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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. When should invasive eletrophysiologic study should be considered?
Medication or chemical esophagitis
ACEi
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
True

2. What are the two common clinical presentations of acute diarrhea?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

3. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

4. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Subarachnoid hemorrhage
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
Infectious esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

5. What does treatment for migrans include?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

6. How is constipation clinically defined?
Less than 3 stools per week
Fever with frontal or maxillary tenderness
Temporal arteritis-biopsy of the temporal artery
Folliculitis

7. What is the next best step if a patient has two or more positive dipstick tests?
Scabies
A 24hr urine protein collection and urine creatinine clearance determination
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

8. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Non-cardiac causes of palpitations
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure

9. What is the caUse of Meniere disease? What are the cardinal symptoms?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Menorrhagia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

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

11. Four muscles of rotator cuff
With a KOH wet mount preparation
Bulk forming: Psyllium - Methycellulose - Polycarbophil
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

12. What medications can cause heart palpitations?
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
Anticoag with warfarin to prevent thromboembolism
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
When the patient has symptoms in association with exercise or who describe chest pain or pressure

13. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Furucnle
Infectious esophagitis
CBC

14. Predictors of cardiac etiology
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pancreatitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil

15. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Cluster headache
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
A 24hr urine protein collection and urine creatinine clearance determination

16. HIgh risk pregnant patients should be evaluated for ____ and ____
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
HIV and syphilis
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
35 (exception for postmenopausal women who have recently been started on HRT)

17. 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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
True
Chest pain during pneumonia or PE
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

18. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Scleroderma/polymyositis with secondary gastroesophageal reflux
Polymenorrhea
MSK - pulmonary - GI - or psychological
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

19. Define proteinuria
>150mg per 24hrs
Less than 80 ml of blood
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
Molluscum contagiosum- pox virus

20. Chronic pain and shoulder stiffness with limited motion
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Tension headache
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

21. What test done in PE measures instability of shoulder?
Non-cardiac causes of palpitations
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Intermenstrual bleeding
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

22. 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
Scabies
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Chest pain during pneumonia or PE
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

23. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
35 (exception for postmenopausal women who have recently been started on HRT)
Echocardiogram
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

24. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Menorrhagia
Viral gastroenteritis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

25. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Warts
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Squamocolumnar junction=most common site of cervical cancer

26. Describe the presentation of pneumonia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Rotator cuff tendonitis
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

27. What are the most common viral causes of diarrhea in kids and adults?
Wolff-Parkinson-White syndrome
Kids: Rotavirus Adults: Norwalk Virus
PVC or Premature atrial contraction (PAC)
Medication or chemical esophagitis

28. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Furucnle
A 24hr urine protein collection and urine creatinine clearance determination
Coronary artery disease/ angina

29. When does troponin rise following myocardial injury or infarction?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Rotator Cuff problem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

30. What is the standard tool used for diagnosis of GERD?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Diuretics -BB -CCB -ACEi
EGD

31. Isolated - extra pounding beats
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
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.
PVC or Premature atrial contraction (PAC)

32. Pneumonia tx: suitable for healthy adults older than 60
High blood pressure - focal neurologic defecit - or papilledema
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
ACEi - ARBS - thiazide diuretics
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

33. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Varicella virus
Bulk forming: Psyllium - Methycellulose - Polycarbophil

34. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Folliculitis
Echocardiogram
Cluster headache
Candida albicans

35. What is benign transient proteinuria?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Common problem that resolves spontaneously and is most often seen in children and young adults
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

36. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
PVC or Premature atrial contraction (PAC)
24 hour halter
Viral gastroenteritis
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

37. Name the diagnosis of heartburn: severe constant mid abdominal pain
Molluscum contagiosum- pox virus
Tension headache
Pancreatitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

38. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
ACEi
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
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

39. 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
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.
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
HIV and syphilis

40. What is the preload?
E. Coli O157:H7
Less than 3 stools per week
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

41. What are the signs of cerebral hemorrhage?
Lightheadedness - dizziness - syncope
Pancreatitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Acute headache - ataxia - profuse nausea - and vomiting

42. What are the primary glomerular diseases?
Impetigo
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
LH surge triggers ovulation

43. Diagnosis of HTN
Nonulcer dyspepsia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Common problem that resolves spontaneously and is most often seen in children and young adults

44. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Kids: Rotavirus Adults: Norwalk Virus
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
Other brainstem or cranial nerve findings
Giardia

45. What drugs do you use to treat H.pylori + PUD?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. What is a markers of CNS vertigo?
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
Other brainstem or cranial nerve findings
Tension headache
Bulk forming: Psyllium - Methycellulose - Polycarbophil

47. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Nonulcer dyspepsia
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
CBC

48. Pneumonia tx: suitable for healthy adults less than 60
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Serotypes 16 - 18 - 31 -52 -58
Warts

49. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
ACEi - ARBS - thiazide diuretics
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
Intermenstrual bleeding
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

50. Oligomenorrhea
HPV
Colposcopy - Endocervical curettage - and directed cervical biopsy
LH surge triggers ovulation
Regular bleeding at intervals of more than 35 days