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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 peripheral caUse of vertigo?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
PVC or Premature atrial contraction (PAC)
Loop diuretics (Check serum K+ levels before drug admin)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

2. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Nonulcer dyspepsia
Coronary artery disease/ angina
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
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

3. How do you know if heart palpitations are due to stimulant or medication use?
Upper sternal area burning pain - associated with a productive cough
Less abrupt onset and cessation of palpitations
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Other brainstem or cranial nerve findings

4. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
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. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HPV testing -Pos=colposcopy -Neg=repeat pap smear

5. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Lightheadedness - dizziness - syncope
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Rotator Cuff problem
Regular bleeding at intervals of more than 35 days

6. Regular bleeding at intervals of less than 21 days
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Polymenorrhea
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

7. What are the indiciations for neuroimaging?
Furucnle
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

8. How to NSAIDs contribute to gastritis and ulcer formation?
Cholelithiasis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Giardia
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.

9. Lab testing for heart palpitation
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
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
Hgb - Electrolytes - and TSH
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. Pain in shoulder when throwing - swimming - or serving a tennis ball
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Rotator cuff tendonitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

11. Chronic pain and shoulder stiffness with limited motion
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Adhesive capsulitis (frozen shoulder): most common in middle age women
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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.

12. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Cluster headache
Peptic ulcer disease or gastritis
Viral gastroenteritis

13. Prenatal visit schedule for low-risk pregnancies
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Scabies
Cholelithiasis
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

14. Name the skin lesion: erythema - warmth - edema - pain - fever
HPV
PE - MI - aortic dissection - pneumothorax
Cellulitis
Impetigo

15. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
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
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
Molluscum contagiosum- pox virus

16. Uterine bleeding between regular cycles
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
>150mg per 24hrs
Anticoag with warfarin to prevent thromboembolism
Intermenstrual bleeding

17. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Scleroderma/polymyositis with secondary gastroesophageal reflux

18. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

19. Name 4 factors that predispose an individual to develop pneumonia.
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

20. Shoulder pain with pain radiating to elbow
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Cervical radiculopathy
GERD
Viral infection of the semicircular apparatus

21. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Candida albicans
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

22. Why is the pap smear one of the most effective cancer screening tools?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Presence of proteinuria on at least two separate ocassion
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Slow progression of cervical cancer changes -Availability of effective early treatment

23. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Molluscum contagiosum- pox virus
HPV testing -Pos=colposcopy -Neg=repeat pap smear

24. Difference between Pneumonia and Bronchitis
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
Presence of proteinuria on at least two separate ocassion
Possibility of Ischemic colitis
Cholelithiasis

25. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
GERD
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
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

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

27. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Coronary artery disease/ angina
S. aureus- beta hemolytic streptococcus
ACEi

28. What the consequences of decreased cardiac output?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

29. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Candida albicans
Analgesic headache
Fever with frontal or maxillary tenderness

30. Name some medications that can cause proteinuria
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.
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
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

31. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Fever with frontal or maxillary tenderness

32. Complete the sentence: pericarditis can cause frictional rub and......
A central clear area
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Intermenstrual bleeding
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

33. What are the physical exam signs of CHF?
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
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
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
PE - MI - aortic dissection - pneumothorax

34. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Variability in the time for follicle development during the proliferative phase
Nonulcer dyspepsia

35. Describe the presentation of myocardial pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

36. Describes what occurs during squamous metaplasia of the cervix.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Medication or chemical esophagitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Excessive bleeding in amount - duration - or both at irregular intervals

37. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Colposcopy - Endocervical curettage - and directed cervical biopsy
Hgb - Electrolytes - and TSH
S. Aureus

38. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Cholelithiasis
Furucnle
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
35 (exception for postmenopausal women who have recently been started on HRT)

39. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
With a KOH wet mount preparation
Hypertension - CAD - valvular heart disease

40. name the 4 emergent causes of chest pain
Rotator Cuff tendonitis
Less abrupt onset and cessation of palpitations
PE - MI - aortic dissection - pneumothorax
MSK - pulmonary - GI - or psychological

41. When should invasive eletrophysiologic study should be considered?
>150mg per 24hrs
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
High blood pressure - focal neurologic defecit - or papilledema

42. What treatments are the cornerstone for treating cases of functional constipation?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increasing fluid (8 - 8oz glasses of water/day) -fiber
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pts with palpitations and dizziness - near syncope - or syncope

43. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
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
Generalized Anxiety disorder and panic disorder
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

44. What HPV serotypes are most commonly associated with cervical cancer?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Serotypes 16 - 18 - 31 -52 -58
Peptic ulcer disease or gastritis
35 (exception for postmenopausal women who have recently been started on HRT)

45. 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
LH surge triggers ovulation
Varicella virus
Giardia
A central clear area

46. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

47. Oligomenorrhea
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Regular bleeding at intervals of more than 35 days
MSK - pulmonary - GI - or psychological
Nonulcer dyspepsia

48. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
EGD
Coag disorders
CBC
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

49. When does troponin rise following myocardial injury or infarction?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Repeat Pap after infection treated
Intermenstrual bleeding

50. What are the most common causes for the common cold?
ACEi
Associated with hypotension
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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