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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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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 benign transient proteinuria?
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
Variability in the time for follicle development during the proliferative phase
Common problem that resolves spontaneously and is most often seen in children and young adults
ACEi - ARBS - thiazide diuretics

2. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV
Peptic ulcer disease or gastritis
Pain

3. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Rotator Cuff tendonitis
Rotator cuff tendonitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Infectious esophagitis

4. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
100mg; means patient can be trace protein positive and not be detected

5. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Furucnle
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Less than 3 stools per week

6. What are the three major risk factors for heart failure?
Associated with hypotension
Hypertension - CAD - valvular heart disease
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
With a KOH wet mount preparation

7. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
Loop diuretics (Check serum K+ levels before drug admin)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Hgb - Electrolytes - and TSH

8. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Hypertension - CAD - valvular heart disease
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

9. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Upper sternal area burning pain - associated with a productive cough
Viral gastroenteritis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

10. What are the common causes for laryngitis?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Presence of proteinuria on at least two separate ocassion
Influenza - Rhinovirus - Adenovirus - Parainfluenza
True

11. Tx of chronic or intermittent afibs
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
100mg; means patient can be trace protein positive and not be detected
Anticoag with warfarin to prevent thromboembolism
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

12. What is a markers of CNS vertigo?
Less than 3 stools per week
Other brainstem or cranial nerve findings
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Cluster headache

13. Name the skin lesion: erythema - warmth - edema - pain - fever
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Echocardiogram
Varicella virus
Cellulitis

14. What are the two common clinical presentations of acute diarrhea?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Temporal arteritis-biopsy of the temporal artery
Streptococci
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

15. Describe the presentation of pericardial pain
Regular bleeding at intervals of more than 35 days
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Adhesive capsulitis (frozen shoulder): most common in middle age women

16. When should a patient get a stress test?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

17. At was quantity does urine dipstick test detect elevated protein?
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
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
Tension headache
100mg; means patient can be trace protein positive and not be detected

18. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Coronary artery disease/ angina
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

19. What are the signs of cerebral hemorrhage?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Acute headache - ataxia - profuse nausea - and vomiting
Irregular bleeding between cycles
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

20. HIgh risk pregnant patients should be evaluated for ____ and ____
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
HIV and syphilis
Impetigo

21. Clinical Manifestations of HTN
HIV and syphilis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Common problem that resolves spontaneously and is most often seen in children and young adults

22. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Furucnle

23. What test done in PE measures instability of shoulder?
Analgesic headache
Colposcopy - Endocervical curettage - and directed cervical biopsy
Subarachnoid hemorrhage
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

24. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Presence of proteinuria on at least two separate ocassion
Molluscum contagiosum- pox virus
>150mg per 24hrs

25. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Molluscum contagiosum- pox virus
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Irregular bleeding between cycles

26. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pancreatitis

27. 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.
Associated with hypotension
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Supraspinatus and bicipital tendons
With a KOH wet mount preparation

28. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

29. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Other brainstem or cranial nerve findings
Lightheadedness - dizziness - syncope

30. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
S. Aureus
Intermenstrual bleeding
Diuretics -BB -CCB -ACEi

31. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
>150mg per 24hrs
Anticoag with warfarin to prevent thromboembolism
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

32. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Scabies
Menorrhagia
Wolff-Parkinson-White syndrome

33. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Other brainstem or cranial nerve findings
Echocardiogram
BB or CCB - catheter ablation of identified bypass tract
Common problem that resolves spontaneously and is most often seen in children and young adults

34. How can GERD (or esophageal motility disorders) lead to chest pain?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
EGD
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

35. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Candida albicans
BB or CCB - catheter ablation of identified bypass tract
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

36. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Streptococci
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

37. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Repeat Pap after infection treated
DM - HTN - DVT - seizures - depression - or anxiety
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. What are the consequences of diastolic dysfunction?
Less than 3 stools per week
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Giardia
35 (exception for postmenopausal women who have recently been started on HRT)

39. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
RBC casts and old to moderate HTN
Subarachnoid hemorrhage
ACEi - ARBS - thiazide diuretics

40. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
High blood pressure - focal neurologic defecit - or papilledema
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Albumin; low molecular weight proteins

41. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
24 hour halter
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
LH surge triggers ovulation

42. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Irregular bleeding between cycles

43. What HPV serotypes are most commonly associated with cervical cancer?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Serotypes 16 - 18 - 31 -52 -58
S. aureus- beta hemolytic streptococcus

44. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Possibility of Ischemic colitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

45. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Wolff-Parkinson-White syndrome
Non-cardiac causes of palpitations

46. 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
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

47. How do you define persistent protein uria?
Echocardiogram
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Presence of proteinuria on at least two separate ocassion

48. PE for a patient getting an abnormal vaginal bleeding work up
Adhesive capsulitis (frozen shoulder): most common in middle age women
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
With a KOH wet mount preparation
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

49. Complete the sentence: pericarditis can cause frictional rub and......
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

50. What are signs of pulmonary congestion?
Dehydration - anemia - cardiac causes
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

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