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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. Define the patient population typically affected by orthostatic or postural proteinuria
Cellulitis
Less than 80 ml of blood
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
LH surge triggers ovulation

2. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Nonulcer dyspepsia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

3. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Medication or chemical esophagitis
35 (exception for postmenopausal women who have recently been started on HRT)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Kids: Rotavirus Adults: Norwalk Virus

4. Where does the development of abnormal cervical cells begin?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Squamocolumnar junction=most common site of cervical cancer
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

5. 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
E. Coli O157:H7
Presence of proteinuria on at least two separate ocassion
True
Analgesic headache

6. Define nephrotic range proteinuria
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
>3.5g of protein per 24hrs
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
Warts

7. Treatment for supraventricular tachycardias
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Associated with hypotension
BB or CCB - catheter ablation of identified bypass tract
Anticoag with warfarin to prevent thromboembolism

8. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
24 hour halter
Viral gastroenteritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

9. When should a patient get a stress test?
Slow progression of cervical cancer changes -Availability of effective early treatment
24 hour halter
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
When the patient has symptoms in association with exercise or who describe chest pain or pressure

10. What type of imaging is need for chronic sinusitis?
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Molluscum contagiosum- pox virus
CT

11. Describe the history and PE of patient presenting with common cold
Pancreatitis
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Streptococci

12. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Scleroderma/polymyositis with secondary gastroesophageal reflux
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

13. Predictors of cardiac etiology
Staphylococcal scalded skin syndrome
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

14. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
A central clear area
S. aureus- beta hemolytic streptococcus
Molluscum contagiosum- pox virus
Intermenstrual bleeding

15. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Cellulitis
Nonulcer dyspepsia

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
Generalized Anxiety disorder and panic disorder
Rotator cuff tendonitis
Hgb - Electrolytes - and TSH
EGD

17. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Presence of proteinuria on at least two separate ocassion
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

18. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Tension headache
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Subarachnoid hemorrhage
These patients are associated with low renin states=less likely to respond to medication

19. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Impetigo
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Possibility of Ischemic colitis

20. Complete the sentence: pericarditis can cause frictional rub and......
Temporal arteritis-biopsy of the temporal artery
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Pleurisy
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

21. 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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A central clear area
24 hour halter
Varicella virus

22. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
E. Coli O157:H7

23. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
35 (exception for postmenopausal women who have recently been started on HRT)
Kids: Rotavirus Adults: Norwalk Virus
Warts

24. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Medication or chemical esophagitis

25. How is constipation clinically defined?
A central clear area
Less than 3 stools per week
Furucnle
Increase; 200 g/day

26. What should preconception counseling include?
Associated with hypotension
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
Increase; 200 g/day
Other brainstem or cranial nerve findings

27. History and PE for Pneumonia
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
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
Folliculitis
Anticoag with warfarin to prevent thromboembolism

28. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Paroxysmal atrial fibrillation or supraventricular tachycardia
Chest pain during pneumonia or PE
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
Giardia

29. Irregular cycles with excessive flow - duration - or both
Menorrhagia
CBC
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Loop diuretics (Check serum K+ levels before drug admin)

30. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

31. What is the role of FSH in one's menstrual cycle
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Subarachnoid hemorrhage
Variability in the time for follicle development during the proliferative phase

32. What medications can cause heart palpitations?
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.
Excessive bleeding in amount - duration - or both at irregular intervals
Cervical radiculopathy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

33. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Impetigo

34. What is a markers of CNS vertigo?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Other brainstem or cranial nerve findings
Kids: Rotavirus Adults: Norwalk Virus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

35. What are the most common causes for the common cold?
Repeat Pap after infection treated
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.
Viral infection of the semicircular apparatus
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

36. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
EGD
S. Aureus
Giardia

37. After treatment of dysplasia - women need Pap smears every...
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Increase; 200 g/day
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Coronary artery disease/ angina

39. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Medication or chemical esophagitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

40. Prenatal visit schedule for low-risk pregnancies
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

41. Mainstay treatment for soft tissue inflammation (Shoulder)
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

42. What are the physical exam signs of CHF?
True
Staphylococcal scalded skin syndrome
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

43. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Warts
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

44. What are the symptoms of palpitations?
Streptococci
Lightheadedness - dizziness - syncope
Less abrupt onset and cessation of palpitations
Pancreatitis

45. What is the preload?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
CT
Warts
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

46. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Scabies
True
Polymenorrhea
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

47. When does troponin rise following myocardial injury or infarction?
35 (exception for postmenopausal women who have recently been started on HRT)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Scabies
Polymenorrhea

48. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Slow progression of cervical cancer changes -Availability of effective early treatment
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
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

49. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

50. Describe the presentation of pericardial pain
Upper sternal area burning pain - associated with a productive cough
Dehydration - anemia - cardiac causes
Slow progression of cervical cancer changes -Availability of effective early treatment
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing