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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 treatments are the cornerstone for treating cases of functional constipation?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Lightheadedness - dizziness - syncope
Varicella virus

2. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
With a KOH wet mount preparation
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Nonulcer dyspepsia
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

3. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

4. How do you know if heart palpitations are due to stimulant or medication use?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Less abrupt onset and cessation of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

5. Pain in shoulder when throwing - swimming - or serving a tennis ball
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Rotator cuff tendonitis
Dehydration - anemia - cardiac causes

6. Who should have Xray testing for shoulder pain?
Presence of proteinuria on at least two separate ocassion
With a KOH wet mount preparation
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

7. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
These patients are associated with low renin states=less likely to respond to medication
Slow progression of cervical cancer changes -Availability of effective early treatment
Serotypes 16 - 18 - 31 -52 -58

8. Describes what occurs during squamous metaplasia of the cervix.
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
Supraspinatus and bicipital tendons
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
PE - MI - aortic dissection - pneumothorax

9. What is afterload?
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
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
Cluster headache
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

10. What are the two common clinical presentations of acute diarrhea?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Higher filling presure - pulmonary congestion - and decreasd cardiac return
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

11. What is a markers of CNS vertigo?
Possibility of Ischemic colitis
Other brainstem or cranial nerve findings
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Increase; 200 g/day

12. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Scleroderma/polymyositis with secondary gastroesophageal reflux

13. Constipation: What are indications for lab testing?
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
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
Tension headache
Adhesive capsulitis (frozen shoulder): most common in middle age women

14. Name 4 factors that predispose an individual to develop pneumonia.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less than 3 stools per week
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

15. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Dehydration - anemia - cardiac causes

16. Discomfort with abducting the arm past 90 degress
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Furucnle
Rotator Cuff tendonitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber

17. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Nonulcer dyspepsia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination
MSK - pulmonary - GI - or psychological

18. Carcinoma in situ is generally referred to a gynecologist and requires ______
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
PE - MI - aortic dissection - pneumothorax
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

19. How do you define persistent protein uria?
Repeat Pap after infection treated
Presence of proteinuria on at least two separate ocassion
Non-cardiac causes of palpitations
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

20. Describe the presentation of pericardial pain
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Fever with frontal or maxillary tenderness

21. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
With a KOH wet mount preparation
Varicella virus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

22. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Paroxysmal atrial fibrillation or supraventricular tachycardia
MSK - pulmonary - GI - or psychological

23. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
ACEi
Albumin; low molecular weight proteins
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

24. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
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
CT
Wolff-Parkinson-White syndrome
Cluster headache

25. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Paroxysmal atrial fibrillation or supraventricular tachycardia
Medication or chemical esophagitis

26. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Non-cardiac causes of palpitations

27. What should preconception counseling include?
Associated with hypotension
Excessive bleeding in amount - duration - or both at irregular intervals
Coag disorders
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

28. 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
Infectious esophagitis
Peptic ulcer disease or gastritis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

29. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Infectious esophagitis
Regular bleeding at intervals of more than 35 days
Presence of proteinuria on at least two separate ocassion
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

30. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
A central clear area
Furucnle
Scleroderma/polymyositis with secondary gastroesophageal reflux
Impetigo

31. What is the caUse of Meniere disease? What are the cardinal symptoms?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Impetigo
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Squamocolumnar junction=most common site of cervical cancer

32. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Infectious esophagitis
Bence-Jones
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

33. Where does the development of abnormal cervical cells begin?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Squamocolumnar junction=most common site of cervical cancer
Pts with palpitations and dizziness - near syncope - or syncope
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

34. How to NSAIDs contribute to gastritis and ulcer formation?
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
High blood pressure - focal neurologic defecit - or papilledema
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

35. How is constipation clinically defined?
Other brainstem or cranial nerve findings
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
Presence of proteinuria on at least two separate ocassion
Less than 3 stools per week

36. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Other brainstem or cranial nerve findings
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
HIV and syphilis

37. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Fever with frontal or maxillary tenderness
Loop diuretics (Check serum K+ levels before drug admin)
Bulk forming: Psyllium - Methycellulose - Polycarbophil

38. What are the common causes for laryngitis?
Folliculitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
ACEi - ARBS - thiazide diuretics
HPV testing -Pos=colposcopy -Neg=repeat pap smear

39. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Repeat Pap after infection treated
Hgb - Electrolytes - and TSH

40. patients with herpes zoster may experience what symptom before the rash appear?
RBC casts and old to moderate HTN
Pain
Scabies
Irregular bleeding between cycles

41. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
HPV
Rotator Cuff problem
Lightheadedness - dizziness - syncope

42. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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.
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.
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

43. What are signs of pulmonary congestion?
Acute headache - ataxia - profuse nausea - and vomiting
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Irregular bleeding between cycles

44. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Common problem that resolves spontaneously and is most often seen in children and young adults
Wolff-Parkinson-White syndrome
Viral gastroenteritis

45. What lab tests are recommended for newly diagnosed hypertensive patients?
E. Coli O157:H7
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Scleroderma/polymyositis with secondary gastroesophageal reflux
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

46. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

47. Chronic pain and shoulder stiffness with limited motion
Molluscum contagiosum- pox virus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Less than 80 ml of blood
Chest pain during pneumonia or PE

48. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
>150mg per 24hrs
Other brainstem or cranial nerve findings
Medication or chemical esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

49. What should be considered in younger patients with menorrhagia
Coag disorders
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Echocardiogram

50. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Excessive bleeding in amount - duration - or both at irregular intervals
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Supraspinatus and bicipital tendons
Viral gastroenteritis