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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. Name the skin lesion: honey colored crusts
ACEi
Impetigo
Temporal arteritis-biopsy of the temporal artery
A 24hr urine protein collection and urine creatinine clearance determination

2. How can GERD (or esophageal motility disorders) lead to chest pain?
Cluster headache
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Wolff-Parkinson-White syndrome
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

3. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
BB or CCB - catheter ablation of identified bypass tract
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Molluscum contagiosum- pox virus

4. What diagnosis does the 'worse headache of my life' suggest?
Impetigo
Variability in the time for follicle development during the proliferative phase
Subarachnoid hemorrhage
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

5. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Hgb - Electrolytes - and TSH
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

6. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Subarachnoid hemorrhage
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
Viral gastroenteritis
Diuretics -BB -CCB -ACEi

7. Define nephrotic range proteinuria
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
>3.5g of protein per 24hrs
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bulk forming: Psyllium - Methycellulose - Polycarbophil

8. Uterine bleeding between regular cycles
Intermenstrual bleeding
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
PVC or Premature atrial contraction (PAC)

9. 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
Less than 3 stools per week
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
MSK - pulmonary - GI - or psychological

10. Why is the pap smear one of the most effective cancer screening tools?
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
Cellulitis
Slow progression of cervical cancer changes -Availability of effective early treatment
Paroxysmal atrial fibrillation or supraventricular tachycardia

11. How does systolic vs. diastolic heart failure present on the echocardiogram?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Lightheadedness - dizziness - syncope
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

12. What are the indiciations for neuroimaging?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Giardia
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

13. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
Furucnle
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
S. Aureus

14. Describe the presentation of pericardial pain
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
EGD
24 hour halter
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

15. Vaccines that should be updated before planned pregnancy
Temporal arteritis-biopsy of the temporal artery
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Possibility of Ischemic colitis
Generalized Anxiety disorder and panic disorder

16. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Menorrhagia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pleurisy

17. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Squamocolumnar junction=most common site of cervical cancer
Scleroderma/polymyositis with secondary gastroesophageal reflux
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.

18. What are the consequences of diastolic dysfunction?
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.
Hypertension - CAD - valvular heart disease
Higher filling presure - pulmonary congestion - and decreasd cardiac return
RBC casts and old to moderate HTN

19. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cholelithiasis
Warts
100mg; means patient can be trace protein positive and not be detected

20. Name types of laxatives
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
Varicella virus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

21. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Presence of proteinuria on at least two separate ocassion
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

22. Name the diagnosis of heartburn: regurgitation - dysphagia
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
GERD
Supraspinatus and bicipital tendons
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

23. What are the common causes for laryngitis?
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
CBC
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

24. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Coronary artery disease/ angina
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
Wolff-Parkinson-White syndrome

25. Four muscles of rotator cuff
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
>150mg per 24hrs
Subarachnoid hemorrhage

26. What does the classic ring worm lesion have?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
A central clear area
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

27. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Analgesic headache
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Temporal arteritis-biopsy of the temporal artery
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

28. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
With a KOH wet mount preparation

29. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
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
Squamocolumnar junction=most common site of cervical cancer
Peptic ulcer disease or gastritis

30. Name some medications that can cause proteinuria
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Paroxysmal atrial fibrillation or supraventricular tachycardia
CBC
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

31. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Loop diuretics (Check serum K+ levels before drug admin)
Pancreatitis

32. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Fever with frontal or maxillary tenderness
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Nonulcer dyspepsia
Influenza - Rhinovirus - Adenovirus - Parainfluenza

33. How does CHF present on X-ray?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
These patients are associated with low renin states=less likely to respond to medication
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Dehydration - anemia - cardiac causes

34. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Anticoag with warfarin to prevent thromboembolism
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

35. Discomfort with abducting the arm past 90 degress
Infectious esophagitis
Warts
Rotator Cuff tendonitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

36. patients with herpes zoster may experience what symptom before the rash appear?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pain

37. What is the difference between a Holter monitor or an event monitor?
24 hour halter
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
PVC or Premature atrial contraction (PAC)
Hypertension - CAD - valvular heart disease

38. Lab testing for heart palpitation
CBC
Supraspinatus and bicipital tendons
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hgb - Electrolytes - and TSH

39. Diarrhea from custard filled pastries
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Albumin; low molecular weight proteins
S. Aureus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

40. Chronic pain and shoulder stiffness with limited motion
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Adhesive capsulitis (frozen shoulder): most common in middle age women
Menorrhagia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

41. 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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Impetigo
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

42. Where does the development of abnormal cervical cells begin?
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Squamocolumnar junction=most common site of cervical cancer
Analgesic headache

43. How is constipation clinically defined?
EGD
Generalized Anxiety disorder and panic disorder
Less than 3 stools per week
Increase; 200 g/day

44. 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.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Medication or chemical esophagitis
Tension headache
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

45. HIgh risk pregnant patients should be evaluated for ____ and ____
Fever with frontal or maxillary tenderness
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Bulk forming: Psyllium - Methycellulose - Polycarbophil
HIV and syphilis

46. What is the Barany maneuver?
Repeat Pap after infection treated
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
A 24hr urine protein collection and urine creatinine clearance determination

47. What places women at higher risk of getting cervical cancer?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Loop diuretics (Check serum K+ levels before drug admin)
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
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

48. 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
E. Coli O157:H7
Variability in the time for follicle development during the proliferative phase
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

49. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Repeat Pap after infection treated
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pain
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

50. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Rotator cuff tendonitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral infection of the semicircular apparatus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing