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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 diagnosis: paroxysmal episodes that begin and resolve abruptly.
A 24hr urine protein collection and urine creatinine clearance determination
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
True
24 hour halter
These patients are associated with low renin states=less likely to respond to medication

3. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
BB or CCB - catheter ablation of identified bypass tract
Serotypes 16 - 18 - 31 -52 -58

4. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
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
Squamocolumnar junction=most common site of cervical cancer
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

5. Shoulder pain with pain radiating to elbow
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
Albumin; low molecular weight proteins
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cervical radiculopathy

6. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator Cuff tendonitis

7. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Kids: Rotavirus Adults: Norwalk Virus
DM - HTN - DVT - seizures - depression - or anxiety
Rotator cuff tendonitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

8. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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
Infectious esophagitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
DM - HTN - DVT - seizures - depression - or anxiety

9. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Slow progression of cervical cancer changes -Availability of effective early treatment
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Common problem that resolves spontaneously and is most often seen in children and young adults

10. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
True
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Possibility of Ischemic colitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

11. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Wolff-Parkinson-White syndrome
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
HPV

12. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
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
Molluscum contagiosum- pox virus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

13. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Coag disorders

14. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
CBC
Chest pain during pneumonia or PE
PVC or Premature atrial contraction (PAC)
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

15. Diagnostic Evaluation of Abnoraml vaginal bleeding
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Warts
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
Subarachnoid hemorrhage

16. What is the caUse of benign positional vertigo?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Furucnle
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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.

17. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
>150mg per 24hrs
Peptic ulcer disease or gastritis
Cluster headache
Streptococci

18. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pancreatitis
>150mg per 24hrs
HPV

19. Metrorrhagia
Irregular bleeding between cycles
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

20. Name some medications that can cause proteinuria
Cellulitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Hypertension - CAD - valvular heart disease

21. name the 4 emergent causes of chest pain
Pancreatitis
Medication or chemical esophagitis
Rotator Cuff tendonitis
PE - MI - aortic dissection - pneumothorax

22. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

23. Describe the presentation tracheobronchitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Viral infection of the semicircular apparatus
Upper sternal area burning pain - associated with a productive cough

24. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Regular bleeding at intervals of more than 35 days
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
Viral gastroenteritis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

25. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Lightheadedness - dizziness - syncope
100mg; means patient can be trace protein positive and not be detected
E. Coli O157:H7
Albumin; low molecular weight proteins

26. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Irregular bleeding between cycles
Tension headache
Repeat Pap after infection treated

27. Prenatal visit schedule for low-risk pregnancies
Analgesic headache
GERD
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
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

28. Constipation: What are indications for lab testing?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Irregular bleeding between cycles
A 24hr urine protein collection and urine creatinine clearance determination
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

29. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Analgesic headache
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

30. How to NSAIDs contribute to gastritis and ulcer formation?
Less abrupt onset and cessation of palpitations
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.
Associated with hypotension
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

31. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Albumin; low molecular weight proteins
Varicella virus
A 24hr urine protein collection and urine creatinine clearance determination

32. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
Folliculitis
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
Increase; 200 g/day

33. 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
Rotator Cuff tendonitis
Cervical radiculopathy
Scleroderma/polymyositis with secondary gastroesophageal reflux

34. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Pts with palpitations and dizziness - near syncope - or syncope
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Peptic ulcer disease or gastritis

35. Name the diagnosis of heartburn: regurgitation - dysphagia
Pts with palpitations and dizziness - near syncope - or syncope
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
GERD

36. How does CHF present on X-ray?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bence-Jones
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

37. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
EGD
Other brainstem or cranial nerve findings
Bulk forming: Psyllium - Methycellulose - Polycarbophil

38. Carcinoma in situ is generally referred to a gynecologist and requires ______
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
A 24hr urine protein collection and urine creatinine clearance determination

39. Define nephrotic range proteinuria
35 (exception for postmenopausal women who have recently been started on HRT)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
>3.5g of protein per 24hrs
24 hour halter

40. Where does the development of abnormal cervical cells begin?
High blood pressure - focal neurologic defecit - or papilledema
Squamocolumnar junction=most common site of cervical cancer
DM - HTN - DVT - seizures - depression - or anxiety
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

41. History for Acute bronchitis
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
BB or CCB - catheter ablation of identified bypass tract
Less abrupt onset and cessation of palpitations

42. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Supraspinatus and bicipital tendons

43. When is a lumbar puncture contraindicated?
These patients are associated with low renin states=less likely to respond to medication
PVC or Premature atrial contraction (PAC)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Colposcopy - Endocervical curettage - and directed cervical biopsy

44. Natural history of cervical cancer
A central clear area
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.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

45. How does systolic vs. diastolic heart failure present on the echocardiogram?
Variability in the time for follicle development during the proliferative phase
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
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

46. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Supraspinatus and bicipital tendons
Viral infection of the semicircular apparatus

47. What are the indiciations for neuroimaging?
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.
Subarachnoid hemorrhage
100mg; means patient can be trace protein positive and not be detected
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

48. Chronic pain and shoulder stiffness with limited motion
Influenza - Rhinovirus - Adenovirus - Parainfluenza
>150mg per 24hrs
With a KOH wet mount preparation
Adhesive capsulitis (frozen shoulder): most common in middle age women

49. What test done in PE measures instability of shoulder?
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
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Colposcopy - Endocervical curettage - and directed cervical biopsy

50. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM