI - or psychological
Peptic ulcer disease or gastritis

28. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Coag disorders

29. Describe the presentation of angina?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pancreatitis
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
EGD

30. How does systolic vs. diastolic heart failure present on the echocardiogram?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Impetigo
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

31. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Upper sternal area burning pain - associated with a productive cough
Candida albicans

32. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
24 hour halter
Common problem that resolves spontaneously and is most often seen in children and young adults
Furucnle
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

33. Tx of chronic or intermittent afibs
Pleurisy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
E. Coli O157:H7
Anticoag with warfarin to prevent thromboembolism

34. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Medication or chemical esophagitis

35. What lab tests are recommended for newly diagnosed hypertensive patients?
Dehydration - anemia - cardiac causes
Possibility of Ischemic colitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Tension headache

36. What the consequences of decreased cardiac output?
Presence of proteinuria on at least two separate ocassion
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Rotator Cuff problem
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

37. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
High blood pressure - focal neurologic defecit - or papilledema

38. Isolated - extra pounding beats
Cholelithiasis
PVC or Premature atrial contraction (PAC)
Less than 80 ml of blood
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

39. What should be considered in younger patients with menorrhagia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Coag disorders
Rotator Cuff tendonitis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

40. Pneumonia tx: suitable for healthy adults older than 60
A central clear area
Less abrupt onset and cessation of palpitations
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

41. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Analgesic headache
Echocardiogram
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Viral gastroenteritis

42. What is considered normal blood loss during a menstrual cycle?
Generalized Anxiety disorder and panic disorder
Less than 80 ml of blood
Tension headache
Scleroderma/polymyositis with secondary gastroesophageal reflux

43. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
With a KOH wet mount preparation
Chest pain during pneumonia or PE

44. What places women at higher risk of getting cervical cancer?
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
Increase; 200 g/day
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Other brainstem or cranial nerve findings

45. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
35 (exception for postmenopausal women who have recently been started on HRT)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

46. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Nonulcer dyspepsia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
E. Coli O157:H7

47. Name 4 factors that predispose an individual to develop pneumonia.
Warts
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
A 24hr urine protein collection and urine creatinine clearance determination
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

48. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Echocardiogram
Repeat Pap after infection treated

49. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Cellulitis
Kids: Rotavirus Adults: Norwalk Virus
Acute headache - ataxia - profuse nausea - and vomiting

50. Irregular cycles with excessive flow - duration - or both
Menorrhagia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport