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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. What occurs after ovulation
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Scabies

2. What are symptoms are CHF?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Scabies
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

3. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A central clear area
>3.5g of protein per 24hrs

4. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Higher filling presure - pulmonary congestion - and decreasd cardiac return
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Upper sternal area burning pain - associated with a productive cough

5. Diagnosis of HTN
Less than 3 stools per week
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
BB or CCB - catheter ablation of identified bypass tract
Furucnle

6. 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.
Excessive bleeding in amount - duration - or both at irregular intervals
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Supraspinatus and bicipital tendons

7. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Less abrupt onset and cessation of palpitations
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Pleurisy

8. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
>3.5g of protein per 24hrs
GERD

9. Oligomenorrhea
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Regular bleeding at intervals of more than 35 days
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

10. Define the patient population typically affected by orthostatic or postural proteinuria
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.
A 24hr urine protein collection and urine creatinine clearance determination
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

11. What are the symptoms of palpitations?
Diuretics -BB -CCB -ACEi
Cervical radiculopathy
Lightheadedness - dizziness - syncope
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

12. Carcinoma in situ is generally referred to a gynecologist and requires ______
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.
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
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
Other brainstem or cranial nerve findings

13. What should be considered in younger patients with menorrhagia
Pts with palpitations and dizziness - near syncope - or syncope
Coag disorders
Non-cardiac causes of palpitations
MSK - pulmonary - GI - or psychological

14. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

15. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
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
Viral gastroenteritis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Associated with hypotension

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

17. How does CHF present on X-ray?
Coag disorders
Coronary artery disease/ angina
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

18. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
Pancreatitis
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

19. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Anticoag with warfarin to prevent thromboembolism
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
35 (exception for postmenopausal women who have recently been started on HRT)
Slow progression of cervical cancer changes -Availability of effective early treatment

20. PE for a patient getting an abnormal vaginal bleeding work up
MSK - pulmonary - GI - or psychological
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
ACEi - ARBS - thiazide diuretics
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

21. HIgh risk pregnant patients should be evaluated for ____ and ____
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
HIV and syphilis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

22. patients with herpes zoster may experience what symptom before the rash appear?
Pain
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Upper sternal area burning pain - associated with a productive cough
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

23. Things that need to be included in history of shoulder pain
MSK - pulmonary - GI - or psychological
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fever with frontal or maxillary tenderness
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

24. Name the diagnosis of heartburn: regurgitation - dysphagia
Albumin; low molecular weight proteins
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
GERD
Chest pain during pneumonia or PE

25. 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
ACEi - ARBS - thiazide diuretics
Varicella virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Folliculitis

26. Natural history of cervical cancer
Loop diuretics (Check serum K+ levels before drug admin)
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Slow progression of cervical cancer changes -Availability of effective early treatment

27. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
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)
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

28. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pleurisy
Wolff-Parkinson-White syndrome
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

29. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Cellulitis
Serotypes 16 - 18 - 31 -52 -58
HPV
24 hour halter

30. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
ACEi - ARBS - thiazide diuretics
Pancreatitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
S. aureus- beta hemolytic streptococcus

31. What is the preload?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Other brainstem or cranial nerve findings
Rotator Cuff tendonitis

32. History for Acute bronchitis
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
>3.5g of protein per 24hrs

33. What should blood work include for suspected heart failure?
Bence-Jones
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Cluster headache
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

34. What are the indiciations for neuroimaging?
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
Viral gastroenteritis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

35. What is considered normal blood loss during a menstrual cycle?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Irregular bleeding between cycles
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Less than 80 ml of blood

36. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cholelithiasis
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

37. What are the common causes for laryngitis?
Coronary artery disease/ angina
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Influenza - Rhinovirus - Adenovirus - Parainfluenza

38. What are the physical exam signs of CHF?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

39. How do you know if heart palpitations are due to stimulant or medication use?
High blood pressure - focal neurologic defecit - or papilledema
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
Less abrupt onset and cessation of palpitations
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

40. Where does the development of abnormal cervical cells begin?
High blood pressure - focal neurologic defecit - or papilledema
Squamocolumnar junction=most common site of cervical cancer
Hypertension - CAD - valvular heart disease
CT

41. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
ACEi
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
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

42. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Less than 3 stools per week
Generalized Anxiety disorder and panic disorder
Medication or chemical esophagitis
Albumin; low molecular weight proteins

43. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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
Warts
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
DM - HTN - DVT - seizures - depression - or anxiety

44. Who should have Xray testing for shoulder pain?
A central clear area
True
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Wolff-Parkinson-White syndrome

45. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Menorrhagia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

46. Clinical Manifestations of HTN
S. Aureus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Viral infection of the semicircular apparatus
Serotypes 16 - 18 - 31 -52 -58

47. Describe the presentation of pericardial pain
Cholelithiasis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Folliculitis
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

48. Mainstay treatment for soft tissue inflammation (Shoulder)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
>150mg per 24hrs

49. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
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
Varicella virus

50. What does orthostatic positional changes that bring on dizziness suggest?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
DM - HTN - DVT - seizures - depression - or anxiety
Dehydration - anemia - cardiac causes