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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. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Analgesic headache
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Serotypes 16 - 18 - 31 -52 -58

2. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
A central clear area
Staphylococcal scalded skin syndrome
A 24hr urine protein collection and urine creatinine clearance determination
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

3. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
These patients are associated with low renin states=less likely to respond to medication
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

4. 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.
Tension headache
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Impetigo
PVC or Premature atrial contraction (PAC)

5. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Adhesive capsulitis (frozen shoulder): most common in middle age women

6. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
DM - HTN - DVT - seizures - depression - or anxiety
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Bulk forming: Psyllium - Methycellulose - Polycarbophil

7. MI - pericardial tamponade - PE - GI bleed - are...
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
Associated with hypotension
Cluster headache
Increase; 200 g/day

8. 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
HIV and syphilis
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
Cellulitis

9. What is the Barany maneuver?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

10. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Increase; 200 g/day
Excessive bleeding in amount - duration - or both at irregular intervals
Pleurisy

11. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Pleurisy
Chest pain during pneumonia or PE
Diuretics -BB -CCB -ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

12. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
24 hour halter

13. When is a lumbar puncture contraindicated?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Increasing fluid (8 - 8oz glasses of water/day) -fiber
HIV and syphilis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

14. How are fungal infections diagnosed?
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.
With a KOH wet mount preparation
Tension headache
Rotator cuff tendonitis

15. What treatments are the cornerstone for treating cases of functional constipation?
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
A central clear area
Rotator cuff tendonitis
Analgesic headache
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

17. What are the secondly causes of glomerular disease?
Regular bleeding at intervals of more than 35 days
Infectious esophagitis
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

18. What is the difference between a Holter monitor or an event monitor?
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.
Non-cardiac causes of palpitations
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

19. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
ACEi
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

20. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
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
Scleroderma/polymyositis with secondary gastroesophageal reflux

21. How to NSAIDs contribute to gastritis and ulcer formation?
Viral gastroenteritis
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.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

22. Metrorrhagia
Irregular bleeding between cycles
Hgb - Electrolytes - and TSH
Tension headache
Pleurisy

23. 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
S. aureus- beta hemolytic streptococcus
E. Coli O157:H7
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

24. How do you define persistent protein uria?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
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

25. What is the next best step if a patient has two or more positive dipstick tests?
CBC
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination
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

26. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Coronary artery disease/ angina
Kids: Rotavirus Adults: Norwalk Virus
Viral gastroenteritis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

27. Describe the presentation of angina?
Molluscum contagiosum- pox virus
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
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
Possibility of Ischemic colitis

28. Define the patient population typically affected by orthostatic or postural proteinuria
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
Pts with palpitations and dizziness - near syncope - or syncope
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

29. 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.
Supraspinatus and bicipital tendons
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
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

30. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
These patients are associated with low renin states=less likely to respond to medication
Temporal arteritis-biopsy of the temporal artery

31. Define proteinuria
Scleroderma/polymyositis with secondary gastroesophageal reflux
>150mg per 24hrs
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

32. What occurs after ovulation
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Hypertension - CAD - valvular heart disease
GERD
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

33. Describe the presentation of pneumonia
E. Coli O157:H7
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
Echocardiogram
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

34. Describes what occurs during squamous metaplasia of the cervix.
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

35. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
CT
Cholelithiasis
PVC or Premature atrial contraction (PAC)

36. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Medication or chemical esophagitis
Peptic ulcer disease or gastritis
Supraspinatus and bicipital tendons
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. What is the preload?
Staphylococcal scalded skin syndrome
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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

38. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

39. What are the three major risk factors for heart failure?
Echocardiogram
Hypertension - CAD - valvular heart disease
MSK - pulmonary - GI - or psychological
Coag disorders

40. Lab testing for heart palpitation
Less abrupt onset and cessation of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Staphylococcal scalded skin syndrome
Hgb - Electrolytes - and TSH

41. After treatment of dysplasia - women need Pap smears every...
HPV
CBC
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

42. Mainstay treatment for soft tissue inflammation (Shoulder)
>150mg per 24hrs
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

43. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Wolff-Parkinson-White syndrome
Albumin; low molecular weight proteins
Cholelithiasis
S. Aureus

44. Diagnosis of HTN
Intermenstrual bleeding
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

45. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
Bence-Jones
Cholelithiasis
High blood pressure - focal neurologic defecit - or papilledema

46. Name the skin lesion: honey colored crusts
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Regular bleeding at intervals of more than 35 days
Impetigo

47. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Rotator Cuff tendonitis
With a KOH wet mount preparation

48. Carcinoma in situ is generally referred to a gynecologist and requires ______
True
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
Fever with frontal or maxillary tenderness
Increase; 200 g/day

49. 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
LH surge triggers ovulation
Cellulitis
Medication or chemical esophagitis

50. Irregular cycles with excessive flow - duration - or both
Serotypes 16 - 18 - 31 -52 -58
Dehydration - anemia - cardiac causes
Menorrhagia
DM - HTN - DVT - seizures - depression - or anxiety