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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 occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A 24hr urine protein collection and urine creatinine clearance determination
>150mg per 24hrs
Increasing fluid (8 - 8oz glasses of water/day) -fiber

2. Four muscles of rotator cuff
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Upper sternal area burning pain - associated with a productive cough

3. What are the features of nephrotic syndrome?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cervical radiculopathy
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

4. 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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Tension headache
PVC or Premature atrial contraction (PAC)
Supraspinatus and bicipital tendons

5. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Loop diuretics (Check serum K+ levels before drug admin)
Temporal arteritis-biopsy of the temporal artery
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

6. What does treatment for migrans include?
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
Presence of proteinuria on at least two separate ocassion
Infectious esophagitis
Diuretics -BB -CCB -ACEi

7. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Colposcopy - Endocervical curettage - and directed cervical biopsy
Hgb - Electrolytes - and TSH
High blood pressure - focal neurologic defecit - or papilledema
Albumin; low molecular weight proteins

8. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Rotator cuff tendonitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV testing -Pos=colposcopy -Neg=repeat pap smear

9. What is the difference between a Holter monitor or an event monitor?
Less than 80 ml of blood
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.
Excessive bleeding in amount - duration - or both at irregular intervals
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

10. When is a lumbar puncture contraindicated?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

11. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
>3.5g of protein per 24hrs
RBC casts and old to moderate HTN
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi

12. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Paroxysmal atrial fibrillation or supraventricular tachycardia
DM - HTN - DVT - seizures - depression - or anxiety
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

13. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
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
Regular bleeding at intervals of more than 35 days
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

14. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Less than 3 stools per week

15. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
24 hour halter

16. What are the signs of malignant hypertension?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Common problem that resolves spontaneously and is most often seen in children and young adults
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
High blood pressure - focal neurologic defecit - or papilledema

17. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Varicella virus
S. aureus- beta hemolytic streptococcus

18. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Kids: Rotavirus Adults: Norwalk Virus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Loop diuretics (Check serum K+ levels before drug admin)

19. MI - pericardial tamponade - PE - GI bleed - are...
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
With a KOH wet mount preparation
Associated with hypotension

20. 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
Molluscum contagiosum- pox virus
Nonulcer dyspepsia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

21. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Other brainstem or cranial nerve findings
Lightheadedness - dizziness - syncope

22. 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
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.
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

23. Cycle length variabilty is primarily due to what?
Bence-Jones
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Hypertension - CAD - valvular heart disease
Variability in the time for follicle development during the proliferative phase

24. What are the signs of acute sinusitis?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Folliculitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Fever with frontal or maxillary tenderness

25. Describe the presentation tracheobronchitis
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
Upper sternal area burning pain - associated with a productive cough
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
35 (exception for postmenopausal women who have recently been started on HRT)

26. What is the caUse of benign positional vertigo?
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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.
Dehydration - anemia - cardiac causes

27. 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
Loop diuretics (Check serum K+ levels before drug admin)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Analgesic headache

28. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
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

29. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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.
Wolff-Parkinson-White syndrome
CBC

30. Name the diagnosis of heartburn: severe constant mid abdominal pain
Peptic ulcer disease or gastritis
Pancreatitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

31. Describe the presentation of myocardial pain?
Echocardiogram
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
>150mg per 24hrs
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

32. What should be considered in younger patients with menorrhagia
Supraspinatus and bicipital tendons
Coag disorders
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

33. HIgh risk pregnant patients should be evaluated for ____ and ____
Kids: Rotavirus Adults: Norwalk Virus
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
HIV and syphilis
MSK - pulmonary - GI - or psychological

34. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pancreatitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Furucnle

35. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Coronary artery disease/ angina
Pancreatitis
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

36. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
GERD

37. Define the patient population typically affected by orthostatic or postural proteinuria
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

38. Name types of laxatives
Viral infection of the semicircular apparatus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Upper sternal area burning pain - associated with a productive cough
Pancreatitis

39. What should blood work include for suspected heart failure?
100mg; means patient can be trace protein positive and not be detected
Excessive bleeding in amount - duration - or both at irregular intervals
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Menorrhagia

40. What is an acoustic neuroma?
Giardia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Subarachnoid hemorrhage
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

41. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
True
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
Associated with hypotension
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

42. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
CT
ACEi - ARBS - thiazide diuretics
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
Streptococci

43. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Chest pain during pneumonia or PE

44. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Kids: Rotavirus Adults: Norwalk Virus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

45. Things that need to be included in history of shoulder pain
Cholelithiasis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Viral infection of the semicircular apparatus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

46. What HPV serotypes are most commonly associated with cervical cancer?
Folliculitis
Serotypes 16 - 18 - 31 -52 -58
Dehydration - anemia - cardiac causes
RBC casts and old to moderate HTN

47. Diagnostic Evaluation of Abnoraml vaginal bleeding
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

48. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

49. Difference between Pneumonia and Bronchitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

50. What are the most common causes for the common cold?
HIV and syphilis
Diuretics -BB -CCB -ACEi
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus