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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. What are the features of glomerular nephritis
ACEi
RBC casts and old to moderate HTN
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Associated with hypotension

2. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Peptic ulcer disease or gastritis
Less abrupt onset and cessation of palpitations

3. How can GERD (or esophageal motility disorders) lead to chest pain?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
DM - HTN - DVT - seizures - depression - or anxiety
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

4. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Cellulitis
Tension headache

5. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Dehydration - anemia - cardiac causes
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bence-Jones

6. What is the mechanism of action for stimulant agents in treating constipation?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
24 hour halter
Possibility of Ischemic colitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

7. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
BB or CCB - catheter ablation of identified bypass tract
35 (exception for postmenopausal women who have recently been started on HRT)
Pain
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

8. Describes what occurs during squamous metaplasia of the cervix.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

9. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Non-cardiac causes of palpitations
Furucnle
Cervical radiculopathy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

10. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
A 24hr urine protein collection and urine creatinine clearance determination

11. Mainstay treatment for soft tissue inflammation (Shoulder)
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
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
Fever with frontal or maxillary tenderness
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

12. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
Impetigo
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
High blood pressure - focal neurologic defecit - or papilledema
Coronary artery disease/ angina
Wolff-Parkinson-White syndrome

14. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Diuretics -BB -CCB -ACEi
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

15. Oligomenorrhea
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
Regular bleeding at intervals of more than 35 days
Common problem that resolves spontaneously and is most often seen in children and young adults
ACEi - ARBS - thiazide diuretics

16. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Increase; 200 g/day
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

17. What are the secondly causes of glomerular disease?
Cholelithiasis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Less than 3 stools per week
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

18. Define nephrotic range proteinuria
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
HPV
CBC
>3.5g of protein per 24hrs

19. Predictors of cardiac etiology
Increase; 200 g/day
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
These patients are associated with low renin states=less likely to respond to medication
Non-cardiac causes of palpitations

20. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
100mg; means patient can be trace protein positive and not be detected
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

21. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. Aureus
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

22. Difference between Pneumonia and Bronchitis
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
Less abrupt onset and cessation of palpitations
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

23. What is the Barany maneuver?
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
Albumin; low molecular weight proteins
CT
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

24. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

25. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
ACEi
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

26. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
DM - HTN - DVT - seizures - depression - or anxiety
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Wolff-Parkinson-White syndrome

27. Name the diagnosis of heartburn: regurgitation - dysphagia
Regular bleeding at intervals of more than 35 days
Anticoag with warfarin to prevent thromboembolism
PE - MI - aortic dissection - pneumothorax
GERD

28. How to NSAIDs contribute to gastritis and ulcer formation?
Coronary artery disease/ angina
EGD
Tension headache
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.

29. 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.
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Tension headache
HIV and syphilis

30. Treatment for supraventricular tachycardias
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
BB or CCB - catheter ablation of identified bypass tract

31. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
CBC
Non-cardiac causes of palpitations

32. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cluster headache
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
Upper sternal area burning pain - associated with a productive cough

33. What is considered normal blood loss during a menstrual cycle?
Coag disorders
Pleurisy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Less than 80 ml of blood

34. Describe the presentation tracheobronchitis
Coronary artery disease/ angina
Upper sternal area burning pain - associated with a productive cough
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

35. What does the classic ring worm lesion have?
Wolff-Parkinson-White syndrome
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Increase; 200 g/day
A central clear area

36. What is the role of FSH in one's menstrual cycle
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

37. What should blood work include for suspected heart failure?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Presence of proteinuria on at least two separate ocassion
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

38. How does CHF present on X-ray?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
S. aureus- beta hemolytic streptococcus
Furucnle
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

39. name the 4 emergent causes of chest pain
35 (exception for postmenopausal women who have recently been started on HRT)
Loop diuretics (Check serum K+ levels before drug admin)
PE - MI - aortic dissection - pneumothorax
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.

40. Describe the presentation of pericardial pain
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
E. Coli O157:H7

41. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
DM - HTN - DVT - seizures - depression - or anxiety
Streptococci
Giardia

42. What are the physical exam signs of CHF?
Excessive bleeding in amount - duration - or both at irregular intervals
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Diuretics -BB -CCB -ACEi

43. What places women at higher risk of getting cervical cancer?
Lightheadedness - dizziness - syncope
Chest pain during pneumonia or PE
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
True

44. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Repeat Pap after infection treated
Viral gastroenteritis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

45. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

46. What does treatment for migrans include?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Generalized Anxiety disorder and panic disorder
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
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

47. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Furucnle

48. Natural history of cervical cancer
Slow progression of cervical cancer changes -Availability of effective early treatment
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
35 (exception for postmenopausal women who have recently been started on HRT)
Less than 3 stools per week

49. History for Sinusitis

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50. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Nonulcer dyspepsia
Wolff-Parkinson-White syndrome
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot