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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. Prenatal visit schedule for low-risk pregnancies
Chest pain during pneumonia or PE
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

2. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Upper sternal area burning pain - associated with a productive cough
Chest pain during pneumonia or PE
Colposcopy - Endocervical curettage - and directed cervical biopsy

3. Menometrorrhagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
Excessive bleeding in amount - duration - or both at irregular intervals
Medication or chemical esophagitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

4. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Generalized Anxiety disorder and panic disorder
Loop diuretics (Check serum K+ levels before drug admin)
A 24hr urine protein collection and urine creatinine clearance determination
CBC

5. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Increase; 200 g/day
Acute headache - ataxia - profuse nausea - and vomiting
When the patient has symptoms in association with exercise or who describe chest pain or pressure

6. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Other brainstem or cranial nerve findings
Furucnle
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

7. At was quantity does urine dipstick test detect elevated protein?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Rotator Cuff problem
100mg; means patient can be trace protein positive and not be detected
Other brainstem or cranial nerve findings

8. What is the peripheral caUse of vertigo?
Medication or chemical esophagitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

9. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
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.
Excessive bleeding in amount - duration - or both at irregular intervals
Coronary artery disease/ angina

10. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Adhesive capsulitis (frozen shoulder): most common in middle age women
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
S. Aureus

11. What are the most common causes for the common cold?
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided

12. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Rotator cuff tendonitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Lightheadedness - dizziness - syncope

13. What are signs of pulmonary congestion?
Squamocolumnar junction=most common site of cervical cancer
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
DM - HTN - DVT - seizures - depression - or anxiety

14. Describe the presentation tracheobronchitis
Irregular bleeding between cycles
Upper sternal area burning pain - associated with a productive cough
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Hypertension - CAD - valvular heart disease

15. Mainstay treatment for soft tissue inflammation (Shoulder)
Cluster headache
LH surge triggers ovulation
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Warts

16. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Lightheadedness - dizziness - syncope
These patients are associated with low renin states=less likely to respond to medication
Excessive bleeding in amount - duration - or both at irregular intervals

17. What test done in PE measures instability of shoulder?
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Menorrhagia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

18. Why don't ACEi work well for the elderly and African Americans when treating HTN?
100mg; means patient can be trace protein positive and not be detected
These patients are associated with low renin states=less likely to respond to medication
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Coronary artery disease/ angina

19. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Analgesic headache
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
Scabies
Impetigo

20. 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
Squamocolumnar junction=most common site of cervical cancer
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

21. What is the difference between a Holter monitor or an event monitor?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Impetigo
Rotator cuff tendonitis

22. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Regular bleeding at intervals of more than 35 days
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
EGD

23. What are the physical exam signs of CHF?
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
Impetigo
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pts with palpitations and dizziness - near syncope - or syncope

24. Predictors of cardiac etiology
Bence-Jones
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Lightheadedness - dizziness - syncope
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

25. What should be considered in younger patients with menorrhagia
Upper sternal area burning pain - associated with a productive cough
Coag disorders
CBC
100mg; means patient can be trace protein positive and not be detected

26. Who should have Xray testing for shoulder pain?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Wolff-Parkinson-White syndrome
Acute headache - ataxia - profuse nausea - and vomiting

27. What does the classic ring worm lesion have?
A central clear area
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

28. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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
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
DM - HTN - DVT - seizures - depression - or anxiety

29. How can GERD (or esophageal motility disorders) lead to chest pain?
Polymenorrhea
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
A central clear area
PE - MI - aortic dissection - pneumothorax

30. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Less abrupt onset and cessation of palpitations
Cellulitis
Cervical radiculopathy
Rotator Cuff problem

31. When is a lumbar puncture contraindicated?
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
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

32. 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
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
Rotator Cuff problem
Variability in the time for follicle development during the proliferative phase

33. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Possibility of Ischemic colitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

34. What should preconception counseling include?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Dehydration - anemia - cardiac causes
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
Fever with frontal or maxillary tenderness

35. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

36. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Medication or chemical esophagitis
Cluster headache
Nonulcer dyspepsia

37. MI - pericardial tamponade - PE - GI bleed - are...
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
Associated with hypotension
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
Other brainstem or cranial nerve findings

38. Isolated - extra pounding beats
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
PVC or Premature atrial contraction (PAC)
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

39. What is the role of FSH in one's menstrual cycle
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Rotator Cuff problem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

40. Name the skin lesion: pustule in association with a hair follice
Dehydration - anemia - cardiac causes
Polymenorrhea
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Folliculitis

41. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
BB or CCB - catheter ablation of identified bypass tract
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

42. Metrorrhagia
Irregular bleeding between cycles
Molluscum contagiosum- pox virus
Infectious esophagitis
Regular bleeding at intervals of more than 35 days

43. When does troponin rise following myocardial injury or infarction?
Dehydration - anemia - cardiac causes
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Less than 80 ml of blood
Subarachnoid hemorrhage

44. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Staphylococcal scalded skin syndrome
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Colposcopy - Endocervical curettage - and directed cervical biopsy
Temporal arteritis-biopsy of the temporal artery

45. What are the symptoms of palpitations?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Staphylococcal scalded skin syndrome
>3.5g of protein per 24hrs
Lightheadedness - dizziness - syncope

46. What is afterload?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Wolff-Parkinson-White syndrome
100mg; means patient can be trace protein positive and not be detected
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

47. How to NSAIDs contribute to gastritis and ulcer formation?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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.
HIV and syphilis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

48. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
>3.5g of protein per 24hrs
Coronary artery disease/ angina
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

49. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Lightheadedness - dizziness - syncope
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

50. Constipation: What are indications for lab testing?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Albumin; low molecular weight proteins
Lightheadedness - dizziness - syncope