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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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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 the skin lesion: erythema - warmth - edema - pain - fever
Loop diuretics (Check serum K+ levels before drug admin)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Rotator Cuff tendonitis
Cellulitis

2. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Paroxysmal atrial fibrillation or supraventricular tachycardia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

3. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Dehydration - anemia - cardiac causes
Coronary artery disease/ angina
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
Echocardiogram

4. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Tension headache
Bence-Jones
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

5. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Loop diuretics (Check serum K+ levels before drug admin)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

6. 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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
LH surge triggers ovulation

7. Complete the sentence: pericarditis can cause frictional rub and......
Temporal arteritis-biopsy of the temporal artery
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Peptic ulcer disease or gastritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

8. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

9. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Variability in the time for follicle development during the proliferative phase
Paroxysmal atrial fibrillation or supraventricular tachycardia

10. Describe the presentation of pericardial pain
Varicella virus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Medication or chemical esophagitis
Intermenstrual bleeding

11. What are the 2 psych disorders most commonly associated with palpitations?
PVC or Premature atrial contraction (PAC)
Presence of proteinuria on at least two separate ocassion
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Generalized Anxiety disorder and panic disorder

12. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

13. History for Acute bronchitis
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Influenza - Rhinovirus - Adenovirus - Parainfluenza

14. 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
Varicella virus
Pain
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

15. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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
35 (exception for postmenopausal women who have recently been started on HRT)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

16. Define the patient population typically affected by orthostatic or postural proteinuria
35 (exception for postmenopausal women who have recently been started on HRT)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Fever with frontal or maxillary tenderness
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

17. Define proteinuria
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Polymenorrhea
Chest pain during pneumonia or PE
>150mg per 24hrs

18. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
>3.5g of protein per 24hrs
Hgb - Electrolytes - and TSH
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
EGD

19. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.
Cholelithiasis
Scleroderma/polymyositis with secondary gastroesophageal reflux

20. Describe the presentation tracheobronchitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Bulk forming: Psyllium - Methycellulose - Polycarbophil
>3.5g of protein per 24hrs
Upper sternal area burning pain - associated with a productive cough

21. What are the secondly causes of glomerular disease?
Pleurisy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Supraspinatus and bicipital tendons
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

22. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Variability in the time for follicle development during the proliferative phase
ACEi
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pts with palpitations and dizziness - near syncope - or syncope

23. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Analgesic headache
Pain
PVC or Premature atrial contraction (PAC)
Non-cardiac causes of palpitations

24. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
These patients are associated with low renin states=less likely to respond to medication
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
ACEi - ARBS - thiazide diuretics

25. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Other brainstem or cranial nerve findings

26. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator cuff tendonitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Rotator Cuff problem

27. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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.
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

28. Who should have Xray testing for shoulder pain?
True
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

29. What are the symptoms of palpitations?
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Lightheadedness - dizziness - syncope

30. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
A central clear area
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Supraspinatus and bicipital tendons

31. What are the most common causes for the common cold?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HPV
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

32. 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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Less than 3 stools per week
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Supraspinatus and bicipital tendons

33. What are the signs of acute sinusitis?
Temporal arteritis-biopsy of the temporal artery
Fever with frontal or maxillary tenderness
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

34. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Echocardiogram
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Less abrupt onset and cessation of palpitations

35. Metrorrhagia
Varicella virus
Irregular bleeding between cycles
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Pleurisy

36. Irregular cycles with excessive flow - duration - or both
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Menorrhagia
ACEi - ARBS - thiazide diuretics

37. 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
Cluster headache
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Giardia
EGD

38. How is constipation clinically defined?
A central clear area
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Less than 3 stools per week
Viral infection of the semicircular apparatus

39. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HPV testing -Pos=colposcopy -Neg=repeat pap smear
LH surge triggers ovulation
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

40. What is the next best step if a patient has two or more positive dipstick tests?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A 24hr urine protein collection and urine creatinine clearance determination
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
HPV

41. Name types of laxatives
Subarachnoid hemorrhage
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Increase; 200 g/day
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

42. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
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

43. Natural history of cervical cancer
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
RBC casts and old to moderate HTN
PVC or Premature atrial contraction (PAC)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

44. Regular bleeding at intervals of less than 21 days
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
24 hour halter
Polymenorrhea

45. How can GERD (or esophageal motility disorders) lead to chest pain?
CBC
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Giardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

46. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
35 (exception for postmenopausal women who have recently been started on HRT)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Candida albicans

47. Name the skin lesion: honey colored crusts
Echocardiogram
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.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Impetigo

48. When should a patient get a stress test?
Giardia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
A central clear area

49. What is the Barany maneuver?
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Serotypes 16 - 18 - 31 -52 -58
PE - MI - aortic dissection - pneumothorax

50. Describe the presentation of myocardial pain?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

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