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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.
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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. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

2. Name some medications that can cause proteinuria
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Supraspinatus and bicipital tendons
Impetigo

3. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Nonulcer dyspepsia
Coag disorders
Tension headache

4. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Coronary artery disease/ angina
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

5. What treatments are the cornerstone for treating cases of functional constipation?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Peptic ulcer disease or gastritis
Lightheadedness - dizziness - syncope

6. Metrorrhagia
GERD
Irregular bleeding between cycles
BB or CCB - catheter ablation of identified bypass tract
Scleroderma/polymyositis with secondary gastroesophageal reflux

7. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pain
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Increase; 200 g/day

8. Describes what occurs during squamous metaplasia of the cervix.
100mg; means patient can be trace protein positive and not be detected
Giardia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Less than 3 stools per week

9. What is the Epley maneuver?
BB or CCB - catheter ablation of identified bypass tract
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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.
These patients are associated with low renin states=less likely to respond to medication

10. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
HPV
Tension headache
Serotypes 16 - 18 - 31 -52 -58

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
>3.5g of protein per 24hrs
Pleurisy
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

12. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Upper sternal area burning pain - associated with a productive cough
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
High blood pressure - focal neurologic defecit - or papilledema
Irregular bleeding between cycles

13. Natural history of cervical cancer
Intermenstrual bleeding
Presence of proteinuria on at least two separate ocassion
Coronary artery disease/ angina
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

14. How do you define persistent protein uria?
Less than 3 stools per week
Anticoag with warfarin to prevent thromboembolism
Presence of proteinuria on at least two separate ocassion
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

15. What does the classic ring worm lesion have?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
A central clear area
Albumin; low molecular weight proteins

16. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
E. Coli O157:H7
Upper sternal area burning pain - associated with a productive cough

17. Who should have Xray testing for shoulder pain?
>150mg per 24hrs
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Supraspinatus and bicipital tendons

18. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pleurisy

19. What type of imaging is need for chronic sinusitis?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
CT
Cluster headache
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

20. When is a lumbar puncture contraindicated?
Fever with frontal or maxillary tenderness
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
S. aureus- beta hemolytic streptococcus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

21. 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
Nonulcer dyspepsia
Warts
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Anticoag with warfarin to prevent thromboembolism

22. What does treatment for migrans include?
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

23. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Pts with palpitations and dizziness - near syncope - or syncope
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

24. What is the peripheral caUse of vertigo?
A 24hr urine protein collection and urine creatinine clearance determination
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

25. What is the goal of CHF treatment? What drugs should be used?
100mg; means patient can be trace protein positive and not be detected
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
True
Less abrupt onset and cessation of palpitations

26. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
35 (exception for postmenopausal women who have recently been started on HRT)
LH surge triggers ovulation
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

27. What is considered normal blood loss during a menstrual cycle?
Subarachnoid hemorrhage
Temporal arteritis-biopsy of the temporal artery
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
Less than 80 ml of blood

28. What are the signs of malignant hypertension?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
High blood pressure - focal neurologic defecit - or papilledema
ACEi
Associated with hypotension

29. Isolated - extra pounding beats
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
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
BB or CCB - catheter ablation of identified bypass tract
PVC or Premature atrial contraction (PAC)

30. 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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pts with palpitations and dizziness - near syncope - or syncope
Nonulcer dyspepsia

31. 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)
Cervical radiculopathy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Dehydration - anemia - cardiac causes

32. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Rotator cuff tendonitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
A central clear area
True

33. How do you know if heart palpitations are due to stimulant or medication use?
Hgb - Electrolytes - and TSH
Less abrupt onset and cessation of palpitations
Pts with palpitations and dizziness - near syncope - or syncope
Slow progression of cervical cancer changes -Availability of effective early treatment

34. Complete the sentence: pericarditis can cause frictional rub and......
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
BB or CCB - catheter ablation of identified bypass tract
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

35. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Nonulcer dyspepsia
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
Polymenorrhea
Excessive bleeding in amount - duration - or both at irregular intervals

36. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

37. Define the patient population typically affected by orthostatic or postural proteinuria
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Medication or chemical esophagitis
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
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

38. Describe the presentation tracheobronchitis
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
CBC
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
Upper sternal area burning pain - associated with a productive cough

39. What is an acoustic neuroma?
Anticoag with warfarin to prevent thromboembolism
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

40. When should invasive eletrophysiologic study should be considered?
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
Impetigo
When the patient has symptoms in association with exercise or who describe chest pain or pressure
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

41. What are the three major risk factors for heart failure?
Chest pain during pneumonia or PE
ACEi
HIV and syphilis
Hypertension - CAD - valvular heart disease

42. Prenatal visit schedule for low-risk pregnancies
Tension headache
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
BB or CCB - catheter ablation of identified bypass tract

43. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Dehydration - anemia - cardiac causes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Scabies
ACEi - ARBS - thiazide diuretics

44. Chronic pain and shoulder stiffness with limited motion
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Adhesive capsulitis (frozen shoulder): most common in middle age women

45. What are the indiciations for neuroimaging?
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

46. History for Acute bronchitis
Variability in the time for follicle development during the proliferative phase
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
>150mg per 24hrs
Rotator Cuff tendonitis

47. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Candida albicans
CT
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
24 hour halter

48. What does orthostatic positional changes that bring on dizziness suggest?
Subarachnoid hemorrhage
High blood pressure - focal neurologic defecit - or papilledema
Dehydration - anemia - cardiac causes
Scleroderma/polymyositis with secondary gastroesophageal reflux

49. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Intermenstrual bleeding
A central clear area
EGD

50. Diagnosis of HTN
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Colposcopy - Endocervical curettage - and directed cervical biopsy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart