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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 proteinuria
>150mg per 24hrs
MSK - pulmonary - GI - or psychological
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pancreatitis

2. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Wolff-Parkinson-White syndrome
Hgb - Electrolytes - and TSH

3. 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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Warts
MSK - pulmonary - GI - or psychological
Rotator Cuff tendonitis

4. 1+ protein level on urine dipstick usually represents how much protein in the urine?
35 (exception for postmenopausal women who have recently been started on HRT)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

5. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
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
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. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Non-cardiac causes of palpitations
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Cervical radiculopathy

7. Name 4 factors that predispose an individual to develop pneumonia.
Viral infection of the semicircular apparatus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Scleroderma/polymyositis with secondary gastroesophageal reflux

8. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Fever with frontal or maxillary tenderness
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

9. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Rotator Cuff tendonitis
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
PE - MI - aortic dissection - pneumothorax

10. What are the signs of malignant hypertension?
Analgesic headache
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Adhesive capsulitis (frozen shoulder): most common in middle age women
High blood pressure - focal neurologic defecit - or papilledema

11. History for Acute bronchitis
Tension headache
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Irregular bleeding between cycles
Warts

12. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
With a KOH wet mount preparation
Temporal arteritis-biopsy of the temporal artery
ACEi
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

13. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cholelithiasis
Rotator Cuff tendonitis

14. Shoulder pain with pain radiating to elbow
Less than 80 ml of blood
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cervical radiculopathy

15. Regular bleeding at intervals of less than 21 days
Cellulitis
Bence-Jones
Polymenorrhea
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

16. What are the indiciations for neuroimaging?
Generalized Anxiety disorder and panic disorder
BB or CCB - catheter ablation of identified bypass tract
Upper sternal area burning pain - associated with a productive cough
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

17. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
EGD
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
24 hour halter

18. Name the skin lesion: pustule in association with a hair follice
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Colposcopy - Endocervical curettage - and directed cervical biopsy
Folliculitis
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

19. Describe the presentation of pericardial pain
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

20. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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
Staphylococcal scalded skin syndrome
Regular bleeding at intervals of more than 35 days
A central clear area

21. 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.
MSK - pulmonary - GI - or psychological
Hypertension - CAD - valvular heart disease
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
Repeat Pap after infection treated

22. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Wolff-Parkinson-White syndrome
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Warts

23. What should blood work include for suspected heart failure?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
E. Coli O157:H7
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

24. How do you define persistent protein uria?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Presence of proteinuria on at least two separate ocassion
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

25. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Cellulitis
Chest pain during pneumonia or PE
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

26. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Viral infection of the semicircular apparatus
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

27. Prenatal visit schedule for low-risk pregnancies
Pts with palpitations and dizziness - near syncope - or syncope
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
MSK - pulmonary - GI - or psychological
S. Aureus

28. How are fungal infections diagnosed?
Analgesic headache
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
PVC or Premature atrial contraction (PAC)
With a KOH wet mount preparation

29. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Peptic ulcer disease or gastritis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Chest pain during pneumonia or PE
Diuretics -BB -CCB -ACEi

30. When should a patient get a stress test?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
When the patient has symptoms in association with exercise or who describe chest pain or pressure
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

31. 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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cluster headache

32. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Higher filling presure - pulmonary congestion - and decreasd cardiac return
ACEi - ARBS - thiazide diuretics
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

33. Describe the history and PE of patient presenting with common cold
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Subarachnoid hemorrhage
Rotator Cuff tendonitis

34. What are the consequences of diastolic dysfunction?
Kids: Rotavirus Adults: Norwalk Virus
Nonulcer dyspepsia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Higher filling presure - pulmonary congestion - and decreasd cardiac return

35. Predictors of cardiac etiology
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

36. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Nonulcer dyspepsia

37. What type of imaging is need for chronic sinusitis?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
CT
When the patient has symptoms in association with exercise or who describe chest pain or pressure

38. What are the two common clinical presentations of acute diarrhea?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Dehydration - anemia - cardiac causes
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

39. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
Common problem that resolves spontaneously and is most often seen in children and young adults
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Analgesic headache

40. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
HIV and syphilis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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.

41. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Increase; 200 g/day
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV

42. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Increase; 200 g/day
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

43. Carcinoma in situ is generally referred to a gynecologist and requires ______
Kids: Rotavirus Adults: Norwalk Virus
CBC
Rotator Cuff tendonitis
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

44. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
ACEi - ARBS - thiazide diuretics
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
GERD

45. What are the signs of acute sinusitis?
Less abrupt onset and cessation of palpitations
Staphylococcal scalded skin syndrome
Fever with frontal or maxillary tenderness
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

46. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Hypertension - CAD - valvular heart disease
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Giardia

47. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Variability in the time for follicle development during the proliferative phase
Kids: Rotavirus Adults: Norwalk Virus
Viral infection of the semicircular apparatus

48. What is the role of LH in the menstrual cycle
Analgesic headache
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
LH surge triggers ovulation

49. How to NSAIDs contribute to gastritis and ulcer formation?
Candida albicans
Non-cardiac causes of palpitations
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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.

50. How does CHF present on X-ray?
24 hour halter
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
>150mg per 24hrs
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions