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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. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Excessive bleeding in amount - duration - or both at irregular intervals
MSK - pulmonary - GI - or psychological
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

2. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Folliculitis
HPV
Infectious esophagitis

3. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Hypertension - CAD - valvular heart disease
Repeat Pap after infection treated

4. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Wolff-Parkinson-White syndrome
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Varicella virus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. Name the diagnosis of heartburn: regurgitation - dysphagia
Variability in the time for follicle development during the proliferative phase
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
GERD

6. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
Generalized Anxiety disorder and panic disorder
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

7. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Polymenorrhea
Paroxysmal atrial fibrillation or supraventricular tachycardia
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

8. 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
Coag disorders
>3.5g of protein per 24hrs
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
True

9. What is considered normal blood loss during a menstrual cycle?
Streptococci
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Less than 80 ml of blood
>3.5g of protein per 24hrs

10. Pneumonia tx: suitable for healthy adults older than 60
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Molluscum contagiosum- pox virus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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.

12. How can GERD (or esophageal motility disorders) lead to chest pain?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
These patients are associated with low renin states=less likely to respond to medication
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

13. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Less abrupt onset and cessation of palpitations
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

14. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
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

15. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
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
Infectious esophagitis
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

16. What are the common causes for laryngitis?
PE - MI - aortic dissection - pneumothorax
Common problem that resolves spontaneously and is most often seen in children and young adults
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Medication or chemical esophagitis

17. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Molluscum contagiosum- pox virus
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
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

18. What are the secondly causes of glomerular disease?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Hgb - Electrolytes - and TSH
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

19. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

20. 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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
HPV testing -Pos=colposcopy -Neg=repeat pap smear
MSK - pulmonary - GI - or psychological

21. Name the skin lesion: pustule in association with a hair follice
PVC or Premature atrial contraction (PAC)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Folliculitis

22. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Variability in the time for follicle development during the proliferative phase
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

23. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Tension headache
Pain
Cholelithiasis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

24. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Other brainstem or cranial nerve findings
35 (exception for postmenopausal women who have recently been started on HRT)
>150mg per 24hrs

25. What is the standard tool used for diagnosis of GERD?
Presence of proteinuria on at least two separate ocassion
S. aureus- beta hemolytic streptococcus
EGD
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

26. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Warts

27. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Lightheadedness - dizziness - syncope
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Medication or chemical esophagitis

28. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
E. Coli O157:H7
Streptococci
Viral gastroenteritis
True

29. Lab testing for heart palpitation
Streptococci
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
>150mg per 24hrs
Hgb - Electrolytes - and TSH

30. What does orthostatic positional changes that bring on dizziness suggest?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Adhesive capsulitis (frozen shoulder): most common in middle age women
Dehydration - anemia - cardiac causes
HIV and syphilis

31. Constipation: What are indications for lab testing?
Increase; 200 g/day
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
E. Coli O157:H7

32. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator cuff tendonitis
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

33. What places women at higher risk of getting cervical cancer?
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
ACEi - ARBS - thiazide diuretics
Higher filling presure - pulmonary congestion - and decreasd cardiac return

34. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Cervical radiculopathy
Cholelithiasis
Furucnle

35. History for Acute bronchitis
Warts
Increase; 200 g/day
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cervical radiculopathy

36. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

37. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
S. Aureus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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.
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

38. Name the skin lesion: erythema - warmth - edema - pain - fever
Tension headache
35 (exception for postmenopausal women who have recently been started on HRT)
Cellulitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

39. Oligomenorrhea
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Regular bleeding at intervals of more than 35 days
Rotator Cuff tendonitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

40. What are the primary glomerular diseases?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Excessive bleeding in amount - duration - or both at irregular intervals

41. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Nonulcer dyspepsia
Pleurisy
S. Aureus

42. Clinical Manifestations of HTN
Infectious esophagitis
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
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

43. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Subarachnoid hemorrhage
ACEi - ARBS - thiazide diuretics
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

44. Four muscles of rotator cuff
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Menorrhagia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

45. What HPV serotypes are most commonly associated with cervical cancer?
CBC
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Serotypes 16 - 18 - 31 -52 -58
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

46. What test done in PE measures instability of shoulder?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Nonulcer dyspepsia
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

47. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hgb - Electrolytes - and TSH
S. aureus- beta hemolytic streptococcus

48. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Rotator Cuff tendonitis
LH surge triggers ovulation
Echocardiogram
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

49. What is the Barany maneuver?
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 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
Bence-Jones
Subarachnoid hemorrhage

50. How do you define persistent protein uria?
Folliculitis
Viral infection of the semicircular apparatus
Presence of proteinuria on at least two separate ocassion
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot