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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. What is considered normal blood loss during a menstrual cycle?
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
Upper sternal area burning pain - associated with a productive cough
Less than 80 ml of blood
Hgb - Electrolytes - and TSH

2. What are the most common viral causes of diarrhea in kids and adults?
Squamocolumnar junction=most common site of cervical cancer
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Kids: Rotavirus Adults: Norwalk Virus
Other brainstem or cranial nerve findings

3. Uterine bleeding between regular cycles
ACEi - ARBS - thiazide diuretics
Intermenstrual bleeding
Bence-Jones
Excessive bleeding in amount - duration - or both at irregular intervals

4. When is a lumbar puncture contraindicated?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Common problem that resolves spontaneously and is most often seen in children and young adults
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

5. What is the Barany maneuver?
Giardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

6. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Lightheadedness - dizziness - syncope
Candida albicans
Pts with palpitations and dizziness - near syncope - or syncope

7. Metrorrhagia
Irregular bleeding between cycles
Nonulcer dyspepsia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

8. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Diuretics -BB -CCB -ACEi
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

9. Initial treatment for Rhinosinusitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Infectious esophagitis
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

10. Name the skin lesion: honey colored crusts
Impetigo
Paroxysmal atrial fibrillation or supraventricular tachycardia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
True

11. 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
Kids: Rotavirus Adults: Norwalk Virus
Rotator Cuff tendonitis
Pain

12. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Acute headache - ataxia - profuse nausea - and vomiting
24 hour halter
ACEi

13. History and PE for Pneumonia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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.
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

14. MI - pericardial tamponade - PE - GI bleed - are...
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Associated with hypotension

15. How do you know if heart palpitations are due to stimulant or medication use?
High blood pressure - focal neurologic defecit - or papilledema
Less abrupt onset and cessation of palpitations
Warts
Wolff-Parkinson-White syndrome

16. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Intermenstrual bleeding
RBC casts and old to moderate HTN
Analgesic headache
Echocardiogram

17. What is the mechanism of action for stimulant agents in treating constipation?
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
DM - HTN - DVT - seizures - depression - or anxiety
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

18. What is a markers of CNS vertigo?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Other brainstem or cranial nerve findings
Albumin; low molecular weight proteins

19. 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.
Supraspinatus and bicipital tendons
Variability in the time for follicle development during the proliferative phase
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

20. What drugs do you use to treat H.pylori + PUD?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Viral infection of the semicircular apparatus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

21. How do you define persistent protein uria?
Molluscum contagiosum- pox virus
Increase; 200 g/day
Presence of proteinuria on at least two separate ocassion
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

22. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
These patients are associated with low renin states=less likely to respond to medication
100mg; means patient can be trace protein positive and not be detected
Variability in the time for follicle development during the proliferative phase
Colposcopy - Endocervical curettage - and directed cervical biopsy

23. Lab testing for heart palpitation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Rotator cuff tendonitis
Repeat Pap after infection treated
Hgb - Electrolytes - and TSH

24. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
DM - HTN - DVT - seizures - depression - or anxiety
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.
Staphylococcal scalded skin syndrome

25. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
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
>150mg per 24hrs

26. What are the physical exam signs of CHF?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

27. What should preconception counseling include?
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
Associated with hypotension
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

28. 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
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
RBC casts and old to moderate HTN

29. What is the caUse of benign positional vertigo?
24 hour halter
Warts
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
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.

30. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Warts
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

31. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Repeat Pap after infection treated
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

32. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Irregular bleeding between cycles
Staphylococcal scalded skin syndrome
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

33. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
DM - HTN - DVT - seizures - depression - or anxiety
Possibility of Ischemic colitis

34. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
GERD
Cluster headache

35. What the consequences of decreased cardiac output?
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
Bence-Jones
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

36. What are the most common causes for the common cold?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Subarachnoid hemorrhage

37. What are the primary glomerular diseases?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
EGD
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

38. When should invasive eletrophysiologic study should be considered?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Staphylococcal scalded skin syndrome
Diuretics -BB -CCB -ACEi
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

39. How to NSAIDs contribute to gastritis and ulcer formation?
Lightheadedness - dizziness - syncope
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.
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
HPV

40. What is the goal of CHF treatment? What drugs should be used?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
CBC
Less than 80 ml of blood

41. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
High blood pressure - focal neurologic defecit - or papilledema
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Non-cardiac causes of palpitations

42. What does the classic ring worm lesion have?
A central clear area
Varicella virus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Upper sternal area burning pain - associated with a productive cough

43. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Rotator Cuff problem
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Rotator cuff tendonitis

44. 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
Serotypes 16 - 18 - 31 -52 -58
Cluster headache
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Polymenorrhea

45. 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
E. Coli O157:H7
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.
Menorrhagia

46. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Pain
Presence of proteinuria on at least two separate ocassion
MSK - pulmonary - GI - or psychological
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

47. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Generalized Anxiety disorder and panic disorder
Varicella virus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

48. How is constipation clinically defined?
Pleurisy
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.
CT
Less than 3 stools per week

49. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Temporal arteritis-biopsy of the temporal artery
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
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

50. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
GERD
Presence of proteinuria on at least two separate ocassion
Impetigo

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