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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. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Warts

2. What is the role of LH in the menstrual cycle
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
S. Aureus
LH surge triggers ovulation

3. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
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
Rotator Cuff problem
Colposcopy - Endocervical curettage - and directed cervical biopsy
Kids: Rotavirus Adults: Norwalk Virus

4. What type of imaging is need for chronic sinusitis?
Intermenstrual bleeding
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
MSK - pulmonary - GI - or psychological
CT

5. Isolated - extra pounding beats
Infectious esophagitis
PVC or Premature atrial contraction (PAC)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

6. Diarrhea from custard filled pastries
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
S. Aureus

7. Shoulder pain with pain radiating to elbow
A central clear area
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Cervical radiculopathy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

8. What the consequences of decreased cardiac output?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Wolff-Parkinson-White syndrome
LH surge triggers ovulation

9. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Impetigo
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Presence of proteinuria on at least two separate ocassion

10. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
LH surge triggers ovulation
Less abrupt onset and cessation of palpitations
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

11. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Acute headache - ataxia - profuse nausea - and vomiting
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
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

12. What is the difference between a Holter monitor or an event monitor?
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
Less than 3 stools per week
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

13. What are signs of pulmonary congestion?
Pancreatitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Wolff-Parkinson-White syndrome
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

14. What should blood work include for suspected heart failure?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

15. What is the next best step if a patient has two or more positive dipstick tests?
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
S. Aureus
A 24hr urine protein collection and urine creatinine clearance determination
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

16. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Furucnle
Supraspinatus and bicipital tendons
Scabies
Coronary artery disease/ angina

17. Difference between Pneumonia and Bronchitis
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
Medication or chemical esophagitis
Hypertension - CAD - valvular heart disease
Diuretics -BB -CCB -ACEi

18. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
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
Peptic ulcer disease or gastritis
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
>3.5g of protein per 24hrs

19. What are the most common causes for the common cold?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

20. Diagnostic Evaluation of Abnoraml vaginal bleeding
Peptic ulcer disease or gastritis
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
Hypertension - CAD - valvular heart disease
True

21. What is the caUse of benign positional vertigo?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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.
CBC
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

22. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Polymenorrhea
HPV testing -Pos=colposcopy -Neg=repeat pap smear

23. What are the secondly causes of glomerular disease?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
S. aureus- beta hemolytic streptococcus
Higher filling presure - pulmonary congestion - and decreasd cardiac return

24. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
DM - HTN - DVT - seizures - depression - or anxiety
Paroxysmal atrial fibrillation or supraventricular tachycardia
Lightheadedness - dizziness - syncope

25. What HPV serotypes are most commonly associated with cervical cancer?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Giardia
Possibility of Ischemic colitis
Serotypes 16 - 18 - 31 -52 -58

26. What is the standard tool used for diagnosis of GERD?
Folliculitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
EGD
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

27. Describe the presentation of pericardial pain
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

28. 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
Folliculitis
Tension headache
Bence-Jones
Warts

29. Constipation: What are indications for lab testing?
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
Giardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

30. Diarrhea is defined as an ____ in stool weight to more than ____g per day
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Other brainstem or cranial nerve findings
S. Aureus
Increase; 200 g/day

31. SE Of Beta blockers?
ACEi - ARBS - thiazide diuretics
Adhesive capsulitis (frozen shoulder): most common in middle age women
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pancreatitis

32. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Rotator Cuff tendonitis
High blood pressure - focal neurologic defecit - or papilledema
Analgesic headache

33. What is the goal of CHF treatment? What drugs should be used?
ACEi
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
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
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

34. What are the most common viral causes of diarrhea in kids and adults?
ACEi
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
Tension headache

35. 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
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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.
Molluscum contagiosum- pox virus

36. Carcinoma in situ is generally referred to a gynecologist and requires ______
>3.5g of protein per 24hrs
Temporal arteritis-biopsy of the temporal artery
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

37. Name 4 factors that predispose an individual to develop pneumonia.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

38. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
ACEi

39. Metrorrhagia
Irregular bleeding between cycles
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Generalized Anxiety disorder and panic disorder
Pancreatitis

40. Where does the development of abnormal cervical cells begin?
100mg; means patient can be trace protein positive and not be detected
Squamocolumnar junction=most common site of cervical cancer
Staphylococcal scalded skin syndrome
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

41. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
E. Coli O157:H7
Common problem that resolves spontaneously and is most often seen in children and young adults
Intermenstrual bleeding

42. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Infectious esophagitis
S. Aureus
A central clear area

43. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cluster headache
Streptococci
Squamocolumnar junction=most common site of cervical cancer

44. Oligomenorrhea
Viral gastroenteritis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days
Supraspinatus and bicipital tendons

45. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
LH surge triggers ovulation

46. 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
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
Candida albicans
Cellulitis

47. What drugs do you use to treat H.pylori + PUD?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
35 (exception for postmenopausal women who have recently been started on HRT)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

48. 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
Scabies
CT
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

49. Define nephrotic range proteinuria
Streptococci
>3.5g of protein per 24hrs
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Excessive bleeding in amount - duration - or both at irregular intervals

50. How are fungal infections diagnosed?
With a KOH wet mount preparation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pts with palpitations and dizziness - near syncope - or syncope
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume