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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 is considered normal blood loss during a menstrual cycle?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
With a KOH wet mount preparation
Less than 80 ml of blood
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

2. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
CBC
Pain
Candida albicans
Pts with palpitations and dizziness - near syncope - or syncope

3. How do you know if heart palpitations are due to stimulant or medication use?
Hgb - Electrolytes - and TSH
Diuretics -BB -CCB -ACEi
Less abrupt onset and cessation of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals

4. What is the next best step if a patient has two or more positive dipstick tests?
100mg; means patient can be trace protein positive and not be detected
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Paroxysmal atrial fibrillation or supraventricular tachycardia
A 24hr urine protein collection and urine creatinine clearance determination

5. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Infectious esophagitis
RBC casts and old to moderate HTN
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Streptococci

6. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Anticoag with warfarin to prevent thromboembolism

7. How to NSAIDs contribute to gastritis and ulcer formation?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

8. 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
E. Coli O157:H7
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
BB or CCB - catheter ablation of identified bypass tract
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

9. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
High blood pressure - focal neurologic defecit - or papilledema
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

10. What are the signs of malignant hypertension?
Nonulcer dyspepsia
High blood pressure - focal neurologic defecit - or papilledema
Kids: Rotavirus Adults: Norwalk Virus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

11. 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
Pancreatitis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Warts
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

12. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Wolff-Parkinson-White syndrome
Possibility of Ischemic colitis
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

13. What does treatment for migrans include?
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
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
A 24hr urine protein collection and urine creatinine clearance determination
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 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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Coronary artery disease/ angina
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

15. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV testing -Pos=colposcopy -Neg=repeat pap smear

16. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Giardia
Coronary artery disease/ angina
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

17. What is the Barany maneuver?
Pleurisy
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
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
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

18. Difference between Pneumonia and Bronchitis
>3.5g of protein per 24hrs
Viral gastroenteritis
EGD
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

19. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Squamocolumnar junction=most common site of cervical cancer
Loop diuretics (Check serum K+ levels before drug admin)
Common problem that resolves spontaneously and is most often seen in children and young adults
Variability in the time for follicle development during the proliferative phase

20. 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
Bence-Jones
Staphylococcal scalded skin syndrome
A 24hr urine protein collection and urine creatinine clearance determination

21. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Medication or chemical esophagitis
Less abrupt onset and cessation of palpitations
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

22. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
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

23. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Staphylococcal scalded skin syndrome
ACEi
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

24. After treatment of dysplasia - women need Pap smears every...
Pts with palpitations and dizziness - near syncope - or syncope
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Peptic ulcer disease or gastritis

25. How are fungal infections diagnosed?
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
With a KOH wet mount preparation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

26. What is the peripheral caUse of vertigo?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
A central clear area
Supraspinatus and bicipital tendons
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

27. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Presence of proteinuria on at least two separate ocassion
24 hour halter
Cellulitis
Loop diuretics (Check serum K+ levels before drug admin)

28. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cervical radiculopathy

29. Name the diagnosis of heartburn: severe constant mid abdominal pain
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pancreatitis
Rotator Cuff problem

30. At was quantity does urine dipstick test detect elevated protein?
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
100mg; means patient can be trace protein positive and not be detected
A 24hr urine protein collection and urine creatinine clearance determination
EGD

31. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Lightheadedness - dizziness - syncope
Temporal arteritis-biopsy of the temporal artery
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

32. How do you define persistent protein uria?
Increase; 200 g/day
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
Presence of proteinuria on at least two separate ocassion
Squamocolumnar junction=most common site of cervical cancer

33. Shoulder pain with pain radiating to elbow
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Albumin; low molecular weight proteins
Cervical radiculopathy
Coronary artery disease/ angina

34. Name the skin lesion: pustule in association with a hair follice
Cholelithiasis
>150mg per 24hrs
Streptococci
Folliculitis

35. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
S. aureus- beta hemolytic streptococcus
Staphylococcal scalded skin syndrome
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

36. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Increasing fluid (8 - 8oz glasses of water/day) -fiber
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Rotator Cuff problem

37. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

38. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Associated with hypotension
Staphylococcal scalded skin syndrome

39. PE for a patient getting an abnormal vaginal bleeding work up
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
S. Aureus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Cellulitis

40. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Increase; 200 g/day
Slow progression of cervical cancer changes -Availability of effective early treatment
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

41. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Viral gastroenteritis
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
Infectious esophagitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

42. Name 4 factors that predispose an individual to develop pneumonia.
Molluscum contagiosum- pox virus
Cervical radiculopathy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Hypertension - CAD - valvular heart disease

43. Four muscles of rotator cuff
Increasing fluid (8 - 8oz glasses of water/day) -fiber
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Giardia

44. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Rotator cuff tendonitis
Echocardiogram
Candida albicans

45. History for Acute bronchitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
A central clear area
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

46. What are the three types of lice?
Slow progression of cervical cancer changes -Availability of effective early treatment
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
MSK - pulmonary - GI - or psychological

47. What diagnosis does the 'worse headache of my life' suggest?
24 hour halter
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Subarachnoid hemorrhage

48. When should invasive eletrophysiologic study should be considered?
Other brainstem or cranial nerve findings
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

49. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Fever with frontal or maxillary tenderness
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

50. What medications can cause heart palpitations?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Possibility of Ischemic colitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med