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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: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Scleroderma/polymyositis with secondary gastroesophageal reflux
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Peptic ulcer disease or gastritis

2. Initial treatment for Rhinosinusitis
>3.5g of protein per 24hrs
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
100mg; means patient can be trace protein positive and not be detected

3. 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)
Hgb - Electrolytes - and TSH
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

4. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Infectious esophagitis
Molluscum contagiosum- pox virus
Pleurisy
Anticoag with warfarin to prevent thromboembolism

5. Isolated - extra pounding beats
Cervical radiculopathy
PVC or Premature atrial contraction (PAC)
Irregular bleeding between cycles
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

6. Prenatal visit schedule for low-risk pregnancies
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
CBC
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

7. What are the primary glomerular diseases?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Coag disorders

8. Constipation: What are indications for lab testing?
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
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
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
S. Aureus

9. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Generalized Anxiety disorder and panic disorder
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Bence-Jones

10. What is the next best step if a patient has two or more positive dipstick tests?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
A 24hr urine protein collection and urine creatinine clearance determination
Lightheadedness - dizziness - syncope
Warts

11. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Presence of proteinuria on at least two separate ocassion

12. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
Candida albicans
Viral gastroenteritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

13. 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
Molluscum contagiosum- pox virus
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

14. When is a lumbar puncture contraindicated?
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.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

15. What is the difference between a Holter monitor or an event monitor?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

16. What are the secondly causes of glomerular disease?
Less abrupt onset and cessation of palpitations
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pleurisy

17. Natural history of cervical cancer
Possibility of Ischemic colitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

18. How does CHF present on X-ray?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Fever with frontal or maxillary tenderness
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

19. What medications can cause heart palpitations?
Acute headache - ataxia - profuse nausea - and vomiting
Other brainstem or cranial nerve findings
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults

20. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Paroxysmal atrial fibrillation or supraventricular tachycardia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

21. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Echocardiogram
CBC
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

22. What are symptoms are CHF?
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

23. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
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
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

24. name the 4 emergent causes of chest pain
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
PE - MI - aortic dissection - pneumothorax

25. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Furucnle
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Colposcopy - Endocervical curettage - and directed cervical biopsy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

26. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fever with frontal or maxillary tenderness
Cluster headache
Less than 80 ml of blood

27. How are fungal infections diagnosed?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Upper sternal area burning pain - associated with a productive cough
With a KOH wet mount preparation
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

28. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
S. aureus- beta hemolytic streptococcus
PE - MI - aortic dissection - pneumothorax

29. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Bulk forming: Psyllium - Methycellulose - Polycarbophil

30. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
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
Viral gastroenteritis
Possibility of Ischemic colitis

31. Name the diagnosis of heartburn: regurgitation - dysphagia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
24 hour halter
GERD
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

32. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

33. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
CBC
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

34. How is constipation clinically defined?
Variability in the time for follicle development during the proliferative phase
Cluster headache
Slow progression of cervical cancer changes -Availability of effective early treatment
Less than 3 stools per week

35. Discomfort with abducting the arm past 90 degress
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Rotator Cuff tendonitis
Loop diuretics (Check serum K+ levels before drug admin)

36. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Acute headache - ataxia - profuse nausea - and vomiting
Viral infection of the semicircular apparatus
Squamocolumnar junction=most common site of cervical cancer

37. What test done in PE measures instability of shoulder?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Paroxysmal atrial fibrillation or supraventricular tachycardia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

38. What should be considered in younger patients with menorrhagia
Coag disorders
Cholelithiasis
Supraspinatus and bicipital tendons
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

39. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
35 (exception for postmenopausal women who have recently been started on HRT)
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

40. Diarrhea from custard filled pastries
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. Aureus
Nonulcer dyspepsia

41. What are the features of glomerular nephritis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
RBC casts and old to moderate HTN
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

42. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Menorrhagia

43. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
A central clear area
Supraspinatus and bicipital tendons

44. Clinical Manifestations of HTN
Colposcopy - Endocervical curettage - and directed cervical biopsy
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Folliculitis

45. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
35 (exception for postmenopausal women who have recently been started on HRT)

46. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
S. aureus- beta hemolytic streptococcus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Albumin; low molecular weight proteins
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

47. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Fever with frontal or maxillary tenderness
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

48. History and PE for Pneumonia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

49. 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
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
Slow progression of cervical cancer changes -Availability of effective early treatment
A 24hr urine protein collection and urine creatinine clearance determination

50. Name some medications that can cause proteinuria
Pts with palpitations and dizziness - near syncope - or syncope
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - 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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides