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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. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Fever with frontal or maxillary tenderness
EGD

2. What are symptoms are CHF?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral infection of the semicircular apparatus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

3. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Squamocolumnar junction=most common site of cervical cancer
Cholelithiasis
Increasing fluid (8 - 8oz glasses of water/day) -fiber

4. Name some medications that can cause proteinuria
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
Associated with hypotension
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

5. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
With a KOH wet mount preparation

6. Constipation: What are indications for lab testing?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Peptic ulcer disease or gastritis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

7. How can GERD (or esophageal motility disorders) lead to chest pain?
Pancreatitis
Cervical radiculopathy
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.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

8. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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.
Temporal arteritis-biopsy of the temporal artery
Subarachnoid hemorrhage

9. Name the skin lesion: pustule in association with a hair follice
Folliculitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

10. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pleurisy
Viral infection of the semicircular apparatus

11. Chronic pain and shoulder stiffness with limited motion
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Streptococci
Adhesive capsulitis (frozen shoulder): most common in middle age women
HPV

12. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Analgesic headache
CBC
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

13. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Variability in the time for follicle development during the proliferative phase
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

14. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
DM - HTN - DVT - seizures - depression - or anxiety
35 (exception for postmenopausal women who have recently been started on HRT)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

15. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
24 hour halter
Less than 80 ml of blood
S. aureus- beta hemolytic streptococcus

16. At was quantity does urine dipstick test detect elevated protein?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Other brainstem or cranial nerve findings
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
100mg; means patient can be trace protein positive and not be detected

17. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Streptococci
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Pts with palpitations and dizziness - near syncope - or syncope
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Viral gastroenteritis

19. What does treatment for migrans include?
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
Increase; 200 g/day
Diuretics -BB -CCB -ACEi
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

20. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Slow progression of cervical cancer changes -Availability of effective early treatment
ACEi - ARBS - thiazide diuretics
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. What is a markers of CNS vertigo?
Loop diuretics (Check serum K+ levels before drug admin)
Excessive bleeding in amount - duration - or both at irregular intervals
Streptococci
Other brainstem or cranial nerve findings

22. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Warts
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
BB or CCB - catheter ablation of identified bypass tract

23. What medications can cause heart palpitations?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Supraspinatus and bicipital tendons

24. What should blood work include for suspected heart failure?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pain
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

25. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Analgesic headache
Rotator Cuff tendonitis

26. Define the patient population typically affected by orthostatic or postural proteinuria
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
S. Aureus
Presence of proteinuria on at least two separate ocassion
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

27. What HPV serotypes are most commonly associated with cervical cancer?
Candida albicans
Serotypes 16 - 18 - 31 -52 -58
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

28. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
ACEi - ARBS - thiazide diuretics
Common problem that resolves spontaneously and is most often seen in children and young adults
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Candida albicans

29. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
24 hour halter
Serotypes 16 - 18 - 31 -52 -58
Regular bleeding at intervals of more than 35 days

30. MI - pericardial tamponade - PE - GI bleed - are...
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Increase; 200 g/day
Associated with hypotension
CBC

31. What are the 2 psych disorders most commonly associated with palpitations?
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
Generalized Anxiety disorder and panic disorder
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
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

32. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Anticoag with warfarin to prevent thromboembolism

33. History and PE for Pneumonia
Presence of proteinuria on at least two separate ocassion
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

34. What are signs of pulmonary congestion?
Molluscum contagiosum- pox virus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Less abrupt onset and cessation of palpitations
Impetigo

35. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Varicella virus

36. Who should have Xray testing for shoulder pain?
Cholelithiasis
Peptic ulcer disease or gastritis
Bence-Jones
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

37. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Varicella virus
35 (exception for postmenopausal women who have recently been started on HRT)

38. Difference between Pneumonia and Bronchitis
Viral infection of the semicircular apparatus
HIV and syphilis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

39. When should invasive eletrophysiologic study should be considered?
E. Coli O157:H7
S. Aureus
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Adhesive capsulitis (frozen shoulder): most common in middle age women

40. What lab tests are recommended for newly diagnosed hypertensive patients?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

41. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Analgesic headache
Non-cardiac causes of palpitations
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
HPV testing -Pos=colposcopy -Neg=repeat pap smear

42. Lab testing for heart palpitation
Candida albicans
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
Hgb - Electrolytes - and TSH
Serotypes 16 - 18 - 31 -52 -58

43. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Lightheadedness - dizziness - syncope
True
Viral gastroenteritis
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

44. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Scleroderma/polymyositis with secondary gastroesophageal reflux
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: 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
Supraspinatus and bicipital tendons

45. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
MSK - pulmonary - GI - or psychological

46. What is the role of FSH in one's menstrual cycle
Repeat Pap after infection treated
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

47. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
When the patient has symptoms in association with exercise or who describe chest pain or pressure
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

48. Oligomenorrhea
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
Viral gastroenteritis
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
Regular bleeding at intervals of more than 35 days

49. What is an acoustic neuroma?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

50. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Increase; 200 g/day
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bulk forming: Psyllium - Methycellulose - Polycarbophil
A central clear area