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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. Uterine bleeding between regular cycles
Intermenstrual bleeding
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
Rotator Cuff tendonitis
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

2. Name the skin lesion: pustule in association with a hair follice
Nonulcer dyspepsia
Temporal arteritis-biopsy of the temporal artery
Folliculitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

3. Chronic pain and shoulder stiffness with limited motion
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Adhesive capsulitis (frozen shoulder): most common in middle age women
Irregular bleeding between cycles

4. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Irregular bleeding between cycles
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

5. Cycle length variabilty is primarily due to what?
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
Variability in the time for follicle development during the proliferative phase
Other brainstem or cranial nerve findings
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

6. What is the next best step if a patient has two or more positive dipstick tests?
E. Coli O157:H7
A 24hr urine protein collection and urine creatinine clearance determination
Temporal arteritis-biopsy of the temporal artery
Other brainstem or cranial nerve findings

7. 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
100mg; means patient can be trace protein positive and not be detected
Influenza - Rhinovirus - Adenovirus - Parainfluenza
PE - MI - aortic dissection - pneumothorax

8. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
MSK - pulmonary - GI - or psychological
Coronary artery disease/ angina
CT

9. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Cellulitis
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
Coronary artery disease/ angina
Increase; 200 g/day

10. Irregular cycles with excessive flow - duration - or both
MSK - pulmonary - GI - or psychological
Menorrhagia
Coronary artery disease/ angina
A central clear area

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
>150mg per 24hrs
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV

12. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
Pancreatitis
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
Impetigo

13. How to NSAIDs contribute to gastritis and ulcer formation?
Cervical radiculopathy
MSK - pulmonary - GI - or psychological
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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

14. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
ACEi

15. Define nephrotic range proteinuria
S. aureus- beta hemolytic streptococcus
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
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
>3.5g of protein per 24hrs

16. Oligomenorrhea
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Regular bleeding at intervals of more than 35 days
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

17. What occurs after ovulation
Albumin; low molecular weight proteins
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Less abrupt onset and cessation of palpitations
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

18. What type of imaging is need for chronic sinusitis?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Upper sternal area burning pain - associated with a productive cough
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
CT

19. What is considered normal blood loss during a menstrual cycle?
Loop diuretics (Check serum K+ levels before drug admin)
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Less than 80 ml of blood

20. What should blood work include for suspected heart failure?
Kids: Rotavirus Adults: Norwalk Virus
Tension headache
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

21. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Scabies
Candida albicans
Echocardiogram

22. What is the caUse of Meniere disease? What are the cardinal symptoms?
Polymenorrhea
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
High blood pressure - focal neurologic defecit - or papilledema
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

23. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Less than 80 ml of blood
Wolff-Parkinson-White syndrome
Furucnle

24. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
EGD
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Temporal arteritis-biopsy of the temporal artery
Bulk forming: Psyllium - Methycellulose - Polycarbophil

25. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
GERD

26. SE Of Beta blockers?
Rotator cuff tendonitis
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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.

27. What is the role of LH in the menstrual cycle
Repeat Pap after infection treated
LH surge triggers ovulation
Acute headache - ataxia - profuse nausea - and vomiting
Pancreatitis

28. Describe the presentation tracheobronchitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Upper sternal area burning pain - associated with a productive cough
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

29. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
HIV and syphilis
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

30. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
RBC casts and old to moderate HTN
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Medication or chemical esophagitis
S. Aureus

31. What are the signs of cerebral hemorrhage?
HIV and syphilis
>150mg per 24hrs
Acute headache - ataxia - profuse nausea - and vomiting
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

32. Pneumonia tx: suitable for healthy adults older than 60
Upper sternal area burning pain - associated with a productive cough
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

33. Define proteinuria
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
>150mg per 24hrs

34. Where does the development of abnormal cervical cells begin?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Squamocolumnar junction=most common site of cervical cancer
Fever with frontal or maxillary tenderness

35. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Molluscum contagiosum- pox virus
E. Coli O157:H7

36. Describe the presentation of pneumonia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff tendonitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Cluster headache

37. 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
Cervical radiculopathy
Less abrupt onset and cessation of palpitations
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

38. 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
ACEi
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

39. Natural history of cervical cancer
Pleurisy
Coag disorders
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

40. Four muscles of rotator cuff
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.
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
Candida albicans
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

41. Predictors of cardiac etiology
Less than 80 ml of blood
A 24hr urine protein collection and urine creatinine clearance determination
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Lightheadedness - dizziness - syncope

42. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Rotator Cuff problem
E. Coli O157:H7
Fever with frontal or maxillary tenderness

43. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
24 hour halter
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

44. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Hgb - Electrolytes - and TSH

45. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Scabies

46. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
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
Repeat Pap after infection treated
24 hour halter

47. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Pancreatitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
LH surge triggers ovulation

48. 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
Less than 3 stools per week
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Molluscum contagiosum- pox virus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

49. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Loop diuretics (Check serum K+ levels before drug admin)
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

50. What is the mechanism of action for stimulant agents in treating constipation?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

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