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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. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Less abrupt onset and cessation of palpitations
Squamocolumnar junction=most common site of cervical cancer
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

2. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pts with palpitations and dizziness - near syncope - or syncope
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

3. 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.
Supraspinatus and bicipital tendons
Hypertension - CAD - valvular heart disease
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

4. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Wolff-Parkinson-White syndrome
Paroxysmal atrial fibrillation or supraventricular tachycardia

5. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Cellulitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

6. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Infectious esophagitis

7. Chronic pain and shoulder stiffness with limited motion
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Less than 3 stools per week
Adhesive capsulitis (frozen shoulder): most common in middle age women
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

8. What should be considered in younger patients with menorrhagia
CT
Coag disorders
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
Cervical radiculopathy

9. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
35 (exception for postmenopausal women who have recently been started on HRT)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Kids: Rotavirus Adults: Norwalk Virus
MSK - pulmonary - GI - or psychological

10. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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.
Irregular bleeding between cycles
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cervical radiculopathy

11. SE Of Beta blockers?
Intermenstrual bleeding
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

12. Name the skin lesion: honey colored crusts
Giardia
Dehydration - anemia - cardiac causes
Impetigo
Furucnle

13. Describe the presentation of pericardial pain
Possibility of Ischemic colitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
>3.5g of protein per 24hrs

14. What the consequences of decreased cardiac output?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
MSK - pulmonary - GI - or psychological
Anticoag with warfarin to prevent thromboembolism
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

15. History and PE for Pneumonia
Pts with palpitations and dizziness - near syncope - or syncope
Impetigo
Cellulitis
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

16. What is the difference between a Holter monitor or an event monitor?
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

17. What are signs of pulmonary congestion?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Varicella virus
Coag disorders

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
HPV
Wolff-Parkinson-White syndrome
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
Pts with palpitations and dizziness - near syncope - or syncope

19. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Nonulcer dyspepsia
Irregular bleeding between cycles

20. Pain in shoulder when throwing - swimming - or serving a tennis ball
Menorrhagia
Rotator cuff tendonitis
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
Diuretics -BB -CCB -ACEi

21. Complete the sentence: pericarditis can cause frictional rub and......
35 (exception for postmenopausal women who have recently been started on HRT)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Furucnle
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

22. Describe the presentation tracheobronchitis
BB or CCB - catheter ablation of identified bypass tract
Upper sternal area burning pain - associated with a productive cough
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

23. How to NSAIDs contribute to gastritis and ulcer formation?
Impetigo
PE - MI - aortic dissection - pneumothorax
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.

24. What lab tests are recommended for newly diagnosed hypertensive patients?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
24 hour halter
Less than 80 ml of blood

25. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Supraspinatus and bicipital tendons
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

26. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Less abrupt onset and cessation of palpitations
A central clear area
Furucnle
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

27. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
CT
Menorrhagia
Analgesic headache
Viral infection of the semicircular apparatus

28. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

29. MI - pericardial tamponade - PE - GI bleed - are...
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
100mg; means patient can be trace protein positive and not be detected
Cluster headache
Associated with hypotension

30. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
S. Aureus
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

31. What is the Epley maneuver?
Presence of proteinuria on at least two separate ocassion
Nonulcer dyspepsia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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.

32. What does the classic ring worm lesion have?
Presence of proteinuria on at least two separate ocassion
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A central clear area
S. aureus- beta hemolytic streptococcus

33. What are the indiciations for neuroimaging?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

34. 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)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Cholelithiasis

35. 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)
CBC
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
S. aureus- beta hemolytic streptococcus

36. What type of imaging is need for chronic sinusitis?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pts with palpitations and dizziness - near syncope - or syncope
CT

37. 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
Wolff-Parkinson-White syndrome
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Repeat Pap after infection treated

38. Things that need to be included in history of shoulder pain
Candida albicans
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Temporal arteritis-biopsy of the temporal artery
CT

39. How do you define persistent protein uria?
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
Other brainstem or cranial nerve findings
Presence of proteinuria on at least two separate ocassion
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

40. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Giardia
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Analgesic headache

41. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Presence of proteinuria on at least two separate ocassion
Nonulcer dyspepsia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
PVC or Premature atrial contraction (PAC)

42. Name the diagnosis of heartburn: regurgitation - dysphagia
Cervical radiculopathy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Excessive bleeding in amount - duration - or both at irregular intervals
GERD

43. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Increase; 200 g/day
Analgesic headache
Echocardiogram
Excessive bleeding in amount - duration - or both at irregular intervals

44. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
BB or CCB - catheter ablation of identified bypass tract
Albumin; low molecular weight proteins
Less than 80 ml of blood

45. 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
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
High blood pressure - focal neurologic defecit - or papilledema
Serotypes 16 - 18 - 31 -52 -58

46. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Rotator Cuff tendonitis
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
Pleurisy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

47. What is the next best step if a patient has two or more positive dipstick tests?
24 hour halter
Analgesic headache
A 24hr urine protein collection and urine creatinine clearance determination
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

48. Diagnosis of HTN
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
Bence-Jones
Repeat Pap after infection treated
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

49. Diagnostic Evaluation of Abnoraml vaginal bleeding
Less than 80 ml of blood
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
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
Kids: Rotavirus Adults: Norwalk Virus

50. Where does the development of abnormal cervical cells begin?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Squamocolumnar junction=most common site of cervical cancer