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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. Prenatal visit schedule for low-risk pregnancies
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Kids: Rotavirus Adults: Norwalk Virus
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
A 24hr urine protein collection and urine creatinine clearance determination

2. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Paroxysmal atrial fibrillation or supraventricular tachycardia
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

3. Cycle length variabilty is primarily due to what?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Variability in the time for follicle development during the proliferative phase

4. Describe the presentation of angina?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pain
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

5. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Molluscum contagiosum- pox virus
CT
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
MSK - pulmonary - GI - or psychological

6. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Serotypes 16 - 18 - 31 -52 -58
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Analgesic headache

7. Vaccines that should be updated before planned pregnancy
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Serotypes 16 - 18 - 31 -52 -58

8. How does CHF present on X-ray?
PE - MI - aortic dissection - pneumothorax
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
E. Coli O157:H7
Streptococci

9. 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
These patients are associated with low renin states=less likely to respond to medication
With a KOH wet mount preparation
Colposcopy - Endocervical curettage - and directed cervical biopsy

10. What are the physical exam signs of CHF?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

11. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Analgesic headache
Staphylococcal scalded skin syndrome
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

12. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Associated with hypotension
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.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

13. What are the features of glomerular nephritis
24 hour halter
S. aureus- beta hemolytic streptococcus
RBC casts and old to moderate HTN
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

14. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Furucnle
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
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

15. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Pancreatitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
ACEi - ARBS - thiazide diuretics

16. Regular bleeding at intervals of less than 21 days
Intermenstrual bleeding
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Polymenorrhea

17. What are the most common viral causes of diarrhea in kids and adults?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
EGD
Kids: Rotavirus Adults: Norwalk Virus
>150mg per 24hrs

18. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Rotator Cuff problem
Colposcopy - Endocervical curettage - and directed cervical biopsy
HPV

19. What is the difference between a Holter monitor or an event monitor?
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
Serotypes 16 - 18 - 31 -52 -58
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

20. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Adhesive capsulitis (frozen shoulder): most common in middle age women
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Presence of proteinuria on at least two separate ocassion

21. 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
True
Other brainstem or cranial nerve findings
Viral infection of the semicircular apparatus
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

22. What are the most common causes for the common cold?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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.
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

23. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
>150mg per 24hrs
Bence-Jones
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

24. What are the three major risk factors for heart failure?
Less abrupt onset and cessation of palpitations
Hypertension - CAD - valvular heart disease
Variability in the time for follicle development during the proliferative phase
Hgb - Electrolytes - and TSH

25. 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.
Tension headache
Increase; 200 g/day
Generalized Anxiety disorder and panic disorder
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

26. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Diuretics -BB -CCB -ACEi
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Furucnle
Nonulcer dyspepsia

27. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
S. aureus- beta hemolytic streptococcus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Possibility of Ischemic colitis

28. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
EGD
Medication or chemical esophagitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

29. Oligomenorrhea
CBC
Regular bleeding at intervals of more than 35 days
ACEi - ARBS - thiazide diuretics
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

30. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

31. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Temporal arteritis-biopsy of the temporal artery
Intermenstrual bleeding

32. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Other brainstem or cranial nerve findings
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
Generalized Anxiety disorder and panic disorder
HPV testing -Pos=colposcopy -Neg=repeat pap smear

33. Diagnosis of HTN
Regular bleeding at intervals of more than 35 days
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Hgb - Electrolytes - and TSH
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

34. What medications can cause heart palpitations?
ACEi - ARBS - thiazide diuretics
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.
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

35. How are fungal infections diagnosed?
Temporal arteritis-biopsy of the temporal artery
With a KOH wet mount preparation
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
Molluscum contagiosum- pox virus

36. Describe the presentation of pericardial pain
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hypertension - CAD - valvular heart disease

37. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Rotator cuff tendonitis
Chest pain during pneumonia or PE
These patients are associated with low renin states=less likely to respond to medication

38. Define the patient population typically affected by orthostatic or postural proteinuria
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pleurisy
High blood pressure - focal neurologic defecit - or papilledema
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. Four muscles of rotator cuff
S. aureus- beta hemolytic streptococcus
Molluscum contagiosum- pox virus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

40. Lab testing for heart palpitation
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Variability in the time for follicle development during the proliferative phase
Hgb - Electrolytes - and TSH
Staphylococcal scalded skin syndrome

41. 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
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
True

42. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Coag disorders
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

43. What should blood work include for suspected heart failure?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Tension headache
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

44. What is the peripheral caUse of vertigo?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

45. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Streptococci
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Increase; 200 g/day
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

46. Name 4 factors that predispose an individual to develop pneumonia.
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

47. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
E. Coli O157:H7
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

48. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
CBC
LH surge triggers ovulation
Presence of proteinuria on at least two separate ocassion

49. What should preconception counseling include?
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
Less than 3 stools per week
Subarachnoid hemorrhage
Tension headache

50. Metrorrhagia
S. Aureus
GERD
Irregular bleeding between cycles
DM - HTN - DVT - seizures - depression - or anxiety