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Family Medicine Shelf

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Menorrhagia
Other brainstem or cranial nerve findings
Associated with hypotension
Analgesic headache

2. What is the Barany maneuver?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Varicella virus
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

3. Why don't ACEi work well for the elderly and African Americans when treating HTN?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
These patients are associated with low renin states=less likely to respond to medication
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

4. What are signs of pulmonary congestion?
Diuretics -BB -CCB -ACEi
Analgesic headache
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

5. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
These patients are associated with low renin states=less likely to respond to medication
A central clear area
100mg; means patient can be trace protein positive and not be detected

6. Initial treatment for Rhinosinusitis
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

7. Metrorrhagia
24 hour halter
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
Irregular bleeding between cycles
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

8. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
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
ACEi - ARBS - thiazide diuretics
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cluster headache

9. At was quantity does urine dipstick test detect elevated protein?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
100mg; means patient can be trace protein positive and not be detected
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Impetigo

10. What are the physical exam signs of CHF?
Nonulcer dyspepsia
Other brainstem or cranial nerve findings
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

11. 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
Cluster headache
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Slow progression of cervical cancer changes -Availability of effective early treatment

12. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Lightheadedness - dizziness - syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Common problem that resolves spontaneously and is most often seen in children and young adults
Fever with frontal or maxillary tenderness

13. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Supraspinatus and bicipital tendons
Peptic ulcer disease or gastritis

14. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Peptic ulcer disease or gastritis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

15. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

16. What occurs after ovulation
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.
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
BB or CCB - catheter ablation of identified bypass tract
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

17. 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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Other brainstem or cranial nerve findings

18. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
ACEi
Supraspinatus and bicipital tendons
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

19. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Non-cardiac causes of palpitations
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Tension headache
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

20. What is the next best step if a patient has two or more positive dipstick tests?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
A 24hr urine protein collection and urine creatinine clearance determination
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

21. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
S. aureus- beta hemolytic streptococcus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

22. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Less than 3 stools per week
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
Loop diuretics (Check serum K+ levels before drug admin)
Excessive bleeding in amount - duration - or both at irregular intervals

23. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
ACEi
Other brainstem or cranial nerve findings
MSK - pulmonary - GI - or psychological
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

24. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
PE - MI - aortic dissection - pneumothorax
Colposcopy - Endocervical curettage - and directed cervical biopsy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

25. What is an acoustic neuroma?
Subarachnoid hemorrhage
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Cervical radiculopathy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

26. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
ACEi
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
S. aureus- beta hemolytic streptococcus

27. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
True
HPV
RBC casts and old to moderate HTN

28. 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
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
True
Molluscum contagiosum- pox virus

29. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
CBC
A central clear area
Menorrhagia

30. Name the diagnosis of heartburn: severe constant mid abdominal pain
Infectious esophagitis
Supraspinatus and bicipital tendons
Pancreatitis
Coag disorders

31. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

32. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
These patients are associated with low renin states=less likely to respond to medication
Paroxysmal atrial fibrillation or supraventricular tachycardia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

33. How is constipation clinically defined?
Less than 3 stools per week
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

34. 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)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Viral gastroenteritis

35. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Irregular bleeding between cycles

36. Define nephrotic range proteinuria
Bence-Jones
Cellulitis
>3.5g of protein per 24hrs
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

37. When should invasive eletrophysiologic study should be considered?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

38. How do you know if heart palpitations are due to stimulant or medication use?
>3.5g of protein per 24hrs
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Tension headache
Less abrupt onset and cessation of palpitations

39. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Squamocolumnar junction=most common site of cervical cancer
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

40. Diagnostic Evaluation of Abnoraml vaginal bleeding
When the patient has symptoms in association with exercise or who describe chest pain or pressure
LH surge triggers ovulation
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
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

41. What the consequences of decreased cardiac output?
Less than 3 stools per week
E. Coli O157:H7
Rotator cuff tendonitis
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

42. Natural history of cervical cancer
Supraspinatus and bicipital tendons
Repeat Pap after infection treated
Rotator Cuff problem
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

43. Name 4 factors that predispose an individual to develop pneumonia.
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
Generalized Anxiety disorder and panic disorder
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
These patients are associated with low renin states=less likely to respond to medication

44. Oligomenorrhea
ACEi
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Regular bleeding at intervals of more than 35 days
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

45. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Possibility of Ischemic colitis
High blood pressure - focal neurologic defecit - or papilledema
PE - MI - aortic dissection - pneumothorax

46. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
S. Aureus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

47. What type of imaging is need for chronic sinusitis?
Molluscum contagiosum- pox virus
CT
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Furucnle

48. Who should have Xray testing for shoulder pain?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

49. What is benign transient 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
Common problem that resolves spontaneously and is most often seen in children and young adults
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
35 (exception for postmenopausal women who have recently been started on HRT)

50. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Cluster headache
DM - HTN - DVT - seizures - depression - or anxiety
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Presence of proteinuria on at least two separate ocassion