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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 is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
LH surge triggers ovulation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Intermenstrual bleeding

2. What diagnosis does the 'worse headache of my life' suggest?
Regular bleeding at intervals of more than 35 days
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
Subarachnoid hemorrhage
Wolff-Parkinson-White syndrome

3. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
These patients are associated with low renin states=less likely to respond to medication
PE - MI - aortic dissection - pneumothorax

4. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
LH surge triggers ovulation
Furucnle
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

5. What is the caUse of Meniere disease? What are the cardinal symptoms?
Candida albicans
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Non-cardiac causes of palpitations
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

6. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
35 (exception for postmenopausal women who have recently been started on HRT)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

7. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Viral gastroenteritis
ACEi

8. What is the caUse of benign positional vertigo?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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.
ACEi - ARBS - thiazide diuretics
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

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

10. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Supraspinatus and bicipital tendons
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Scleroderma/polymyositis with secondary gastroesophageal reflux

11. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Albumin; low molecular weight proteins
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Wolff-Parkinson-White syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment

12. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Furucnle
Molluscum contagiosum- pox virus
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

13. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Increase; 200 g/day
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cluster headache

14. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Temporal arteritis-biopsy of the temporal artery
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
With a KOH wet mount preparation

15. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
True
E. Coli O157:H7
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

16. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Scleroderma/polymyositis with secondary gastroesophageal reflux
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
High blood pressure - focal neurologic defecit - or papilledema

17. What is benign transient proteinuria?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Common problem that resolves spontaneously and is most often seen in children and young adults
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Albumin; low molecular weight proteins

18. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
GERD

19. What is a markers of CNS vertigo?
Viral gastroenteritis
Regular bleeding at intervals of more than 35 days
Other brainstem or cranial nerve findings
Possibility of Ischemic colitis

20. What does treatment for migrans include?
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination

21. History and PE for Pneumonia
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: 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Candida albicans

22. What is the Barany maneuver?
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
Dehydration - anemia - cardiac causes
>150mg per 24hrs
Folliculitis

23. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Chest pain during pneumonia or PE
Viral infection of the semicircular apparatus

24. When should a patient get a stress test?
Anticoag with warfarin to prevent thromboembolism
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Common problem that resolves spontaneously and is most often seen in children and young adults
Candida albicans

25. What are the features of nephrotic syndrome?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Menorrhagia

26. What is the Epley maneuver?
Albumin; low molecular weight proteins
Colposcopy - Endocervical curettage - and directed cervical biopsy
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

27. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Pleurisy
>150mg per 24hrs
Less than 3 stools per week

28. What lab tests are recommended for newly diagnosed hypertensive patients?
CBC
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Higher filling presure - pulmonary congestion - and decreasd cardiac return

29. Name the skin lesion: pustule in association with a hair follice
>150mg per 24hrs
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Folliculitis

30. Name 4 factors that predispose an individual to develop pneumonia.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
BB or CCB - catheter ablation of identified bypass tract
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Non-cardiac causes of palpitations

31. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Infectious esophagitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

32. Describe the presentation tracheobronchitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Upper sternal area burning pain - associated with a productive cough

33. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
CBC
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

34. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Bence-Jones
Pleurisy

35. HIgh risk pregnant patients should be evaluated for ____ and ____
Squamocolumnar junction=most common site of cervical cancer
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
Nonulcer dyspepsia
HIV and syphilis

36. What is the standard tool used for diagnosis of GERD?
EGD
Hypertension - CAD - valvular heart disease
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

37. How to NSAIDs contribute to gastritis and ulcer formation?
Pleurisy
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.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less abrupt onset and cessation of palpitations

38. How does CHF present on X-ray?
Excessive bleeding in amount - duration - or both at irregular intervals
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

39. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
EGD
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Variability in the time for follicle development during the proliferative phase

40. Irregular cycles with excessive flow - duration - or both
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Upper sternal area burning pain - associated with a productive cough
Menorrhagia
Acute headache - ataxia - profuse nausea - and vomiting

41. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Lightheadedness - dizziness - syncope
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
EGD

42. What are the symptoms of palpitations?
Pleurisy
Lightheadedness - dizziness - syncope
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

43. What is the role of FSH in one's menstrual cycle
Associated with hypotension
Cervical radiculopathy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

44. What are the signs of malignant hypertension?
Rotator Cuff problem
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
High blood pressure - focal neurologic defecit - or papilledema
Generalized Anxiety disorder and panic disorder

45. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
With a KOH wet mount preparation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

46. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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
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
Streptococci
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

47. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Varicella virus
Diuretics -BB -CCB -ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

48. What is the mechanism of action for stimulant agents in treating constipation?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Diuretics -BB -CCB -ACEi
Furucnle
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

49. What does orthostatic positional changes that bring on dizziness suggest?
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
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
Dehydration - anemia - cardiac causes
Rotator Cuff tendonitis

50. Pneumonia tx: suitable for healthy adults less than 60
Menorrhagia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise