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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. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Less than 80 ml of blood
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Scleroderma/polymyositis with secondary gastroesophageal reflux
Wolff-Parkinson-White syndrome

2. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Chest pain during pneumonia or PE
RBC casts and old to moderate HTN

3. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
HPV
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

4. Define nephrotic range proteinuria
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
>3.5g of protein per 24hrs
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Less than 3 stools per week

5. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Scabies

6. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Cellulitis
True
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

7. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Analgesic headache

8. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
Adhesive capsulitis (frozen shoulder): most common in middle age women
Colposcopy - Endocervical curettage - and directed cervical biopsy
EGD

9. What is the role of FSH in one's menstrual cycle
Hypertension - CAD - valvular heart disease
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Coronary artery disease/ angina

10. How does CHF present on X-ray?
Viral gastroenteritis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

11. Clinical Manifestations of HTN
Streptococci
DM - HTN - DVT - seizures - depression - or anxiety
Nonulcer dyspepsia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

12. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Loop diuretics (Check serum K+ levels before drug admin)
Cellulitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

13. How is constipation clinically defined?
Less than 3 stools per week
HIV and syphilis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
When the patient has symptoms in association with exercise or who describe chest pain or pressure

14. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Intermenstrual bleeding
Hgb - Electrolytes - and TSH
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Non-cardiac causes of palpitations

15. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Viral infection of the semicircular apparatus
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.

16. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pancreatitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

17. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Rotator Cuff tendonitis
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.
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
Loop diuretics (Check serum K+ levels before drug admin)

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Pts with palpitations and dizziness - near syncope - or syncope
Acute headache - ataxia - profuse nausea - and vomiting
PE - MI - aortic dissection - pneumothorax

19. 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
Irregular bleeding between cycles
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

20. What are the primary glomerular diseases?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Peptic ulcer disease or gastritis
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

21. Predictors of cardiac etiology
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Impetigo
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
EGD

22. How do you know if heart palpitations are due to stimulant or medication use?
24 hour halter
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Less abrupt onset and cessation of palpitations
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

23. What occurs after ovulation
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Paroxysmal atrial fibrillation or supraventricular tachycardia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
DM - HTN - DVT - seizures - depression - or anxiety

24. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Adhesive capsulitis (frozen shoulder): most common in middle age women
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Rotator Cuff tendonitis

25. What is the peripheral caUse of vertigo?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Temporal arteritis-biopsy of the temporal artery
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

26. What are the 2 psych disorders most commonly associated with palpitations?
Excessive bleeding in amount - duration - or both at irregular intervals
Generalized Anxiety disorder and panic disorder
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

27. What is an acoustic neuroma?
Pts with palpitations and dizziness - near syncope - or syncope
Furucnle
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
35 (exception for postmenopausal women who have recently been started on HRT)

28. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Infectious esophagitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bence-Jones

29. 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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

30. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
Scabies
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

31. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
EGD
Anticoag with warfarin to prevent thromboembolism
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

32. Diagnostic Evaluation of Abnoraml vaginal bleeding
Variability in the time for follicle development during the proliferative phase
Molluscum contagiosum- pox virus
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
A 24hr urine protein collection and urine creatinine clearance determination

33. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Serotypes 16 - 18 - 31 -52 -58
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

34. When is a lumbar puncture contraindicated?
100mg; means patient can be trace protein positive and not be detected
Diuretics -BB -CCB -ACEi
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

35. Describes what occurs during squamous metaplasia of the cervix.
Tension headache
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Cluster headache

36. What is the next best step if a patient has two or more positive dipstick tests?
Analgesic headache
A 24hr urine protein collection and urine creatinine clearance determination
Repeat Pap after infection treated
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

37. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Presence of proteinuria on at least two separate ocassion
EGD
CT
E. Coli O157:H7

38. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
With a KOH wet mount preparation
Bence-Jones
Candida albicans

39. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Molluscum contagiosum- pox virus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Viral infection of the semicircular apparatus

40. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
A central clear area
Supraspinatus and bicipital tendons

41. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Furucnle
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

42. What are the two common clinical presentations of acute diarrhea?
Giardia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Impetigo
When the patient has symptoms in association with exercise or who describe chest pain or pressure

43. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Echocardiogram
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Analgesic headache

44. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
BB or CCB - catheter ablation of identified bypass tract
ACEi
Kids: Rotavirus Adults: Norwalk Virus

45. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
MSK - pulmonary - GI - or psychological
Pain

46. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
S. Aureus
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
>3.5g of protein per 24hrs
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

47. What are the features of glomerular nephritis
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH

48. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
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
35 (exception for postmenopausal women who have recently been started on HRT)
Cellulitis

49. What does the classic ring worm lesion have?
Cholelithiasis
A central clear area
MSK - pulmonary - GI - or psychological
Folliculitis

50. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Peptic ulcer disease or gastritis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
24 hour halter