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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. Irregular cycles with excessive flow - duration - or both
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Menorrhagia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
These patients are associated with low renin states=less likely to respond to medication
24 hour halter
Associated with hypotension
Echocardiogram

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
35 (exception for postmenopausal women who have recently been started on HRT)
Supraspinatus and bicipital tendons
Bence-Jones

4. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

5. How do you define persistent protein uria?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Presence of proteinuria on at least two separate ocassion

6. What are the indiciations for neuroimaging?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Staphylococcal scalded skin syndrome
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

7. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
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
S. aureus- beta hemolytic streptococcus
HPV

8. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
With a KOH wet mount preparation
Paroxysmal atrial fibrillation or supraventricular tachycardia
>3.5g of protein per 24hrs
24 hour halter

9. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
High blood pressure - focal neurologic defecit - or papilledema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

10. Predictors of cardiac etiology
Increase; 200 g/day
Streptococci
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

11. 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
Staphylococcal scalded skin syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment
Pts with palpitations and dizziness - near syncope - or syncope

12. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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.
Presence of proteinuria on at least two separate ocassion
CBC

13. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bence-Jones
Coronary artery disease/ angina
ACEi

14. Diagnosis of HTN
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

15. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Less than 3 stools per week
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

16. Name 4 factors that predispose an individual to develop pneumonia.
Rotator Cuff problem
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

17. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
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
HPV
Nonulcer dyspepsia
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

18. What are the primary glomerular diseases?
Dehydration - anemia - cardiac causes
Variability in the time for follicle development during the proliferative phase
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Non-cardiac causes of palpitations

19. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Pleurisy
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
PVC or Premature atrial contraction (PAC)
Cholelithiasis

20. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
CBC
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

21. What is afterload?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

22. 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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Warts

23. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

24. What are symptoms are CHF?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
With a KOH wet mount preparation
Kids: Rotavirus Adults: Norwalk Virus

25. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Rotator Cuff tendonitis
Possibility of Ischemic colitis
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. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Molluscum contagiosum- pox virus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Viral infection of the semicircular apparatus

27. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Medication or chemical esophagitis
Pts with palpitations and dizziness - near syncope - or syncope
Lightheadedness - dizziness - syncope
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

28. Pneumonia tx: suitable for healthy adults older than 60
Other brainstem or cranial nerve findings
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

29. Name the diagnosis of heartburn: regurgitation - dysphagia
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
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
GERD
35 (exception for postmenopausal women who have recently been started on HRT)

30. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

31. Name types of laxatives
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

32. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Temporal arteritis-biopsy of the temporal artery
Folliculitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

33. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Medication or chemical esophagitis
Scleroderma/polymyositis with secondary gastroesophageal reflux
Giardia

34. What is the difference between a Holter monitor or an event monitor?
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
CBC
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Candida albicans

35. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
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
Less abrupt onset and cessation of palpitations

36. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Pain
Coronary artery disease/ angina
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

37. What is a markers of CNS vertigo?
Polymenorrhea
Varicella virus
Other brainstem or cranial nerve findings
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

38. How does CHF present on X-ray?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Warts
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

39. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Analgesic headache
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

40. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Other brainstem or cranial nerve findings
Cluster headache
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

41. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bence-Jones
DM - HTN - DVT - seizures - depression - or anxiety

42. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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.
Coronary artery disease/ angina

43. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Excessive bleeding in amount - duration - or both at irregular intervals

44. What is the role of LH in the menstrual cycle
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Lightheadedness - dizziness - syncope
LH surge triggers ovulation

45. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
S. Aureus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Streptococci
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

46. Constipation: What are indications for lab testing?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
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

47. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
These patients are associated with low renin states=less likely to respond to medication
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

48. What is an acoustic neuroma?
Pleurisy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Diuretics -BB -CCB -ACEi

49. Describe the presentation of angina?
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
Upper sternal area burning pain - associated with a productive cough
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
Coronary artery disease/ angina

50. Define the patient population typically affected by orthostatic or postural proteinuria
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Temporal arteritis-biopsy of the temporal artery
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin