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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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1. What is benign transient proteinuria?
Associated with hypotension
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Tension headache
Common problem that resolves spontaneously and is most often seen in children and young adults

2. How to NSAIDs contribute to gastritis and ulcer formation?
Excessive bleeding in amount - duration - or both at irregular intervals
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.
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Rotator Cuff problem

3. What are the signs of acute sinusitis?
Cervical radiculopathy
Fever with frontal or maxillary tenderness
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.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

4. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Variability in the time for follicle development during the proliferative phase
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

5. Name some medications that can cause proteinuria
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Lightheadedness - dizziness - syncope
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

6. What are the three types of lice?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Bence-Jones
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

7. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Variability in the time for follicle development during the proliferative phase
Loop diuretics (Check serum K+ levels before drug admin)
GERD
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

8. Treatment for supraventricular tachycardias
Polymenorrhea
BB or CCB - catheter ablation of identified bypass tract
Intermenstrual bleeding
Variability in the time for follicle development during the proliferative phase

9. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults
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

10. Shoulder pain with pain radiating to elbow
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
ACEi - ARBS - thiazide diuretics
Cervical radiculopathy
Increase; 200 g/day

11. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Loop diuretics (Check serum K+ levels before drug admin)
EGD
Kids: Rotavirus Adults: Norwalk Virus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

12. Predictors of cardiac etiology
PVC or Premature atrial contraction (PAC)
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
When the patient has symptoms in association with exercise or who describe chest pain or pressure

13. Irregular cycles with excessive flow - duration - or both
Squamocolumnar junction=most common site of cervical cancer
35 (exception for postmenopausal women who have recently been started on HRT)
Echocardiogram
Menorrhagia

14. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
LH surge triggers ovulation
Pleurisy
Generalized Anxiety disorder and panic disorder
DM - HTN - DVT - seizures - depression - or anxiety

15. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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
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
Chest pain during pneumonia or PE
Less than 3 stools per week

16. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Streptococci
Pancreatitis
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

17. What HPV serotypes are most commonly associated with cervical cancer?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Serotypes 16 - 18 - 31 -52 -58
Anticoag with warfarin to prevent thromboembolism

18. Name the skin lesion: honey colored crusts
100mg; means patient can be trace protein positive and not be detected
Impetigo
Subarachnoid hemorrhage
Colposcopy - Endocervical curettage - and directed cervical biopsy

19. Diarrhea from custard filled pastries
S. Aureus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Upper sternal area burning pain - associated with a productive cough
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. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
GERD
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

21. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Variability in the time for follicle development during the proliferative phase
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pts with palpitations and dizziness - near syncope - or syncope
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

22. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Streptococci
Increase; 200 g/day

23. What is the caUse of benign positional vertigo?
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.
Hgb - Electrolytes - and TSH
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
HIV and syphilis

24. What diagnosis does the 'worse headache of my life' suggest?
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
Subarachnoid hemorrhage
Diuretics -BB -CCB -ACEi
Associated with hypotension

25. What is the mechanism of action for stimulant agents in treating constipation?
HIV and syphilis
With a KOH wet mount preparation
35 (exception for postmenopausal women who have recently been started on HRT)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

26. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
Supraspinatus and bicipital tendons
HPV
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

27. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Cervical radiculopathy
CBC
Excessive bleeding in amount - duration - or both at irregular intervals
Anticoag with warfarin to prevent thromboembolism

28. Uterine bleeding between regular cycles
GERD
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Intermenstrual bleeding
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

29. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
MSK - pulmonary - GI - or psychological
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Associated with hypotension

30. What the consequences of decreased cardiac output?
Supraspinatus and bicipital tendons
True
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
Chest pain during pneumonia or PE

31. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Scleroderma/polymyositis with secondary gastroesophageal reflux
24 hour halter
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Kids: Rotavirus Adults: Norwalk Virus

32. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Menorrhagia

33. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Non-cardiac causes of palpitations

34. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Acute headache - ataxia - profuse nausea - and vomiting
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

35. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Less than 3 stools per week
S. Aureus
Viral infection of the semicircular apparatus
Candida albicans

36. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
BB or CCB - catheter ablation of identified bypass tract
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Peptic ulcer disease or gastritis

37. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
100mg; means patient can be trace protein positive and not be detected
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
CT

38. Describe the presentation of angina?
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
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
Chest pain during pneumonia or PE
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

39. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Upper sternal area burning pain - associated with a productive cough
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
E. Coli O157:H7
EGD

40. Diagnostic Evaluation of Abnoraml vaginal bleeding
Other brainstem or cranial nerve findings
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

41. Discomfort with abducting the arm past 90 degress
ACEi - ARBS - thiazide diuretics
Rotator Cuff tendonitis
True
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

42. What is afterload?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Echocardiogram
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
A 24hr urine protein collection and urine creatinine clearance determination
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Paroxysmal atrial fibrillation or supraventricular tachycardia

44. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Generalized Anxiety disorder and panic disorder
Scabies
Slow progression of cervical cancer changes -Availability of effective early treatment

45. What is the goal of CHF treatment? What drugs should be used?
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
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

46. Who should have Xray testing for shoulder pain?
Cellulitis
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.
Hgb - Electrolytes - and TSH
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

47. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Generalized Anxiety disorder and panic disorder
Menorrhagia

48. What is the caUse of Meniere disease? What are the cardinal symptoms?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Serotypes 16 - 18 - 31 -52 -58
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CT

49. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Warts

50. How is constipation clinically defined?
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
Less than 3 stools per week
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

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