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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. Lab testing for heart palpitation
Viral gastroenteritis
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
Hgb - Electrolytes - and TSH
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

2. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Bence-Jones
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Analgesic headache

3. What occurs after ovulation
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

4. What is the Barany maneuver?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
35 (exception for postmenopausal women who have recently been started on HRT)
Bence-Jones

5. Difference between Pneumonia and Bronchitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

6. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Supraspinatus and bicipital tendons
E. Coli O157:H7

7. Describe the presentation of pneumonia
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Other brainstem or cranial nerve findings

8. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
35 (exception for postmenopausal women who have recently been started on HRT)
Folliculitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

9. Describe the presentation tracheobronchitis
Pain
Upper sternal area burning pain - associated with a productive cough
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. History and PE for Pneumonia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - 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
RBC casts and old to moderate HTN
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

11. What are symptoms are CHF?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Excessive bleeding in amount - duration - or both at irregular intervals

12. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Molluscum contagiosum- pox virus
Subarachnoid hemorrhage
Increase; 200 g/day

13. What is benign transient proteinuria?
Impetigo
Common problem that resolves spontaneously and is most often seen in children and young adults
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

14. 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
Serotypes 16 - 18 - 31 -52 -58
Colposcopy - Endocervical curettage - and directed cervical biopsy
Squamocolumnar junction=most common site of cervical cancer

15. What are the primary glomerular diseases?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Paroxysmal atrial fibrillation or supraventricular tachycardia

16. Diarrhea from custard filled pastries
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
S. Aureus
35 (exception for postmenopausal women who have recently been started on HRT)

17. What does treatment for migrans include?
Molluscum contagiosum- pox virus
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
Streptococci
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 HPV serotypes are most commonly associated with cervical cancer?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Rotator Cuff problem
Serotypes 16 - 18 - 31 -52 -58
ACEi

19. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

20. MI - pericardial tamponade - PE - GI bleed - are...
Streptococci
ACEi - ARBS - thiazide diuretics
Coronary artery disease/ angina
Associated with hypotension

21. What test done in PE measures instability of shoulder?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
GERD
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

22. What is the caUse of Meniere disease? What are the cardinal symptoms?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Less than 80 ml of blood

23. How is constipation clinically defined?
Generalized Anxiety disorder and panic disorder
Analgesic headache
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Less than 3 stools per week

24. patients with herpes zoster may experience what symptom before the rash appear?
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Chest pain during pneumonia or PE
Pain

25. What is the next best step if a patient has two or more positive dipstick tests?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A central clear area
A 24hr urine protein collection and urine creatinine clearance determination
Cluster headache

26. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pts with palpitations and dizziness - near syncope - or syncope
Upper sternal area burning pain - associated with a productive cough

27. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
E. Coli O157:H7
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

28. Regular bleeding at intervals of less than 21 days
Coronary artery disease/ angina
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
Polymenorrhea
Analgesic headache

29. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
24 hour halter
Rotator Cuff tendonitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber

30. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Coag disorders
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
BB or CCB - catheter ablation of identified bypass tract

31. What are the signs of acute sinusitis?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Fever with frontal or maxillary tenderness

32. 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
Increase; 200 g/day
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Non-cardiac causes of palpitations

33. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Staphylococcal scalded skin syndrome

34. Pain in shoulder when throwing - swimming - or serving a tennis ball
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator cuff tendonitis

35. Menometrorrhagia
Adhesive capsulitis (frozen shoulder): most common in middle age women
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Excessive bleeding in amount - duration - or both at irregular intervals

36. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
DM - HTN - DVT - seizures - depression - or anxiety

37. What are the common causes for laryngitis?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

38. What is the preload?
Cervical radiculopathy
Infectious esophagitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

39. How does systolic vs. diastolic heart failure present on the echocardiogram?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Coronary artery disease/ angina
ACEi
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

40. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
With a KOH wet mount preparation
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

41. Name 4 factors that predispose an individual to develop pneumonia.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Folliculitis

42. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
DM - HTN - DVT - seizures - depression - or anxiety
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination

43. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
CBC
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
ACEi

44. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
S. aureus- beta hemolytic streptococcus
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pts with palpitations and dizziness - near syncope - or syncope

45. What are the 2 psych disorders most commonly associated with palpitations?
S. Aureus
Impetigo
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Generalized Anxiety disorder and panic disorder

46. Chronic pain and shoulder stiffness with limited motion
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Adhesive capsulitis (frozen shoulder): most common in middle age women
Hgb - Electrolytes - and TSH
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

47. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Diuretics -BB -CCB -ACEi
Infectious esophagitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

48. What places women at higher risk of getting cervical cancer?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Irregular bleeding between cycles
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

49. What are the most common viral causes of diarrhea in kids and adults?
Diuretics -BB -CCB -ACEi
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
>3.5g of protein per 24hrs
Kids: Rotavirus Adults: Norwalk Virus

50. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Furucnle
Analgesic headache