Family Medicine Shelf

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. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
These patients are associated with low renin states=less likely to respond to medication
PE - MI - aortic dissection - pneumothorax
Polymenorrhea


2. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Bulk forming: Psyllium - Methycellulose - Polycarbophil


3. Describe the presentation of pericardial pain
Chest pain during pneumonia or PE
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
BB or CCB - catheter ablation of identified bypass tract
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


4. Oligomenorrhea
Common problem that resolves spontaneously and is most often seen in children and young adults
HIV and syphilis
Adhesive capsulitis (frozen shoulder): most common in middle age women
Regular bleeding at intervals of more than 35 days


5. Define the patient population typically affected by orthostatic or postural proteinuria
Upper sternal area burning pain - associated with a productive cough
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Infectious esophagitis


6. What should be considered in younger patients with menorrhagia
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.
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
Coag disorders
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus


7. What type of imaging is need for chronic sinusitis?
With a KOH wet mount preparation
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CT
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)


8. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Squamocolumnar junction=most common site of cervical cancer
Chest pain during pneumonia or PE
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med


9. Name the diagnosis of heartburn: severe constant mid abdominal pain
Intermenstrual bleeding
Temporal arteritis-biopsy of the temporal artery
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pancreatitis


10. What are the signs of cerebral hemorrhage?
MSK - pulmonary - GI - or psychological
True
Acute headache - ataxia - profuse nausea - and vomiting
Variability in the time for follicle development during the proliferative phase


11. What are the features of nephrotic syndrome?
Irregular bleeding between cycles
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria


12. What are the secondly causes of glomerular disease?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides


13. MI - pericardial tamponade - PE - GI bleed - are...
35 (exception for postmenopausal women who have recently been started on HRT)
Associated with hypotension
Increase; 200 g/day
ACEi - ARBS - thiazide diuretics


14. Constipation: What are indications for lab testing?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy


15. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
35 (exception for postmenopausal women who have recently been started on HRT)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Regular bleeding at intervals of more than 35 days


16. Name the skin lesion: erythema - warmth - edema - pain - fever
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Cellulitis
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
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


17. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Menorrhagia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Anticoag with warfarin to prevent thromboembolism


18. What is the role of FSH in one's menstrual cycle
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
PVC or Premature atrial contraction (PAC)
RBC casts and old to moderate HTN
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium


19. HIgh risk pregnant patients should be evaluated for ____ and ____
Pleurisy
HIV and syphilis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Coag disorders


20. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Irregular bleeding between cycles


21. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Temporal arteritis-biopsy of the temporal artery


22. Clinical Manifestations of HTN
Cholelithiasis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Folliculitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema


23. What is a markers of CNS vertigo?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Other brainstem or cranial nerve findings


24. Carcinoma in situ is generally referred to a gynecologist and requires ______
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Cellulitis
Anticoag with warfarin to prevent thromboembolism


25. What is the caUse of Meniere disease? What are the cardinal symptoms?
With a KOH wet mount preparation
HPV testing -Pos=colposcopy -Neg=repeat pap smear
PVC or Premature atrial contraction (PAC)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss


26. Four muscles of rotator cuff
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pancreatitis


27. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
HPV
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
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


28. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Supraspinatus and bicipital tendons
Giardia
Generalized Anxiety disorder and panic disorder
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


29. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF


30. 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
Folliculitis
Warts
Coronary artery disease/ angina
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)


31. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Polymenorrhea
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline


32. Irregular cycles with excessive flow - duration - or both
Pleurisy
Menorrhagia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Generalized Anxiety disorder and panic disorder


33. Describe the presentation tracheobronchitis
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Upper sternal area burning pain - associated with a productive cough
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem


34. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Rotator Cuff problem
Hgb - Electrolytes - and TSH
Dehydration - anemia - cardiac causes


35. Cycle length variabilty is primarily due to what?
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.
Variability in the time for follicle development during the proliferative phase
Acute headache - ataxia - profuse nausea - and vomiting
HPV


36. Pain in shoulder when throwing - swimming - or serving a tennis ball
Paroxysmal atrial fibrillation or supraventricular tachycardia
Rotator cuff tendonitis
ACEi - ARBS - thiazide diuretics
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume


37. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Furucnle
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Medication or chemical esophagitis


38. Why is the pap smear one of the most effective cancer screening tools?
BB or CCB - catheter ablation of identified bypass tract
Less than 80 ml of blood
Slow progression of cervical cancer changes -Availability of effective early treatment
Pleurisy


39. Describe the presentation of myocardial pain?
Staphylococcal scalded skin syndrome
Warts
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
LH surge triggers ovulation


40. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)


41. How does CHF present on X-ray?
35 (exception for postmenopausal women who have recently been started on HRT)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Menorrhagia
Candida albicans


42. 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)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Acute headache - ataxia - profuse nausea - and vomiting
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


43. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Paroxysmal atrial fibrillation or supraventricular tachycardia
Other brainstem or cranial nerve findings
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


44. Things that need to be included in history of shoulder pain
Presence of proteinuria on at least two separate ocassion
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp


45. What HPV serotypes are most commonly associated with cervical cancer?
Rotator Cuff tendonitis
Serotypes 16 - 18 - 31 -52 -58
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes


46. Uterine bleeding between regular cycles
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
Intermenstrual bleeding
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
BB or CCB - catheter ablation of identified bypass tract


47. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
ACEi - ARBS - thiazide diuretics
Fever with frontal or maxillary tenderness
True


48. 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.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Tension headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Bence-Jones


49. Mainstay treatment for soft tissue inflammation (Shoulder)
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Rotator Cuff tendonitis
Analgesic headache


50. What occurs after ovulation
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
True