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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. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Hgb - Electrolytes - and TSH
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
Lightheadedness - dizziness - syncope
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

2. 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
Pleurisy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
LH surge triggers ovulation

3. What is the role of FSH in one's menstrual cycle
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
Lightheadedness - dizziness - syncope
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

4. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
ACEi - ARBS - thiazide diuretics
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PE - MI - aortic dissection - pneumothorax

5. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

6. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Irregular bleeding between cycles

7. What test done in PE measures instability of shoulder?
Other brainstem or cranial nerve findings
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Molluscum contagiosum- pox virus

8. Irregular cycles with excessive flow - duration - or both
Menorrhagia
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
Dehydration - anemia - cardiac causes
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

9. What is benign transient proteinuria?
Cervical radiculopathy
Common problem that resolves spontaneously and is most often seen in children and young adults
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Varicella virus

10. What diagnosis does the 'worse headache of my life' suggest?
Kids: Rotavirus Adults: Norwalk Virus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Subarachnoid hemorrhage
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

11. Describe the presentation of angina?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Coag disorders
A 24hr urine protein collection and urine creatinine clearance determination

12. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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.
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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

13. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
E. Coli O157:H7
Albumin; low molecular weight proteins
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
PVC or Premature atrial contraction (PAC)

14. Things that need to be included in history of shoulder pain
Candida albicans
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pts with palpitations and dizziness - near syncope - or syncope
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

15. What places women at higher risk of getting cervical cancer?
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Irregular bleeding between cycles
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

16. What is the caUse of benign positional vertigo?
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.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
ACEi
Rotator cuff tendonitis

17. 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
Menorrhagia
Varicella virus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

18. What are the physical exam signs of CHF?
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
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
Albumin; low molecular weight proteins
Furucnle

19. What are signs of pulmonary congestion?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Tension headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

20. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Folliculitis

21. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Pleurisy
DM - HTN - DVT - seizures - depression - or anxiety
Coag disorders

22. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

23. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
High blood pressure - focal neurologic defecit - or papilledema
Nonulcer dyspepsia
Candida albicans
Diuretics -BB -CCB -ACEi

24. 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
BB or CCB - catheter ablation of identified bypass tract
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
CT

25. Why is the pap smear one of the most effective cancer screening tools?
Loop diuretics (Check serum K+ levels before drug admin)
Slow progression of cervical cancer changes -Availability of effective early treatment
Other brainstem or cranial nerve findings
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

26. What is the Epley maneuver?
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.
Less than 3 stools per week
Giardia
Medication or chemical esophagitis

27. 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
Warts
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Rotator Cuff problem
Higher filling presure - pulmonary congestion - and decreasd cardiac return

28. Define nephrotic range proteinuria
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
>3.5g of protein per 24hrs
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

29. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pts with palpitations and dizziness - near syncope - or syncope

30. 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)
Less than 80 ml of blood
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

31. 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
Tension headache
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
HIV and syphilis

32. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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
A 24hr urine protein collection and urine creatinine clearance determination
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Staphylococcal scalded skin syndrome

33. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pts with palpitations and dizziness - near syncope - or syncope
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

34. Prenatal visit schedule for low-risk 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
Coronary artery disease/ angina
Chest pain during pneumonia or PE
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

35. What are the symptoms of palpitations?
Cholelithiasis
Presence of proteinuria on at least two separate ocassion
Lightheadedness - dizziness - syncope
Furucnle

36. At was quantity does urine dipstick test detect elevated protein?
Paroxysmal atrial fibrillation or supraventricular tachycardia
HPV
Intermenstrual bleeding
100mg; means patient can be trace protein positive and not be detected

37. Uterine bleeding between regular cycles
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Intermenstrual bleeding
Possibility of Ischemic colitis
LH surge triggers ovulation

38. 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
EGD
Tension headache
Subarachnoid hemorrhage

39. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Lightheadedness - dizziness - syncope
Upper sternal area burning pain - associated with a productive cough
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

40. Lab testing for heart palpitation
Polymenorrhea
Hgb - Electrolytes - and TSH
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Squamocolumnar junction=most common site of cervical cancer

41. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
A 24hr urine protein collection and urine creatinine clearance determination
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
PE - MI - aortic dissection - pneumothorax
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

42. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

43. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Rotator Cuff problem
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
ACEi

44. What does the classic ring worm lesion have?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
A central clear area

45. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
Supraspinatus and bicipital tendons
S. aureus- beta hemolytic streptococcus
ACEi

46. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Increase; 200 g/day
Influenza - Rhinovirus - Adenovirus - Parainfluenza
ACEi - ARBS - thiazide diuretics

47. What is the goal of CHF treatment? What drugs should be used?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
A central clear area
Irregular bleeding between cycles
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

48. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Increase; 200 g/day

49. Pain in shoulder when throwing - swimming - or serving a tennis ball
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Rotator cuff tendonitis
Cellulitis
>150mg per 24hrs

50. What is considered normal blood loss during a menstrual cycle?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Less than 80 ml of blood
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing