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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. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Wolff-Parkinson-White syndrome
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

2. HIgh risk pregnant patients should be evaluated for ____ and ____
Generalized Anxiety disorder and panic disorder
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

3. History for Acute bronchitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cellulitis

4. Natural history of cervical cancer
Viral gastroenteritis
Coronary artery disease/ angina
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

5. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pleurisy
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Colposcopy - Endocervical curettage - and directed cervical biopsy

6. What medications can cause heart palpitations?
Menorrhagia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
PVC or Premature atrial contraction (PAC)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

7. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Irregular bleeding between cycles
Non-cardiac causes of palpitations

8. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Coag disorders
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
Subarachnoid hemorrhage

9. Define the patient population typically affected by orthostatic or postural proteinuria
These patients are associated with low renin states=less likely to respond to medication
Supraspinatus and bicipital tendons
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
PVC or Premature atrial contraction (PAC)

10. Name the skin lesion: erythema - warmth - edema - pain - fever
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Temporal arteritis-biopsy of the temporal artery
Cellulitis
ACEi - ARBS - thiazide diuretics

11. What is the difference between a Holter monitor or an event monitor?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
With a KOH wet mount preparation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

12. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Increase; 200 g/day
Echocardiogram
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

13. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
RBC casts and old to moderate HTN

14. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Pleurisy
Bence-Jones
>3.5g of protein per 24hrs

15. What are the most common viral causes of diarrhea in kids and adults?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Kids: Rotavirus Adults: Norwalk 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
E. Coli O157:H7

16. Isolated - extra pounding beats
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
Increase; 200 g/day
PVC or Premature atrial contraction (PAC)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

17. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Wolff-Parkinson-White syndrome
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
Non-cardiac causes of palpitations

18. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral gastroenteritis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Serotypes 16 - 18 - 31 -52 -58

19. How can GERD (or esophageal motility disorders) lead to chest pain?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
EGD
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

20. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Less than 3 stools per week
Bence-Jones
Presence of proteinuria on at least two separate ocassion

21. What are the primary glomerular diseases?
Varicella virus
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

22. PE for a patient getting an abnormal vaginal bleeding work up
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

23. Things that need to be included in history of shoulder pain
PVC or Premature atrial contraction (PAC)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Diuretics -BB -CCB -ACEi

24. What are signs of pulmonary congestion?
Hgb - Electrolytes - and TSH
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A 24hr urine protein collection and urine creatinine clearance determination

25. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Squamocolumnar junction=most common site of cervical cancer
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Influenza - Rhinovirus - Adenovirus - Parainfluenza

26. What are the secondly causes of glomerular disease?
Molluscum contagiosum- pox virus
Repeat Pap after infection treated
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

27. What is the Barany maneuver?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Viral infection of the semicircular apparatus
High blood pressure - focal neurologic defecit - or papilledema

28. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Rotator Cuff problem
Loop diuretics (Check serum K+ levels before drug admin)

29. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
Warts
Rotator Cuff tendonitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

30. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
RBC casts and old to moderate HTN
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Serotypes 16 - 18 - 31 -52 -58

31. What are the physical exam signs of 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
Furucnle
EGD
Medication or chemical esophagitis

32. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Acute headache - ataxia - profuse nausea - and vomiting
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

33. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Fever with frontal or maxillary tenderness
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Molluscum contagiosum- pox virus

34. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Warts
Viral infection of the semicircular apparatus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Diuretics -BB -CCB -ACEi

35. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Giardia
Tension headache
Bulk forming: Psyllium - Methycellulose - Polycarbophil

36. 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
Warts
Generalized Anxiety disorder and panic disorder
Medication or chemical esophagitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

37. History for Sinusitis

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38. Complete the sentence: pericarditis can cause frictional rub and......
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.
Intermenstrual bleeding
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

39. Name 4 factors that predispose an individual to develop pneumonia.
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
HIV and syphilis

40. What is the next best step if a patient has two or more positive dipstick tests?
Viral gastroenteritis
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

41. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Fever with frontal or maxillary tenderness
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Intermenstrual bleeding
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

42. How does systolic vs. diastolic heart failure present on the echocardiogram?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Coag disorders
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

43. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Acute headache - ataxia - profuse nausea - and vomiting
Echocardiogram
Furucnle

44. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
ACEi - ARBS - thiazide diuretics
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
A central clear area

45. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Bence-Jones
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
Serotypes 16 - 18 - 31 -52 -58

46. 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
Albumin; low molecular weight proteins
These patients are associated with low renin states=less likely to respond to medication
Dehydration - anemia - cardiac causes
Scabies

47. Uterine bleeding between regular cycles
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Possibility of Ischemic colitis
Nonulcer dyspepsia
Intermenstrual bleeding

48. Predictors of cardiac etiology
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Increase; 200 g/day

49. patients with herpes zoster may experience what symptom before the rash appear?
Analgesic headache
Pain
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
PVC or Premature atrial contraction (PAC)

50. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Adhesive capsulitis (frozen shoulder): most common in middle age women
Menorrhagia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema