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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. What is the caUse of benign positional vertigo?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
PVC or Premature atrial contraction (PAC)
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

2. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Increase; 200 g/day
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

3. What should preconception counseling include?
Less than 3 stools per week
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
Fever with frontal or maxillary tenderness
Dehydration - anemia - cardiac causes

4. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Possibility of Ischemic colitis
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
HPV

5. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
ACEi
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

6. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
LH surge triggers ovulation
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

7. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Pain
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

8. What should be considered in younger patients with menorrhagia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Coag disorders
Cholelithiasis
Associated with hypotension

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Irregular bleeding between cycles
Squamocolumnar junction=most common site of cervical cancer
Regular bleeding at intervals of more than 35 days

10. What are the symptoms of palpitations?
Associated with hypotension
Temporal arteritis-biopsy of the temporal artery
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Lightheadedness - dizziness - syncope

11. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Peptic ulcer disease or gastritis

12. Cycle length variabilty is primarily due to what?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Variability in the time for follicle development during the proliferative phase
Rotator cuff tendonitis
Chest pain during pneumonia or PE

13. What are the indiciations for neuroimaging?
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
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
Coag disorders
Analgesic headache

14. Constipation: What are indications for lab testing?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Lightheadedness - dizziness - syncope
Generalized Anxiety disorder and panic disorder
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

15. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Subarachnoid hemorrhage
35 (exception for postmenopausal women who have recently been started on HRT)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
PE - MI - aortic dissection - pneumothorax

16. Where does the development of abnormal cervical cells begin?
Regular bleeding at intervals of more than 35 days
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Squamocolumnar junction=most common site of cervical cancer
PE - MI - aortic dissection - pneumothorax

17. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Anticoag with warfarin to prevent thromboembolism
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Medication or chemical esophagitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

18. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Hypertension - CAD - valvular heart disease
Fever with frontal or maxillary tenderness
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

19. Shoulder pain with pain radiating to elbow
Excessive bleeding in amount - duration - or both at irregular intervals
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
S. Aureus
Cervical radiculopathy

20. What drugs do you use to treat H.pylori + PUD?
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
GERD
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Giardia

21. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Furucnle
Generalized Anxiety disorder and panic disorder
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

22. What test done in PE measures instability of shoulder?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cellulitis

23. Diagnosis of HTN
Common problem that resolves spontaneously and is most often seen in children and young adults
Serotypes 16 - 18 - 31 -52 -58
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Less abrupt onset and cessation of palpitations

24. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

25. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
LH surge triggers ovulation
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Kids: Rotavirus Adults: Norwalk Virus

26. Describe the history and PE of patient presenting with common cold
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
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
CT
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

27. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Candida albicans
Chest pain during pneumonia or PE
Hgb - Electrolytes - and TSH
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

28. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Squamocolumnar junction=most common site of cervical cancer
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

29. Complete the sentence: pericarditis can cause frictional rub and......
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cluster headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
E. Coli O157:H7

30. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Rotator Cuff tendonitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

31. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Streptococci
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

32. 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
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
Furucnle
Upper sternal area burning pain - associated with a productive cough
Warts

33. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Irregular bleeding between cycles
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
Possibility of Ischemic colitis
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.

34. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
S. Aureus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

35. Why is the pap smear one of the most effective cancer screening tools?
Folliculitis
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.
Slow progression of cervical cancer changes -Availability of effective early treatment
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

36. 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
True
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Presence of proteinuria on at least two separate ocassion

37. What does orthostatic positional changes that bring on dizziness suggest?
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
Analgesic headache
Dehydration - anemia - cardiac causes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

38. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
S. aureus- beta hemolytic streptococcus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Intermenstrual bleeding

39. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Scleroderma/polymyositis with secondary gastroesophageal reflux
PVC or Premature atrial contraction (PAC)
Giardia
Viral gastroenteritis

40. Describe the presentation of angina?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
HIV and syphilis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

41. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
DM - HTN - DVT - seizures - depression - or anxiety
Intermenstrual bleeding

42. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Dehydration - anemia - cardiac causes
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
Hgb - Electrolytes - and TSH
Non-cardiac causes of palpitations

43. Pain in shoulder when throwing - swimming - or serving a tennis ball
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Rotator cuff tendonitis
HPV
>3.5g of protein per 24hrs

44. 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
Chest pain during pneumonia or PE
Molluscum contagiosum- pox virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Bence-Jones

45. Tx of chronic or intermittent afibs
MSK - pulmonary - GI - or psychological
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Anticoag with warfarin to prevent thromboembolism

46. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Echocardiogram

47. What is considered normal blood loss during a menstrual cycle?
Streptococci
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Less than 80 ml of blood
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

48. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
LH surge triggers ovulation
Pts with palpitations and dizziness - near syncope - or syncope

49. What are the 2 psych disorders most commonly associated with palpitations?
Hypertension - CAD - valvular heart disease
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Generalized Anxiety disorder and panic disorder
These patients are associated with low renin states=less likely to respond to medication

50. What places women at higher risk of getting cervical cancer?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Possibility of Ischemic colitis
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