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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Pneumothorax - sudden sharp chest pain - preceded by viral illness
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Pleurisy
Acute headache - ataxia - profuse nausea - and vomiting
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

2. What are signs of pulmonary congestion?
CBC
Common problem that resolves spontaneously and is most often seen in children and young adults
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

3. Treatment for supraventricular tachycardias
Candida albicans
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
BB or CCB - catheter ablation of identified bypass tract

4. 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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Dehydration - anemia - cardiac causes
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

5. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Fever with frontal or maxillary tenderness
PVC or Premature atrial contraction (PAC)

6. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Menorrhagia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Pain

7. Describe the presentation of myocardial pain?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
HIV and syphilis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

8. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Scleroderma/polymyositis with secondary gastroesophageal reflux
Increase; 200 g/day
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

9. How can GERD (or esophageal motility disorders) lead to chest pain?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

10. When should a patient get a stress test?
Pancreatitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Loop diuretics (Check serum K+ levels before drug admin)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

11. What are the symptoms of palpitations?
Non-cardiac causes of palpitations
RBC casts and old to moderate HTN
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Lightheadedness - dizziness - syncope

12. 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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Viral infection of the semicircular apparatus
Coronary artery disease/ angina

13. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
BB or CCB - catheter ablation of identified bypass tract
RBC casts and old to moderate HTN
Impetigo

14. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Albumin; low molecular weight proteins
Tension headache

15. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
ACEi - ARBS - thiazide diuretics
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HIV and syphilis

16. Difference between Pneumonia and Bronchitis
CBC
Candida albicans
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

17. Prenatal visit schedule for low-risk pregnancies
Irregular bleeding between cycles
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
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.
Squamocolumnar junction=most common site of cervical cancer

18. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Temporal arteritis-biopsy of the temporal artery
Candida albicans
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

19. 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.
Generalized Anxiety disorder and panic disorder
Rotator Cuff problem
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Tension headache

20. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

21. Describe the presentation of pneumonia
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

22. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Cholelithiasis
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

23. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Other brainstem or cranial nerve findings
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When the patient has symptoms in association with exercise or who describe chest pain or pressure

24. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Pts with palpitations and dizziness - near syncope - or syncope
High blood pressure - focal neurologic defecit - or papilledema
Infectious esophagitis
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

25. At was quantity does urine dipstick test detect elevated protein?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
100mg; means patient can be trace protein positive and not be detected
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

26. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Tension headache
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
ACEi - ARBS - thiazide diuretics

27. What diagnosis does the 'worse headache of my life' suggest?
Pts with palpitations and dizziness - near syncope - or syncope
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Subarachnoid hemorrhage

28. 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
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
Hgb - Electrolytes - and TSH
35 (exception for postmenopausal women who have recently been started on HRT)

29. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
These patients are associated with low renin states=less likely to respond to medication
Pts with palpitations and dizziness - near syncope - or syncope
Viral infection of the semicircular apparatus

30. Define the patient population typically affected by orthostatic or postural proteinuria
Cholelithiasis
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Dehydration - anemia - cardiac causes

31. Lab testing for heart palpitation
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Hgb - Electrolytes - and TSH
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

32. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Albumin; low molecular weight proteins
CBC
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
>3.5g of protein per 24hrs

33. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

34. Uterine bleeding between regular cycles
Albumin; low molecular weight proteins
Intermenstrual bleeding
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

35. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
S. Aureus
Cluster headache
LH surge triggers ovulation
Adhesive capsulitis (frozen shoulder): most common in middle age women

36. Metrorrhagia
Less than 3 stools per week
Irregular bleeding between cycles
Other brainstem or cranial nerve findings
Molluscum contagiosum- pox virus

37. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Chest pain during pneumonia or PE
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
Intermenstrual bleeding

38. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
ACEi
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

39. What is the standard tool used for diagnosis of GERD?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
EGD
HIV and syphilis

40. What type of imaging is need for chronic sinusitis?
ACEi - ARBS - thiazide diuretics
Intermenstrual bleeding
Adhesive capsulitis (frozen shoulder): most common in middle age women
CT

41. What occurs after ovulation
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Regular bleeding at intervals of more than 35 days
35 (exception for postmenopausal women who have recently been started on HRT)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

42. Oligomenorrhea
Analgesic headache
Regular bleeding at intervals of more than 35 days
Wolff-Parkinson-White syndrome
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

43. What are the primary glomerular diseases?
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
Rotator Cuff problem
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

44. What is the mechanism of action for stimulant agents in treating constipation?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Impetigo
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Candida albicans

45. Where does the development of abnormal cervical cells begin?
HPV
Squamocolumnar junction=most common site of cervical cancer
Loop diuretics (Check serum K+ levels before drug admin)
LH surge triggers ovulation

46. What are the most common viral causes of diarrhea in kids and adults?
HIV and syphilis
Kids: Rotavirus Adults: Norwalk Virus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Folliculitis

47. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Giardia
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral infection of the semicircular apparatus

48. Name the skin lesion: pustule in association with a hair follice
Folliculitis
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
EGD
Irregular bleeding between cycles

49. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Folliculitis
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
Candida albicans

50. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Coronary artery disease/ angina
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

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