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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. How are fungal infections diagnosed?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Albumin; low molecular weight proteins
ACEi
With a KOH wet mount preparation

2. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

3. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Higher filling presure - pulmonary congestion - and decreasd cardiac return
True
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

4. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Infectious esophagitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Giardia

5. What are symptoms are CHF?
Slow progression of cervical cancer changes -Availability of effective early treatment
Cluster headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

6. Complete the sentence: pericarditis can cause frictional rub and......
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

7. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Medication or chemical esophagitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Other brainstem or cranial nerve findings

8. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Supraspinatus and bicipital tendons
True

9. What are the indiciations for neuroimaging?
Associated with hypotension
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
RBC casts and old to moderate HTN
Rotator cuff tendonitis

10. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Less than 3 stools per week
Cervical radiculopathy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Echocardiogram

11. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pleurisy
Serotypes 16 - 18 - 31 -52 -58

12. What treatments are the cornerstone for treating cases of functional constipation?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
LH surge triggers ovulation
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

13. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Impetigo
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff problem
Viral gastroenteritis

14. What the consequences of decreased cardiac output?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
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

15. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Variability in the time for follicle development during the proliferative phase
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

16. Define nephrotic range proteinuria
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
>3.5g of protein per 24hrs
RBC casts and old to moderate HTN
True

17. How to NSAIDs contribute to gastritis and ulcer formation?
Acute headache - ataxia - profuse nausea - and vomiting
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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.

18. After treatment of dysplasia - women need Pap smears every...
Excessive bleeding in amount - duration - or both at irregular intervals
Impetigo
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Folliculitis

19. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Excessive bleeding in amount - duration - or both at irregular intervals
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

20. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Regular bleeding at intervals of more than 35 days
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

21. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
EGD
Possibility of Ischemic colitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

22. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pancreatitis

23. HIgh risk pregnant patients should be evaluated for ____ and ____
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Common problem that resolves spontaneously and is most often seen in children and young adults
ACEi
HIV and syphilis

24. Isolated - extra pounding beats
Streptococci
Impetigo
PVC or Premature atrial contraction (PAC)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

25. How do you know if heart palpitations are due to stimulant or medication use?
Excessive bleeding in amount - duration - or both at irregular intervals
Adhesive capsulitis (frozen shoulder): most common in middle age women
CBC
Less abrupt onset and cessation of palpitations

26. What places women at higher risk of getting cervical cancer?
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
Kids: Rotavirus Adults: Norwalk Virus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

27. Define the patient population typically affected by orthostatic or postural proteinuria
Lightheadedness - dizziness - syncope
Possibility of Ischemic colitis
Presence of proteinuria on at least two separate ocassion
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

28. Irregular cycles with excessive flow - duration - or both
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Menorrhagia
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH
Rotator Cuff tendonitis

29. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Serotypes 16 - 18 - 31 -52 -58
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Colposcopy - Endocervical curettage - and directed cervical biopsy

30. Diarrhea from custard filled pastries
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
S. Aureus
Varicella virus
GERD

31. What is the Barany maneuver?
Peptic ulcer disease or gastritis
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

32. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
LH surge triggers ovulation

33. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Repeat Pap after infection treated
Medication or chemical esophagitis

34. Initial treatment for Rhinosinusitis
Giardia
LH surge triggers ovulation
Pancreatitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

35. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Repeat Pap after infection treated
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Other brainstem or cranial nerve findings

36. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
MSK - pulmonary - GI - or psychological
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

37. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Supraspinatus and bicipital tendons
CBC
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

38. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
CBC
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Bence-Jones
A central clear area

39. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
>150mg per 24hrs
Hx: Onset of menarche and duration and frequency of the menstrual period - Bleeding pattern - hx of liver - renal - thyroid disease - Use of anticoags - oral contraception - hormone replacement - ROS: weight change - hirsutism (indicating PCOS=LH:FSH
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
S. aureus- beta hemolytic streptococcus

40. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Infectious esophagitis
Peptic ulcer disease or gastritis
Less than 80 ml of blood
Wolff-Parkinson-White syndrome

41. 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)
These patients are associated with low renin states=less likely to respond to medication
S. aureus- beta hemolytic streptococcus
PE - MI - aortic dissection - pneumothorax

42. What should be considered in younger patients with menorrhagia
Increase; 200 g/day
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
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
Coag disorders

43. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Polymenorrhea
Associated with hypotension
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
Pleurisy

44. What are the signs of acute sinusitis?
35 (exception for postmenopausal women who have recently been started on HRT)
PVC or Premature atrial contraction (PAC)
Regular bleeding at intervals of more than 35 days
Fever with frontal or maxillary tenderness

45. History and PE for Pneumonia
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
Non-cardiac causes of palpitations
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

46. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
PVC or Premature atrial contraction (PAC)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

47. History for Sinusitis

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48. What HPV serotypes are most commonly associated with cervical cancer?
Repeat Pap after infection treated
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Serotypes 16 - 18 - 31 -52 -58

49. Define proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
>150mg per 24hrs
Albumin; low molecular weight proteins

50. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Squamocolumnar junction=most common site of cervical cancer
Coronary artery disease/ angina
Infectious esophagitis
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