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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
MSK - pulmonary - GI - or psychological
CBC
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

2. What places women at higher risk of getting cervical cancer?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Non-cardiac causes of palpitations
E. Coli O157:H7

3. Where does the development of abnormal cervical cells begin?
Scabies
Medication or chemical esophagitis
Squamocolumnar junction=most common site of cervical cancer
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

4. When does troponin rise following myocardial injury or infarction?
Staphylococcal scalded skin syndrome
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
E. Coli O157:H7

5. 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
Warts
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
Nonulcer dyspepsia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

6. Describes what occurs during squamous metaplasia of the cervix.
Impetigo
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

7. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Rotator Cuff tendonitis

8. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Colposcopy - Endocervical curettage - and directed cervical biopsy
Coag disorders
Fever with frontal or maxillary tenderness

9. Who should have Xray testing for shoulder pain?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Subarachnoid hemorrhage
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

10. 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
Coag disorders
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
Common problem that resolves spontaneously and is most often seen in children and young adults

11. Cycle length variabilty is primarily due to what?
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.
PVC or Premature atrial contraction (PAC)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Variability in the time for follicle development during the proliferative phase

12. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Pts with palpitations and dizziness - near syncope - or syncope
Tension headache
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV

13. Name the skin lesion: honey colored crusts
GERD
Impetigo
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Cellulitis

14. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
CBC
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Cholelithiasis

15. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Increase; 200 g/day
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
E. Coli O157:H7

16. Mainstay treatment for soft tissue inflammation (Shoulder)
Rotator Cuff tendonitis
Slow progression of cervical cancer changes -Availability of effective early treatment
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

17. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Menorrhagia
High blood pressure - focal neurologic defecit - or papilledema
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

18. Name the diagnosis of heartburn: regurgitation - dysphagia
Echocardiogram
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
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.
GERD

19. Isolated - extra pounding beats
GERD
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
PVC or Premature atrial contraction (PAC)
>3.5g of protein per 24hrs

20. Describe the presentation of angina?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pancreatitis
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

21. 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
Varicella virus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

22. What are signs of pulmonary congestion?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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.
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

23. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
35 (exception for postmenopausal women who have recently been started on HRT)

24. History for Sinusitis

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25. What does the classic ring worm lesion have?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
A central clear area
BB or CCB - catheter ablation of identified bypass tract
Viral gastroenteritis

26. Define the patient population typically affected by orthostatic or postural proteinuria
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Slow progression of cervical cancer changes -Availability of effective early treatment
DM - HTN - DVT - seizures - depression - or anxiety

27. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Repeat Pap after infection treated
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
HIV and syphilis

28. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Pts with palpitations and dizziness - near syncope - or syncope
Menorrhagia
Furucnle
Excessive bleeding in amount - duration - or both at irregular intervals

29. What is the caUse of Meniere disease? What are the cardinal symptoms?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Candida albicans
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

30. Complete the sentence: pericarditis can cause frictional rub and......
Fever with frontal or maxillary tenderness
Bence-Jones
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
These patients are associated with low renin states=less likely to respond to medication

31. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Candida albicans
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
Coronary artery disease/ angina
Peptic ulcer disease or gastritis

32. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
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
GERD

33. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
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
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.
With a KOH wet mount preparation

34. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Upper sternal area burning pain - associated with a productive cough
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

35. What does orthostatic positional changes that bring on dizziness suggest?
Intermenstrual bleeding
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
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
Dehydration - anemia - cardiac causes

36. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Repeat Pap after infection treated
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

37. When should invasive eletrophysiologic study should be considered?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Regular bleeding at intervals of more than 35 days
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

38. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Candida albicans
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
Nonulcer dyspepsia

39. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Scabies
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
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
A central clear area

40. MI - pericardial tamponade - PE - GI bleed - are...
Upper sternal area burning pain - associated with a productive cough
Pancreatitis
Associated with hypotension
CT

41. What is the role of FSH in one's menstrual cycle
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Increase; 200 g/day
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

42. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Common problem that resolves spontaneously and is most often seen in children and young adults
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

43. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Bence-Jones
Diuretics -BB -CCB -ACEi

44. What are the two common clinical presentations of acute diarrhea?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cholelithiasis
Giardia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

45. 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
True
Furucnle
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

46. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Viral gastroenteritis
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
Polymenorrhea

47. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
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

48. What diagnosis does the 'worse headache of my life' suggest?
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
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
Pts with palpitations and dizziness - near syncope - or syncope

49. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Rotator cuff tendonitis
Giardia
Non-cardiac causes of palpitations
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

50. After treatment of dysplasia - women need Pap smears every...
HPV testing -Pos=colposcopy -Neg=repeat pap smear
ACEi - ARBS - thiazide diuretics
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Repeat Pap after infection treated