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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. 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
Anticoag with warfarin to prevent thromboembolism
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Analgesic headache

2. Cycle length variabilty is primarily due to what?
A 24hr urine protein collection and urine creatinine clearance determination
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Variability in the time for follicle development during the proliferative phase

3. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Presence of proteinuria on at least two separate ocassion
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
PVC or Premature atrial contraction (PAC)

4. Prenatal visit schedule for low-risk pregnancies
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
Regular bleeding at intervals of more than 35 days
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

5. What is the mechanism of action for stimulant agents in treating constipation?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Loop diuretics (Check serum K+ levels before drug admin)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

6. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
>3.5g of protein per 24hrs
E. Coli O157:H7
Influenza - Rhinovirus - Adenovirus - Parainfluenza

7. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Generalized Anxiety disorder and panic disorder
Furucnle
Cellulitis
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

8. PE for a patient getting an abnormal vaginal bleeding work up
Dehydration - anemia - cardiac causes
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Albumin; low molecular weight proteins
ACEi - ARBS - thiazide diuretics

9. 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
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

10. Uterine bleeding between regular cycles
Pain
S. Aureus
>150mg per 24hrs
Intermenstrual bleeding

11. How do you know if heart palpitations are due to stimulant or medication use?
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.
Less abrupt onset and cessation of palpitations
ACEi - ARBS - thiazide diuretics
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.

12. Menometrorrhagia
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
Excessive bleeding in amount - duration - or both at irregular intervals
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Acute headache - ataxia - profuse nausea - and vomiting

13. When should invasive eletrophysiologic study should be considered?
PVC or Premature atrial contraction (PAC)
Menorrhagia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

14. What is the caUse of Meniere disease? What are the cardinal symptoms?
Streptococci
Medication or chemical esophagitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

15. 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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Streptococci
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Repeat Pap after infection treated

16. Describe the history and PE of patient presenting with common cold
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

17. What is the role of LH in the menstrual cycle
Acute headache - ataxia - profuse nausea - and vomiting
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
LH surge triggers ovulation
Peptic ulcer disease or gastritis

18. How to NSAIDs contribute to gastritis and ulcer formation?
Molluscum contagiosum- pox virus
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.
Polymenorrhea
Associated with hypotension

19. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
35 (exception for postmenopausal women who have recently been started on HRT)

20. What diagnosis does the 'worse headache of my life' suggest?
Varicella virus
ACEi - ARBS - thiazide diuretics
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.
Subarachnoid hemorrhage

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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
True
Less abrupt onset and cessation of palpitations

22. Clinical Manifestations of HTN
Cholelithiasis
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
True

23. Diarrhea from custard filled pastries
Pain
Paroxysmal atrial fibrillation or supraventricular tachycardia
S. Aureus
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

24. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Wolff-Parkinson-White syndrome
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

25. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
PE - MI - aortic dissection - pneumothorax
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Fever with frontal or maxillary tenderness
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

26. Shoulder pain with pain radiating to elbow
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
Cervical radiculopathy
Repeat Pap after infection treated
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.

27. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Upper sternal area burning pain - associated with a productive cough

28. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

29. Where does the development of abnormal cervical cells begin?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Kids: Rotavirus Adults: Norwalk Virus
Squamocolumnar junction=most common site of cervical cancer

30. Oligomenorrhea
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Regular bleeding at intervals of more than 35 days
Repeat Pap after infection treated

31. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

32. Chronic pain and shoulder stiffness with limited motion
100mg; means patient can be trace protein positive and not be detected
Adhesive capsulitis (frozen shoulder): most common in middle age women
S. Aureus
Paroxysmal atrial fibrillation or supraventricular tachycardia

33. Define the patient population typically affected by orthostatic or postural proteinuria
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

34. What is the difference between a Holter monitor or an event monitor?
Lightheadedness - dizziness - syncope
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

35. Natural history of cervical cancer
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Candida albicans
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

36. What are the secondly causes of glomerular disease?
Increase; 200 g/day
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

37. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
35 (exception for postmenopausal women who have recently been started on HRT)
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

38. SE Of Beta blockers?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
E. Coli O157:H7
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

39. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

40. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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
Streptococci
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Paroxysmal atrial fibrillation or supraventricular tachycardia

41. What is benign transient proteinuria?
Subarachnoid hemorrhage
Common problem that resolves spontaneously and is most often seen in children and young adults
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

42. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

43. Name the skin lesion: pustule in association with a hair follice
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Folliculitis
Medication or chemical esophagitis
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

44. Vaccines that should be updated before planned pregnancy
Cholelithiasis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

45. What are the most common causes for the common cold?
35 (exception for postmenopausal women who have recently been started on HRT)
BB or CCB - catheter ablation of identified bypass tract
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

46. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

47. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
DM - HTN - DVT - seizures - depression - or anxiety
Regular bleeding at intervals of more than 35 days

48. Why is the pap smear one of the most effective cancer screening tools?
Non-cardiac causes of palpitations
Slow progression of cervical cancer changes -Availability of effective early treatment
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

49. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Analgesic headache
Echocardiogram
Anticoag with warfarin to prevent thromboembolism

50. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pancreatitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pts with palpitations and dizziness - near syncope - or syncope