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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 the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Cervical radiculopathy
Associated with hypotension
Staphylococcal scalded skin syndrome

2. Regular bleeding at intervals of less than 21 days
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
Peptic ulcer disease or gastritis
Polymenorrhea
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

3. Name the diagnosis of heartburn: severe constant mid abdominal pain
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pancreatitis
CBC

4. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
35 (exception for postmenopausal women who have recently been started on HRT)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

5. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
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
Supraspinatus and bicipital tendons

6. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Acute headache - ataxia - profuse nausea - and vomiting

7. Prenatal visit schedule for low-risk pregnancies
With a KOH wet mount preparation
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
Viral gastroenteritis

8. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
ACEi - ARBS - thiazide diuretics
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

9. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
S. aureus- beta hemolytic streptococcus
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Warts

10. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Menorrhagia
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

11. Pneumonia tx: suitable for healthy adults older than 60
Hgb - Electrolytes - and TSH
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.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

12. Treatment for supraventricular tachycardias
Candida albicans
24 hour halter
BB or CCB - catheter ablation of identified bypass tract
Excessive bleeding in amount - duration - or both at irregular intervals

13. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
E. Coli O157:H7

14. What are the signs of cerebral hemorrhage?
Polymenorrhea
RBC casts and old to moderate HTN
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Acute headache - ataxia - profuse nausea - and vomiting

15. What are the 2 psych disorders most commonly associated with palpitations?
Pts with palpitations and dizziness - near syncope - or syncope
Staphylococcal scalded skin syndrome
Generalized Anxiety disorder and panic disorder
DM - HTN - DVT - seizures - depression - or anxiety

16. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Infectious esophagitis

17. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

18. History for Acute bronchitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
S. aureus- beta hemolytic streptococcus
Candida albicans
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

19. At was quantity does urine dipstick test detect elevated protein?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Other brainstem or cranial nerve findings
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
100mg; means patient can be trace protein positive and not be detected

20. What is an acoustic neuroma?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator Cuff problem
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Less than 3 stools per week

21. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Less than 3 stools per week
Viral infection of the semicircular apparatus

22. What are symptoms are CHF?
Cervical radiculopathy
Temporal arteritis-biopsy of the temporal artery
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

23. 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.
Associated with hypotension
Warts
Chest pain during pneumonia or PE

24. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Less than 3 stools per week
Analgesic headache

25. Lab testing for heart palpitation
Scabies
Hgb - Electrolytes - and TSH
Nonulcer dyspepsia
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

26. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
RBC casts and old to moderate HTN
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pts with palpitations and dizziness - near syncope - or syncope

27. MI - pericardial tamponade - PE - GI bleed - are...
Candida albicans
These patients are associated with low renin states=less likely to respond to medication
With a KOH wet mount preparation
Associated with hypotension

28. What are the three types of lice?
S. aureus- beta hemolytic streptococcus
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
PE - MI - aortic dissection - pneumothorax
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

29. Difference between Pneumonia and Bronchitis
Viral gastroenteritis
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

30. Define the patient population typically affected by orthostatic or postural proteinuria
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Infectious esophagitis
Diuretics -BB -CCB -ACEi
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

31. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Slow progression of cervical cancer changes -Availability of effective early treatment

32. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Less than 80 ml of blood
Furucnle
GERD
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Nonulcer dyspepsia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Diuretics -BB -CCB -ACEi

34. Define nephrotic range proteinuria
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
>3.5g of protein per 24hrs
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

35. Describe the history and PE of patient presenting with common cold
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Cellulitis

36. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
HPV
Cervical radiculopathy
Infectious esophagitis

37. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Analgesic headache
CBC
Less than 3 stools per week

38. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Medication or chemical esophagitis
Fever with frontal or maxillary tenderness
S. aureus- beta hemolytic streptococcus
Peptic ulcer disease or gastritis

39. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
HPV
Candida albicans
Wolff-Parkinson-White syndrome

40. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

41. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
DM - HTN - DVT - seizures - depression - or anxiety
Less than 3 stools per week
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

42. What is the Barany maneuver?
Loop diuretics (Check serum K+ levels before drug admin)
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Bulk forming: Psyllium - Methycellulose - Polycarbophil

43. What is the role of FSH in one's menstrual cycle
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Less than 3 stools per week
ACEi - ARBS - thiazide diuretics

44. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
24 hour halter
Increase; 200 g/day
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Loop diuretics (Check serum K+ levels before drug admin)

45. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Lightheadedness - dizziness - syncope
Cholelithiasis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

46. Name the skin lesion: erythema - warmth - edema - pain - fever
Regular bleeding at intervals of more than 35 days
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Cellulitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

47. Things that need to be included in history of shoulder pain
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Presence of proteinuria on at least two separate ocassion

48. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Infectious esophagitis
Pleurisy
Other brainstem or cranial nerve findings
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

49. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Infectious esophagitis
Viral infection of the semicircular apparatus
Coronary artery disease/ angina

50. Tx of chronic or intermittent afibs
Pancreatitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Anticoag with warfarin to prevent thromboembolism
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