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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 lab tests are recommended for newly diagnosed hypertensive patients?
Other brainstem or cranial nerve findings
RBC casts and old to moderate HTN
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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.

2. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Rotator Cuff tendonitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Viral gastroenteritis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

3. Name 4 factors that predispose an individual to develop pneumonia.
Paroxysmal atrial fibrillation or supraventricular tachycardia
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.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

4. What is the Barany maneuver?
Scleroderma/polymyositis with secondary gastroesophageal reflux
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
GERD

5. Initial treatment for Rhinosinusitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

6. What is the next best step if a patient has two or more positive dipstick tests?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Fever with frontal or maxillary tenderness
A 24hr urine protein collection and urine creatinine clearance determination

7. What is the role of FSH in one's menstrual cycle
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Serotypes 16 - 18 - 31 -52 -58

8. Natural history of cervical cancer
Infectious esophagitis
Chest pain during pneumonia or PE
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

9. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Other brainstem or cranial nerve findings
Wolff-Parkinson-White syndrome

10. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
RBC casts and old to moderate HTN
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fever with frontal or maxillary tenderness

11. Carcinoma in situ is generally referred to a gynecologist and requires ______
Pancreatitis
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
Menorrhagia
High blood pressure - focal neurologic defecit - or papilledema

12. 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
Pts with palpitations and dizziness - near syncope - or syncope
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
A 24hr urine protein collection and urine creatinine clearance determination

13. What are signs of pulmonary congestion?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Common problem that resolves spontaneously and is most often seen in children and young adults

14. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/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 (exception for postmenopausal women who have recently been started on HRT)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

15. What is afterload?
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
True
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

16. What the consequences of decreased cardiac output?
Pancreatitis
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Rotator Cuff tendonitis

17. Uterine bleeding between regular cycles
Furucnle
Giardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Intermenstrual bleeding

18. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
With a KOH wet mount preparation
Less than 80 ml of blood
BB or CCB - catheter ablation of identified bypass tract

19. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Higher filling presure - pulmonary congestion - and decreasd cardiac return
100mg; means patient can be trace protein positive and not be detected

20. Treatment for supraventricular tachycardias
Streptococci
BB or CCB - catheter ablation of identified bypass tract
Less than 80 ml of blood
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

21. Describe the history and PE of patient presenting with common cold
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
35 (exception for postmenopausal women who have recently been started on HRT)
A 24hr urine protein collection and urine creatinine clearance determination
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

22. What is the preload?
ACEi - ARBS - thiazide diuretics
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

23. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Rotator Cuff tendonitis
Folliculitis

24. What are the secondly causes of glomerular disease?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

25. Describe the presentation of pericardial pain
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

26. Oligomenorrhea
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Regular bleeding at intervals of more than 35 days
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

27. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Impetigo
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

28. Define the patient population typically affected by orthostatic or postural proteinuria
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
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

29. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Variability in the time for follicle development during the proliferative phase
ACEi - ARBS - thiazide diuretics
Varicella virus
Paroxysmal atrial fibrillation or supraventricular tachycardia

30. 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
Analgesic headache
Upper sternal area burning pain - associated with a productive cough
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

31. Metrorrhagia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Anticoag with warfarin to prevent thromboembolism
Pain
Irregular bleeding between cycles

32. What are the three major risk factors for heart failure?
A central clear area
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
Hypertension - CAD - valvular heart disease
ACEi

33. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

34. What are the signs of acute sinusitis?
PVC or Premature atrial contraction (PAC)
Fever with frontal or maxillary tenderness
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
Regular bleeding at intervals of more than 35 days

35. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Varicella virus
35 (exception for postmenopausal women who have recently been started on HRT)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

36. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
A 24hr urine protein collection and urine creatinine clearance determination
Cluster headache
E. Coli O157:H7
Kids: Rotavirus Adults: Norwalk Virus

37. Prenatal visit schedule for low-risk pregnancies
A 24hr urine protein collection and urine creatinine clearance determination
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

38. Lab testing for heart palpitation
Pancreatitis
Generalized Anxiety disorder and panic disorder
Scabies
Hgb - Electrolytes - and TSH

39. Where does the development of abnormal cervical cells begin?
GERD
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Squamocolumnar junction=most common site of cervical cancer
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

40. How does systolic vs. diastolic heart failure present on the echocardiogram?
Possibility of Ischemic colitis
>150mg per 24hrs
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
Menorrhagia

41. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
GERD
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

42. Define proteinuria
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
>150mg per 24hrs
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Warts

43. What is an acoustic neuroma?
35 (exception for postmenopausal women who have recently been started on HRT)
Echocardiogram
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

44. After treatment of dysplasia - women need Pap smears every...
Pancreatitis
CBC
Folliculitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

45. When should invasive eletrophysiologic study should be considered?
Slow progression of cervical cancer changes -Availability of effective early treatment
Varicella virus
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

46. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
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
>150mg per 24hrs
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

47. Name the skin lesion: pustule in association with a hair follice
PVC or Premature atrial contraction (PAC)
Upper sternal area burning pain - associated with a productive cough
Presence of proteinuria on at least two separate ocassion
Folliculitis

48. PE for a patient getting an abnormal vaginal bleeding work up
Repeat Pap after infection treated
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Slow progression of cervical cancer changes -Availability of effective early treatment
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

49. What should be considered in younger patients with menorrhagia
Coag disorders
HIV and syphilis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Squamocolumnar junction=most common site of cervical cancer

50. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Scleroderma/polymyositis with secondary gastroesophageal reflux
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)