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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 are the consequences of diastolic dysfunction?
Pleurisy
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Loop diuretics (Check serum K+ levels before drug admin)
Common problem that resolves spontaneously and is most often seen in children and young adults

2. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
CT
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Pain

3. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

4. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Temporal arteritis-biopsy of the temporal artery
Chest pain during pneumonia or PE
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
Repeat Pap after infection treated

5. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Streptococci

6. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Rotator cuff tendonitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Candida albicans
Impetigo

7. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Irregular bleeding between cycles
Serotypes 16 - 18 - 31 -52 -58
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

8. Things that need to be included in history of shoulder pain
Cellulitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Anticoag with warfarin to prevent thromboembolism
Streptococci

9. name the 4 emergent causes of chest pain
When the patient has symptoms in association with exercise or who describe chest pain or pressure
PE - MI - aortic dissection - pneumothorax
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Coronary artery disease/ angina

10. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Fever with frontal or maxillary tenderness
Possibility of Ischemic colitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV testing -Pos=colposcopy -Neg=repeat pap smear

11. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Nonulcer dyspepsia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Fever with frontal or maxillary tenderness

12. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Rotator Cuff tendonitis
These patients are associated with low renin states=less likely to respond to medication
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
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

13. Metrorrhagia
Bence-Jones
Irregular bleeding between cycles
Adhesive capsulitis (frozen shoulder): most common in middle age women
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

14. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
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
Diuretics -BB -CCB -ACEi
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

15. After treatment of dysplasia - women need Pap smears every...
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
GERD
Cervical radiculopathy

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Pleurisy
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
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. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increase; 200 g/day
Chest pain during pneumonia or PE
Slow progression of cervical cancer changes -Availability of effective early treatment

18. 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
Adhesive capsulitis (frozen shoulder): most common in middle age women
RBC casts and old to moderate HTN
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

19. 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
Warts
E. Coli O157:H7
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral infection of the semicircular apparatus

20. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Peptic ulcer disease or gastritis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
35 (exception for postmenopausal women who have recently been started on HRT)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

21. Describe the presentation of pericardial pain
Repeat Pap after infection treated
Colposcopy - Endocervical curettage - and directed cervical biopsy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Cellulitis

22. What occurs after ovulation
Subarachnoid hemorrhage
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.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Cluster headache

23. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Lightheadedness - dizziness - syncope
HPV
EGD
Pleurisy

24. What does the classic ring worm lesion have?
A central clear area
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Albumin; low molecular weight proteins
Warts

25. Where does the development of abnormal cervical cells begin?
Pain
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Upper sternal area burning pain - associated with a productive cough
Squamocolumnar junction=most common site of cervical cancer

26. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Viral infection of the semicircular apparatus
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.
LH surge triggers ovulation

27. SE Of Beta blockers?
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
HPV
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

28. Describe the presentation tracheobronchitis
Squamocolumnar junction=most common site of cervical cancer
Temporal arteritis-biopsy of the temporal artery
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Upper sternal area burning pain - associated with a productive cough

29. 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
Temporal arteritis-biopsy of the temporal artery
Pancreatitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

30. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Staphylococcal scalded skin syndrome
Medication or chemical esophagitis
Hgb - Electrolytes - and TSH

31. What is the preload?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Diuretics -BB -CCB -ACEi
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

32. What are the three major risk factors for heart failure?
Menorrhagia
Hypertension - CAD - valvular heart disease
Common problem that resolves spontaneously and is most often seen in children and young adults
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

33. Name the skin lesion: pustule in association with a hair follice
Folliculitis
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

34. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Menorrhagia
MSK - pulmonary - GI - or psychological
Polymenorrhea
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

35. History for Sinusitis

36. Irregular cycles with excessive flow - duration - or both
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Rotator Cuff tendonitis
Menorrhagia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

37. Treatment for supraventricular tachycardias
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Possibility of Ischemic colitis
BB or CCB - catheter ablation of identified bypass tract
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

38. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
>3.5g of protein per 24hrs

39. Why is the pap smear one of the most effective cancer screening tools?
Bence-Jones
Variability in the time for follicle development during the proliferative phase
Increase; 200 g/day
Slow progression of cervical cancer changes -Availability of effective early treatment

40. Regular bleeding at intervals of less than 21 days
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Polymenorrhea
CT
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

41. 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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

42. Who should have Xray testing for shoulder pain?
Upper sternal area burning pain - associated with a productive cough
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

43. What does orthostatic positional changes that bring on dizziness suggest?
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
Dehydration - anemia - cardiac causes
Molluscum contagiosum- pox virus
Hgb - Electrolytes - and TSH

44. Constipation: What are indications for lab testing?
S. Aureus
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
These patients are associated with low renin states=less likely to respond to medication
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

45. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Generalized Anxiety disorder and panic disorder
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Non-cardiac causes of palpitations

46. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Squamocolumnar junction=most common site of cervical cancer
HPV
BB or CCB - catheter ablation of identified bypass tract

47. What type of imaging is need for chronic sinusitis?
CT
Regular bleeding at intervals of more than 35 days
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

48. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Viral infection of the semicircular apparatus
Pleurisy

49. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Wolff-Parkinson-White syndrome

50. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Pts with palpitations and dizziness - near syncope - or syncope
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