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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. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

2. What the consequences of decreased cardiac output?
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
Candida albicans
PVC or Premature atrial contraction (PAC)
A 24hr urine protein collection and urine creatinine clearance determination

3. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
A central clear area
Albumin; low molecular weight proteins
Common problem that resolves spontaneously and is most often seen in children and young adults

4. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
LH surge triggers ovulation
CT
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

5. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
35 (exception for postmenopausal women who have recently been started on HRT)
Peptic ulcer disease or gastritis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
100mg; means patient can be trace protein positive and not be detected

6. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming: Psyllium - Methycellulose - Polycarbophil

7. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
With a KOH wet mount preparation
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

8. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
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
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
Echocardiogram
Supraspinatus and bicipital tendons

9. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
GERD
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

10. What are the two common clinical presentations of acute diarrhea?
Temporal arteritis-biopsy of the temporal artery
Acute headache - ataxia - profuse nausea - and vomiting
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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
>150mg per 24hrs
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Scleroderma/polymyositis with secondary gastroesophageal reflux

12. What is the peripheral caUse of vertigo?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Impetigo

13. What are the three major risk factors for heart failure?
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
Hypertension - CAD - valvular heart disease
Coronary artery disease/ angina
Diuretics -BB -CCB -ACEi

14. Discomfort with abducting the arm past 90 degress
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Rotator Cuff tendonitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

15. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
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 abrupt onset and cessation of palpitations
Cluster headache
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

16. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Rotator cuff tendonitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

17. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
HPV
Upper sternal area burning pain - associated with a productive cough
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

18. Diarrhea from custard filled pastries
Candida albicans
S. Aureus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

19. Predictors of cardiac etiology
Pain
Staphylococcal scalded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Increase; 200 g/day

20. What does the classic ring worm lesion have?
A central clear area
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
Impetigo
Furucnle

21. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Common problem that resolves spontaneously and is most often seen in children and young adults
Cholelithiasis
Albumin; low molecular weight proteins
Colposcopy - Endocervical curettage - and directed cervical biopsy

22. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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
Tension headache
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

23. What is an acoustic neuroma?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Cervical radiculopathy

24. What is afterload?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
GERD
Paroxysmal atrial fibrillation or supraventricular tachycardia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

25. Prenatal visit schedule for low-risk pregnancies
Viral gastroenteritis
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
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

26. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Upper sternal area burning pain - associated with a productive cough
Furucnle
Temporal arteritis-biopsy of the temporal artery

27. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
LH surge triggers ovulation
Increase; 200 g/day
Intermenstrual bleeding

28. What are the 2 psych disorders most commonly associated with palpitations?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Generalized Anxiety disorder and panic disorder
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

29. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Coronary artery disease/ angina

30. What are the consequences of diastolic dysfunction?
Cervical radiculopathy
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

31. Menometrorrhagia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Excessive bleeding in amount - duration - or both at irregular intervals
Hypertension - CAD - valvular heart disease
Folliculitis

32. What are the indiciations for neuroimaging?
Acute headache - ataxia - profuse nausea - and vomiting
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
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

33. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Analgesic headache
Furucnle
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

34. At was quantity does urine dipstick test detect elevated protein?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Regular bleeding at intervals of more than 35 days
100mg; means patient can be trace protein positive and not be detected
Higher filling presure - pulmonary congestion - and decreasd cardiac return

35. Isolated - extra pounding beats
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.
100mg; means patient can be trace protein positive and not be detected
PVC or Premature atrial contraction (PAC)
Folliculitis

36. What places women at higher risk of getting cervical cancer?
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
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

37. What are the signs of acute sinusitis?
Excessive bleeding in amount - duration - or both at irregular intervals
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
>150mg per 24hrs
Fever with frontal or maxillary tenderness

38. What type of imaging is need for chronic sinusitis?
Generalized Anxiety disorder and panic disorder
CT
Cholelithiasis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

39. What does treatment for migrans include?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Infectious esophagitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

40. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Cervical radiculopathy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Less than 80 ml of blood

41. 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
Excessive bleeding in amount - duration - or both at irregular intervals
Variability in the time for follicle development during the proliferative phase
Rotator Cuff problem

42. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Supraspinatus and bicipital tendons
24 hour halter
Medication or chemical esophagitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

43. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Albumin; low molecular weight proteins
Warts
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
CBC

44. What is the caUse of benign positional vertigo?
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
CT
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

45. What is the difference between a Holter monitor or an event monitor?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

46. Name the skin lesion: pustule in association with a hair follice
Folliculitis
S. aureus- beta hemolytic streptococcus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Upper sternal area burning pain - associated with a productive cough

47. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Furucnle
Pleurisy

48. Treatment for supraventricular tachycardias
HIV and syphilis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
BB or CCB - catheter ablation of identified bypass tract
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

49. When should a patient get a stress test?
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.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Possibility of Ischemic colitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

50. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Tension headache
Infectious esophagitis
Pts with palpitations and dizziness - near syncope - or syncope