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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.
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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. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Medication or chemical esophagitis
Increase; 200 g/day
These patients are associated with low renin states=less likely to respond to medication
Possibility of Ischemic colitis

2. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
HIV and syphilis
These patients are associated with low renin states=less likely to respond to medication

3. What is considered normal blood loss during a menstrual cycle?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
With a KOH wet mount preparation
Less than 80 ml of blood
Supraspinatus and bicipital tendons

4. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
GERD
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
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

5. What is the Epley maneuver?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Common problem that resolves spontaneously and is most often seen in children and young adults

6. What are symptoms are CHF?
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
Cluster headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Peptic ulcer disease or gastritis

7. What is the caUse of benign positional vertigo?
Cervical radiculopathy
Hypertension - CAD - valvular heart disease
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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.

8. What places women at higher risk of getting cervical cancer?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Menorrhagia
Diuretics -BB -CCB -ACEi

9. What is the Barany maneuver?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Warts
A central clear area

10. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
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
Hgb - Electrolytes - and TSH
Fever with frontal or maxillary tenderness

11. Shoulder pain with pain radiating to elbow
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cervical radiculopathy

12. Mainstay treatment for soft tissue inflammation (Shoulder)
Less abrupt onset and cessation of palpitations
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Polymenorrhea
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

13. Name the skin lesion: honey colored crusts
Pts with palpitations and dizziness - near syncope - or syncope
Impetigo
Colposcopy - Endocervical curettage - and directed cervical biopsy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

14. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

15. How is constipation clinically defined?
Excessive bleeding in amount - duration - or both at irregular intervals
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 3 stools per week
>150mg per 24hrs

16. Cycle length variabilty is primarily due to what?
>150mg per 24hrs
Variability in the time for follicle development during the proliferative phase
Anticoag with warfarin to prevent thromboembolism
Associated with hypotension

17. Diarrhea from custard filled pastries
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
S. Aureus
Infectious esophagitis
Scleroderma/polymyositis with secondary gastroesophageal reflux

18. Initial treatment for Rhinosinusitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Scleroderma/polymyositis with secondary gastroesophageal reflux
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

19. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
True
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
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

20. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Coronary artery disease/ angina

21. Name the diagnosis of heartburn: regurgitation - dysphagia
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
Chest pain during pneumonia or PE
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
GERD

22. MI - pericardial tamponade - PE - GI bleed - are...
Hgb - Electrolytes - and TSH
Associated with hypotension
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Colposcopy - Endocervical curettage - and directed cervical biopsy

23. What is the standard tool used for diagnosis of GERD?
Pancreatitis
EGD
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

24. PE for a patient getting an abnormal vaginal bleeding work up
Staphylococcal scalded skin syndrome
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Wolff-Parkinson-White syndrome
Rotator cuff tendonitis

25. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

26. After treatment of dysplasia - women need Pap smears every...
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Increase; 200 g/day
Other brainstem or cranial nerve findings

27. Describe the history and PE of patient presenting with common cold
Supraspinatus and bicipital tendons
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
ACEi - ARBS - thiazide diuretics
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

28. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Nonulcer dyspepsia
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

29. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Peptic ulcer disease or gastritis
Loop diuretics (Check serum K+ levels before drug admin)
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
Viral gastroenteritis

30. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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
Staphylococcal scalded skin syndrome
Diuretics -BB -CCB -ACEi
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

31. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Folliculitis
Upper sternal area burning pain - associated with a productive cough
A central clear area

32. History for Sinusitis

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33. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Other brainstem or cranial nerve findings

34. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Less than 80 ml of blood
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

35. 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
Streptococci
E. Coli O157:H7
Pts with palpitations and dizziness - near syncope - or syncope
LH surge triggers ovulation

36. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
>3.5g of protein per 24hrs
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
CT

37. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HPV
High blood pressure - focal neurologic defecit - or papilledema

38. Treatment for supraventricular tachycardias
Peptic ulcer disease or gastritis
BB or CCB - catheter ablation of identified bypass tract
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Cluster headache

39. What treatments are the cornerstone for treating cases of functional constipation?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Higher filling presure - pulmonary congestion - and decreasd cardiac return

40. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Pancreatitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Diuretics -BB -CCB -ACEi

41. Regular bleeding at intervals of less than 21 days
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
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
Polymenorrhea
These patients are associated with low renin states=less likely to respond to medication

42. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Viral gastroenteritis
Infectious esophagitis

43. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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.
Increase; 200 g/day
Chest pain during pneumonia or PE
High blood pressure - focal neurologic defecit - or papilledema

44. How does CHF present on X-ray?
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)
Less abrupt onset and cessation of palpitations
High blood pressure - focal neurologic defecit - or papilledema

45. What should blood work include for suspected heart failure?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Menorrhagia
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

46. Carcinoma in situ is generally referred to a gynecologist and requires ______
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Wolff-Parkinson-White syndrome
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
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

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)
Analgesic headache
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

48. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
CBC
Loop diuretics (Check serum K+ levels before drug admin)
Colposcopy - Endocervical curettage - and directed cervical biopsy

49. Chronic pain and shoulder stiffness with limited motion
Analgesic headache
Squamocolumnar junction=most common site of cervical cancer
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pain

50. How to NSAIDs contribute to gastritis and ulcer formation?
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
Furucnle
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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.