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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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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. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
24 hour halter
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

2. What is an acoustic neuroma?
Anticoag with warfarin to prevent thromboembolism
CT
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
GERD

3. What does orthostatic positional changes that bring on dizziness suggest?
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
Dehydration - anemia - cardiac causes
A 24hr urine protein collection and urine creatinine clearance determination
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

4. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Squamocolumnar junction=most common site of cervical cancer
Variability in the time for follicle development during the proliferative phase
Pleurisy

5. Shoulder pain with pain radiating to elbow
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Cervical radiculopathy
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
Rotator cuff tendonitis

6. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Polymenorrhea
Loop diuretics (Check serum K+ levels before drug admin)
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

7. What is the peripheral caUse of vertigo?
A 24hr urine protein collection and urine creatinine clearance determination
PE - MI - aortic dissection - pneumothorax
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Peptic ulcer disease or gastritis

8. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Non-cardiac causes of palpitations

9. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
A central clear area
Hgb - Electrolytes - and TSH
Chest pain during pneumonia or PE
Kids: Rotavirus Adults: Norwalk Virus

10. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
EGD
35 (exception for postmenopausal women who have recently been started on HRT)

11. What test done in PE measures instability of shoulder?
Possibility of Ischemic colitis
HPV
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

12. What is the caUse of benign positional vertigo?
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
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.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Molluscum contagiosum- pox virus

13. Chronic pain and shoulder stiffness with limited motion
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bence-Jones
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
Adhesive capsulitis (frozen shoulder): most common in middle age women

14. What should preconception counseling include?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Less than 80 ml of blood
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

15. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
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
Analgesic headache

16. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
S. Aureus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Medication or chemical esophagitis

17. What type of imaging is need for chronic sinusitis?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scabies
CT

18. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Candida albicans
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

19. Diagnostic Evaluation of Abnoraml vaginal bleeding
Loop diuretics (Check serum K+ levels before drug admin)
Fever with frontal or maxillary tenderness
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

20. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
ACEi
Cervical radiculopathy
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.

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
Coronary artery disease/ angina
BB or CCB - catheter ablation of identified bypass tract
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

22. What is the mechanism of action for stimulant agents in treating constipation?
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
Bence-Jones
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

23. 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
CBC
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Less than 3 stools per week

24. What are the most common viral causes of diarrhea in kids and adults?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Kids: Rotavirus Adults: Norwalk Virus
Serotypes 16 - 18 - 31 -52 -58

25. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Viral gastroenteritis
Albumin; low molecular weight proteins

26. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Generalized Anxiety disorder and panic disorder
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
Pain
Scleroderma/polymyositis with secondary gastroesophageal reflux

27. What are the signs of acute sinusitis?
Irregular bleeding between cycles
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Diuretics -BB -CCB -ACEi
Fever with frontal or maxillary tenderness

28. What are the physical exam signs of CHF?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

29. What is the Epley maneuver?
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

30. When is a lumbar puncture contraindicated?
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
Rotator cuff tendonitis
Non-cardiac causes of palpitations
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

31. What is the next best step if a patient has two or more positive dipstick tests?
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
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
PE - MI - aortic dissection - pneumothorax
A 24hr urine protein collection and urine creatinine clearance determination

32. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Excessive bleeding in amount - duration - or both at irregular intervals
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.
Medication or chemical esophagitis
Viral infection of the semicircular apparatus

33. What places women at higher risk of getting cervical cancer?
Cellulitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Regular bleeding at intervals of more than 35 days
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

34. Treatment for supraventricular tachycardias
ACEi - ARBS - thiazide diuretics
BB or CCB - catheter ablation of identified bypass tract
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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.

35. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Hgb - Electrolytes - and TSH

36. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cervical radiculopathy
HPV

37. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Coronary artery disease/ angina
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

38. When should a patient get a stress test?
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.
Albumin; low molecular weight proteins
A 24hr urine protein collection and urine creatinine clearance determination
When the patient has symptoms in association with exercise or who describe chest pain or pressure

39. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

40. How does systolic vs. diastolic heart failure present on the echocardiogram?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Excessive bleeding in amount - duration - or both at irregular intervals
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

41. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Candida albicans
Possibility of Ischemic colitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

42. How are fungal infections diagnosed?
CBC
With a KOH wet mount preparation
Rotator Cuff problem
Hgb - Electrolytes - and TSH

43. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Polymenorrhea

44. MI - pericardial tamponade - PE - GI bleed - are...
BB or CCB - catheter ablation of identified bypass tract
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
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
Associated with hypotension

45. Natural history of cervical cancer
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
LH surge triggers ovulation
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

46. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Analgesic headache
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pain

47. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Associated with hypotension
Cholelithiasis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

48. What is the role of LH in the menstrual cycle
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
PVC or Premature atrial contraction (PAC)
LH surge triggers ovulation
With a KOH wet mount preparation

49. History and PE for Pneumonia
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
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
DM - HTN - DVT - seizures - depression - or anxiety
Slow progression of cervical cancer changes -Availability of effective early treatment

50. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
EGD

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