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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. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
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
MSK - pulmonary - GI - or psychological
Peptic ulcer disease or gastritis
E. Coli O157:H7

2. SE Of Beta blockers?
Less than 80 ml of blood
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

3. What is the goal of CHF treatment? What drugs should be used?
RBC casts and old to moderate HTN
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
High blood pressure - focal neurologic defecit - or papilledema

4. 1+ protein level on urine dipstick usually represents how much protein in the urine?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A central clear area
Slow progression of cervical cancer changes -Availability of effective early treatment
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

5. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
24 hour halter
Candida albicans

6. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Echocardiogram
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

7. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
100mg; means patient can be trace protein positive and not be detected
Colposcopy - Endocervical curettage - and directed cervical biopsy
PVC or Premature atrial contraction (PAC)

8. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
PE - MI - aortic dissection - pneumothorax
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Staphylococcal scalded skin syndrome

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
>3.5g of protein per 24hrs
Hypertension - CAD - valvular heart disease
Giardia
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

10. How does systolic vs. diastolic heart failure present on the echocardiogram?
Peptic ulcer disease or gastritis
Dehydration - anemia - cardiac causes
Nonulcer dyspepsia
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

11. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Tension headache
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Folliculitis

12. What are the secondly causes of glomerular disease?
Viral gastroenteritis
Possibility of Ischemic colitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Non-cardiac causes of palpitations

13. What is the Epley maneuver?
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.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Loop diuretics (Check serum K+ levels before drug admin)
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

14. What are the consequences of diastolic dysfunction?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Possibility of Ischemic colitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Higher filling presure - pulmonary congestion - and decreasd cardiac return

15. 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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
24 hour halter
Serotypes 16 - 18 - 31 -52 -58

16. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
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
LH surge triggers ovulation
Regular bleeding at intervals of more than 35 days

17. Define the patient population typically affected by orthostatic or postural proteinuria
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Repeat Pap after infection treated
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
RBC casts and old to moderate HTN

18. 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.
Repeat Pap after infection treated
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Serotypes 16 - 18 - 31 -52 -58
Cluster headache

19. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
A 24hr urine protein collection and urine creatinine clearance determination
Polymenorrhea
EGD

20. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

21. What is the mechanism of action for stimulant agents in treating constipation?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Variability in the time for follicle development during the proliferative phase
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

22. What type of imaging is need for chronic sinusitis?
Polymenorrhea
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
CT
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

23. Discomfort with abducting the arm past 90 degress
Less abrupt onset and cessation of palpitations
Rotator Cuff tendonitis
Presence of proteinuria on at least two separate ocassion
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

24. After treatment of dysplasia - women need Pap smears every...
Subarachnoid hemorrhage
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Temporal arteritis-biopsy of the temporal artery

25. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Albumin; low molecular weight proteins
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Varicella virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

26. What drugs do you use to treat H.pylori + PUD?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Chest pain during pneumonia or PE
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

27. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
High blood pressure - focal neurologic defecit - or papilledema
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
Polymenorrhea

28. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Pts with palpitations and dizziness - near syncope - or syncope
Pleurisy
Hgb - Electrolytes - and TSH
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

29. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
EGD
LH surge triggers ovulation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

30. Vaccines that should be updated before planned pregnancy
Variability in the time for follicle development during the proliferative phase
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
ACEi - ARBS - thiazide diuretics

31. Clinical Manifestations of HTN
Polymenorrhea
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
HPV testing -Pos=colposcopy -Neg=repeat pap smear

32. What is the caUse of Meniere disease? What are the cardinal symptoms?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Lightheadedness - dizziness - syncope
Upper sternal area burning pain - associated with a productive cough

33. What the consequences of decreased cardiac output?
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
Molluscum contagiosum- pox virus
Presence of proteinuria on at least two separate ocassion
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

34. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
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
Temporal arteritis-biopsy of the temporal artery
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

35. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Pleurisy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Giardia

36. What is benign transient proteinuria?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Supraspinatus and bicipital tendons
Pain

37. Describe the presentation of angina?
Subarachnoid hemorrhage
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
Rotator cuff tendonitis
Medication or chemical esophagitis

38. What are the features of glomerular nephritis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
RBC casts and old to moderate HTN
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
>150mg per 24hrs

39. How can GERD (or esophageal motility disorders) lead to chest pain?
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.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

40. What is the Barany maneuver?
Analgesic headache
Upper sternal area burning pain - associated with a productive cough
Varicella virus
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

41. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Staphylococcal scalded skin syndrome
Intermenstrual bleeding
>3.5g of protein per 24hrs

42. Describe the presentation of myocardial pain?
Peptic ulcer disease or gastritis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

43. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
A 24hr urine protein collection and urine creatinine clearance determination
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

44. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Less than 80 ml of blood
Warts
Albumin; low molecular weight proteins

45. What is an acoustic neuroma?
A central clear area
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Pancreatitis

46. What does orthostatic positional changes that bring on dizziness suggest?
Furucnle
Intermenstrual bleeding
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Dehydration - anemia - cardiac causes

47. 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)
GERD
100mg; means patient can be trace protein positive and not be detected
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

48. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Squamocolumnar junction=most common site of cervical cancer
Scleroderma/polymyositis with secondary gastroesophageal reflux
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
DM - HTN - DVT - seizures - depression - or anxiety

49. Diarrhea from custard filled pastries
Hypertension - CAD - valvular heart disease
Folliculitis
S. Aureus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

50. When is a lumbar puncture contraindicated?
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
Streptococci
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation