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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. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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.
>3.5g of protein per 24hrs
Chest pain during pneumonia or PE
Influenza - Rhinovirus - Adenovirus - Parainfluenza

2. History and PE for Pneumonia
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
Coronary artery disease/ angina
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
Presence of proteinuria on at least two separate ocassion

3. How is constipation clinically defined?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
These patients are associated with low renin states=less likely to respond to medication
Less than 3 stools per week

4. Name the skin lesion: erythema - warmth - edema - pain - fever
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Hgb - Electrolytes - and TSH
Cellulitis

5. How can GERD (or esophageal motility disorders) lead to chest pain?
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
Possibility of Ischemic colitis
Menorrhagia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

6. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
EGD
Analgesic headache
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

7. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Bulk forming: Psyllium - Methycellulose - Polycarbophil
PVC or Premature atrial contraction (PAC)

8. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
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
Viral gastroenteritis

9. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
HIV and syphilis
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

10. Four muscles of rotator cuff
Pts with palpitations and dizziness - near syncope - or syncope
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
Loop diuretics (Check serum K+ levels before drug admin)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

11. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Slow progression of cervical cancer changes -Availability of effective early treatment
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Varicella virus

12. Pain in shoulder when throwing - swimming - or serving a tennis ball
Hgb - Electrolytes - and TSH
Cervical radiculopathy
BB or CCB - catheter ablation of identified bypass tract
Rotator cuff tendonitis

13. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Associated with hypotension
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.
E. Coli O157:H7

14. Who should have Xray testing for shoulder pain?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

15. 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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
E. Coli O157:H7
Temporal arteritis-biopsy of the temporal artery
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

16. What is the preload?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Cluster headache

17. Name the skin lesion: honey colored crusts
Impetigo
Less than 80 ml of blood
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

18. What should be considered in younger patients with menorrhagia
ACEi
Hgb - Electrolytes - and TSH
Dehydration - anemia - cardiac causes
Coag disorders

19. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
MSK - pulmonary - GI - or psychological
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
HPV

20. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Acute headache - ataxia - profuse nausea - and vomiting
Rotator Cuff tendonitis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

21. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Irregular bleeding between cycles
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

22. Name some medications that can cause proteinuria
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
S. Aureus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

23. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Molluscum contagiosum- pox virus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Subarachnoid hemorrhage
Echocardiogram

24. Diarrhea from custard filled pastries
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
S. Aureus
Temporal arteritis-biopsy of the temporal artery

25. What are the signs of acute sinusitis?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Fever with frontal or maxillary tenderness

26. History for Acute bronchitis
Viral infection of the semicircular apparatus
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

27. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Bence-Jones
24 hour halter
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

28. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Coronary artery disease/ angina
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Non-cardiac causes of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals

29. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Colposcopy - Endocervical curettage - and directed cervical biopsy
Bence-Jones
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

30. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Kids: Rotavirus Adults: Norwalk Virus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

31. How does CHF present on X-ray?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Acute headache - ataxia - profuse nausea - and vomiting
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Echocardiogram

32. How does systolic vs. diastolic heart failure present on the echocardiogram?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Chest pain during pneumonia or PE
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
Supraspinatus and bicipital tendons

33. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Nonulcer dyspepsia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Staphylococcal scalded skin syndrome

34. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Diuretics -BB -CCB -ACEi
Molluscum contagiosum- pox virus
Coag disorders
Furucnle

35. What is the goal of CHF treatment? What drugs should be used?
Giardia
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

36. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Bulk forming: Psyllium - Methycellulose - Polycarbophil

37. MI - pericardial tamponade - PE - GI bleed - are...
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Associated with hypotension
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

38. What drugs do you use to treat H.pylori + PUD?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

39. What are the features of glomerular nephritis
Anticoag with warfarin to prevent thromboembolism
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
RBC casts and old to moderate HTN
Presence of proteinuria on at least two separate ocassion

40. 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
Kids: Rotavirus Adults: Norwalk Virus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
A central clear area

41. What is the mechanism of action for stimulant agents in treating constipation?
PE - MI - aortic dissection - pneumothorax
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Cluster headache
A central clear area
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
ACEi - ARBS - thiazide diuretics

43. What the consequences of decreased cardiac output?
Viral gastroenteritis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Pancreatitis

44. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Viral gastroenteritis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

45. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
BB or CCB - catheter ablation of identified bypass tract
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

46. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Temporal arteritis-biopsy of the temporal artery

47. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
MSK - pulmonary - GI - or psychological

48. Mainstay treatment for soft tissue inflammation (Shoulder)
Cholelithiasis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Less than 80 ml of blood
Presence of proteinuria on at least two separate ocassion

49. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
CBC
Less than 3 stools per week
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

50. Predictors of cardiac etiology
Temporal arteritis-biopsy of the temporal artery
Viral gastroenteritis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Rotator cuff tendonitis