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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. Name types of laxatives
Non-cardiac causes of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

2. 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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Regular bleeding at intervals of more than 35 days
Scabies

3. What is the standard tool used for diagnosis of GERD?
EGD
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
Coronary artery disease/ angina
Cellulitis

4. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
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
Non-cardiac causes of palpitations
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

5. Describes what occurs during squamous metaplasia of the cervix.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Warts

6. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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.
Rotator Cuff tendonitis
Slow progression of cervical cancer changes -Availability of effective early treatment

7. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Molluscum contagiosum- pox virus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral infection of the semicircular apparatus

8. Menometrorrhagia
Regular bleeding at intervals of more than 35 days
These patients are associated with low renin states=less likely to respond to medication
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Excessive bleeding in amount - duration - or both at irregular intervals

9. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Repeat Pap after infection treated
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
Pleurisy
Viral infection of the semicircular apparatus

10. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Anticoag with warfarin to prevent thromboembolism
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

11. Uterine bleeding between regular cycles
ACEi - ARBS - thiazide diuretics
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Intermenstrual bleeding
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

12. Name the diagnosis of heartburn: regurgitation - dysphagia
Polymenorrhea
GERD
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

13. What is the mechanism of action for stimulant agents in treating constipation?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Colposcopy - Endocervical curettage - and directed cervical biopsy
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
100mg; means patient can be trace protein positive and not be detected

14. Diagnosis of HTN
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Giardia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

15. Constipation: What are indications for lab testing?
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
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

16. When should a patient get a stress test?
HPV
When the patient has symptoms in association with exercise or who describe chest pain or pressure
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Menorrhagia

17. What is the difference between a Holter monitor or an event monitor?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Menorrhagia
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

18. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
E. Coli O157:H7
Regular bleeding at intervals of more than 35 days

19. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Generalized Anxiety disorder and panic disorder
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
With a KOH wet mount preparation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

20. What should blood work include for suspected heart failure?
ACEi - ARBS - thiazide diuretics
EGD
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

21. History for Acute bronchitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Analgesic headache

22. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Infectious esophagitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
>150mg per 24hrs

23. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
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
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.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

24. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pts with palpitations and dizziness - near syncope - or syncope

25. What type of imaging is need for chronic sinusitis?
Generalized Anxiety disorder and panic disorder
Colposcopy - Endocervical curettage - and directed cervical biopsy
A 24hr urine protein collection and urine creatinine clearance determination
CT

26. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Echocardiogram
PVC or Premature atrial contraction (PAC)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

27. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Warts
Hgb - Electrolytes - and TSH
Cellulitis

28. Carcinoma in situ is generally referred to a gynecologist and requires ______
S. aureus- beta hemolytic streptococcus
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
Infectious esophagitis
Medication or chemical esophagitis

29. What is the Barany maneuver?
35 (exception for postmenopausal women who have recently been started on HRT)
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

30. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Infectious esophagitis
True

31. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

32. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Medication or chemical esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Subarachnoid hemorrhage
Upper sternal area burning pain - associated with a productive cough

33. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

34. PE for a patient getting an abnormal vaginal bleeding work up
True
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Cervical radiculopathy

35. What is the role of FSH in one's menstrual cycle
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
DM - HTN - DVT - seizures - depression - or anxiety
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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.

36. What are the two common clinical presentations of acute diarrhea?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

37. What is afterload?
35 (exception for postmenopausal women who have recently been started on HRT)
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
S. Aureus
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

38. What are the indiciations for neuroimaging?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Giardia
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
Pts with palpitations and dizziness - near syncope - or syncope

39. Who should have Xray testing for shoulder pain?
Less than 3 stools per week
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
S. Aureus
100mg; means patient can be trace protein positive and not be detected

40. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Coronary artery disease/ angina

41. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Generalized Anxiety disorder and panic disorder
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
S. Aureus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

42. Things that need to be included in history of shoulder pain
Tension headache
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Infectious esophagitis

43. What is the caUse of Meniere disease? What are the cardinal symptoms?
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.
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Viral gastroenteritis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

44. When should invasive eletrophysiologic study should be considered?
CBC
Variability in the time for follicle development during the proliferative phase
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Warts

45. What is considered normal blood loss during a menstrual cycle?
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
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 than 80 ml of blood
Presence of proteinuria on at least two separate ocassion

46. At was quantity does urine dipstick test detect elevated protein?
Hgb - Electrolytes - and TSH
100mg; means patient can be trace protein positive and not be detected
Intermenstrual bleeding
MSK - pulmonary - GI - or psychological

47. When does troponin rise following myocardial injury or infarction?
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

48. Difference between Pneumonia and Bronchitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Coronary artery disease/ angina
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

49. Predictors of cardiac etiology
Less than 3 stools per week
Medication or chemical esophagitis
Irregular bleeding between cycles
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

50. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Medication or chemical esophagitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

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