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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. What is the role of LH in the menstrual cycle
Cluster headache
LH surge triggers ovulation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Nonulcer dyspepsia

2. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Anticoag with warfarin to prevent thromboembolism
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
MSK - pulmonary - GI - or psychological
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

3. Describe the presentation of pneumonia
Molluscum contagiosum- pox virus
Less than 80 ml of blood
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

4. Define the patient population typically affected by orthostatic or postural proteinuria
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Furucnle

5. Describe the presentation of pericardial pain
Squamocolumnar junction=most common site of cervical cancer
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Hgb - Electrolytes - and TSH

6. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Bence-Jones
Supraspinatus and bicipital tendons
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

7. 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
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.
Viral infection of the semicircular apparatus
Warts
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

8. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hgb - Electrolytes - and TSH

9. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Coronary artery disease/ angina
Adhesive capsulitis (frozen shoulder): most common in middle age women
24 hour halter

10. At was quantity does urine dipstick test detect elevated protein?
Viral infection of the semicircular apparatus
Scabies
Supraspinatus and bicipital tendons
100mg; means patient can be trace protein positive and not be detected

11. Four muscles of rotator cuff
Diuretics -BB -CCB -ACEi
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Tension headache

12. What are the primary glomerular diseases?
Non-cardiac causes of palpitations
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
DM - HTN - DVT - seizures - depression - or anxiety
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

13. Name the skin lesion: erythema - warmth - edema - pain - fever
Echocardiogram
Cellulitis
Impetigo
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

14. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
BB or CCB - catheter ablation of identified bypass tract
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Scleroderma/polymyositis with secondary gastroesophageal reflux
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

15. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
CT
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Less than 3 stools per week

16. What is the peripheral caUse of vertigo?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Lightheadedness - dizziness - syncope
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

17. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Tension headache
Increase; 200 g/day
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Variability in the time for follicle development during the proliferative phase

18. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Repeat Pap after infection treated
Bulk forming: Psyllium - Methycellulose - Polycarbophil
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

19. Name 4 factors that predispose an individual to develop pneumonia.
Acute headache - ataxia - profuse nausea - and vomiting
Variability in the time for follicle development during the proliferative phase
Upper sternal area burning pain - associated with a productive cough
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

20. Diagnosis of HTN
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Rotator Cuff tendonitis
Repeat Pap after infection treated

21. History for Acute bronchitis
Loop diuretics (Check serum K+ levels before drug admin)
Coronary artery disease/ angina
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

22. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cervical radiculopathy
MSK - pulmonary - GI - or psychological

23. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Excessive bleeding in amount - duration - or both at irregular intervals

24. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Lightheadedness - dizziness - syncope
DM - HTN - DVT - seizures - depression - or anxiety
Scleroderma/polymyositis with secondary gastroesophageal reflux

25. Regular bleeding at intervals of less than 21 days
Slow progression of cervical cancer changes -Availability of effective early treatment
Polymenorrhea
Warts
RBC casts and old to moderate HTN

26. 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
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.
Rotator Cuff problem
Kids: Rotavirus Adults: Norwalk Virus

27. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
PE - MI - aortic dissection - pneumothorax
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Loop diuretics (Check serum K+ levels before drug admin)
Anticoag with warfarin to prevent thromboembolism

28. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Rotator Cuff problem
GERD

29. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
EGD
Irregular bleeding between cycles
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.
Peptic ulcer disease or gastritis

30. What is the next best step if a patient has two or more positive dipstick tests?
Fever with frontal or maxillary tenderness
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Viral infection of the semicircular apparatus
A 24hr urine protein collection and urine creatinine clearance determination

31. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Dehydration - anemia - cardiac causes
Non-cardiac causes of palpitations
Viral infection of the semicircular apparatus

32. How does systolic vs. diastolic heart failure present on the echocardiogram?
Irregular bleeding between cycles
Cluster headache
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

33. How to NSAIDs contribute to gastritis and ulcer formation?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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.
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Paroxysmal atrial fibrillation or supraventricular tachycardia

34. Define proteinuria
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
>150mg per 24hrs
Streptococci
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

35. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Excessive bleeding in amount - duration - or both at irregular intervals
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Scabies
CT

36. Prenatal visit schedule for low-risk pregnancies
Infectious esophagitis
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
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

37. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Furucnle
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Analgesic headache

38. History and PE for Pneumonia
MSK - pulmonary - GI - or psychological
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

39. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

40. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
CBC
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

41. Metrorrhagia
Irregular bleeding between cycles
Possibility of Ischemic colitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Furucnle

42. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

43. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Lightheadedness - dizziness - syncope
A central clear area

44. What should be considered in younger patients with menorrhagia
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Coag disorders
Molluscum contagiosum- pox virus

45. What is the goal of CHF treatment? What drugs should be used?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

46. What are the secondly causes of glomerular disease?
Loop diuretics (Check serum K+ levels before drug admin)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Serotypes 16 - 18 - 31 -52 -58
Irregular bleeding between cycles

47. Shoulder pain with pain radiating to elbow
Pancreatitis
Cervical radiculopathy
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Coronary artery disease/ angina

48. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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.
Warts

49. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Coronary artery disease/ angina

50. What is afterload?
MSK - pulmonary - GI - or psychological
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
With a KOH wet mount preparation

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