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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 are the primary glomerular diseases?
Impetigo
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Chest pain during pneumonia or PE

2. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
ACEi
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

3. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Variability in the time for follicle development during the proliferative phase
High blood pressure - focal neurologic defecit - or papilledema
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

4. 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.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Tension headache
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
These patients are associated with low renin states=less likely to respond to medication

5. What does orthostatic positional changes that bring on dizziness suggest?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Dehydration - anemia - cardiac causes
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
Less than 80 ml of blood

6. When is a lumbar puncture contraindicated?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Echocardiogram
Upper sternal area burning pain - associated with a productive cough

7. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
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.
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

8. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

9. Tx of chronic or intermittent afibs
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Anticoag with warfarin to prevent thromboembolism
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
CT

10. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
S. aureus- beta hemolytic streptococcus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scabies

11. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
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
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
Giardia

12. Pneumonia tx: suitable for healthy adults older than 60
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Coag disorders
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

13. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Temporal arteritis-biopsy of the temporal artery
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

14. What is the next best step if a patient has two or more positive dipstick tests?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator Cuff problem
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
A 24hr urine protein collection and urine creatinine clearance determination

15. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Menorrhagia
Repeat Pap after infection treated
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
HPV

16. Discomfort with abducting the arm past 90 degress
EGD
Excessive bleeding in amount - duration - or both at irregular intervals
These patients are associated with low renin states=less likely to respond to medication
Rotator Cuff tendonitis

17. When does troponin rise following myocardial injury or infarction?
Non-cardiac causes of palpitations
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
GERD
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

18. HIgh risk pregnant patients should be evaluated for ____ and ____
S. Aureus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
HIV and syphilis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

19. Shoulder pain with pain radiating to elbow
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
Cervical radiculopathy
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

20. Metrorrhagia
Irregular bleeding between cycles
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Molluscum contagiosum- pox virus
Nonulcer dyspepsia

21. Name some medications that can cause proteinuria
Rotator Cuff problem
Non-cardiac causes of palpitations
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

22. What are the physical exam signs of CHF?
Variability in the time for follicle development during the proliferative phase
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
Wolff-Parkinson-White syndrome
Pts with palpitations and dizziness - near syncope - or syncope

23. Treatment for supraventricular tachycardias
Pleurisy
Giardia
100mg; means patient can be trace protein positive and not be detected
BB or CCB - catheter ablation of identified bypass tract

24. What are the features of nephrotic syndrome?
Warts
100mg; means patient can be trace protein positive and not be detected
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

25. Diarrhea from custard filled pastries
These patients are associated with low renin states=less likely to respond to medication
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
S. Aureus

26. What are the signs of acute sinusitis?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Fever with frontal or maxillary tenderness
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

27. Difference between Pneumonia and Bronchitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Cervical radiculopathy
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

28. Oligomenorrhea
>150mg per 24hrs
Generalized Anxiety disorder and panic disorder
Regular bleeding at intervals of more than 35 days
Non-cardiac causes of palpitations

29. Define proteinuria
>150mg per 24hrs
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

30. Chronic pain and shoulder stiffness with limited motion
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Adhesive capsulitis (frozen shoulder): most common in middle age women
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

31. Name the skin lesion: erythema - warmth - edema - pain - fever
PE - MI - aortic dissection - pneumothorax
A central clear area
Cellulitis
S. Aureus

32. When should invasive eletrophysiologic study should be considered?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

33. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Infectious esophagitis
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
Analgesic headache

34. History and PE for Pneumonia
Cervical radiculopathy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

35. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Coronary artery disease/ angina
Candida albicans
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Wolff-Parkinson-White syndrome

36. What are the features of glomerular nephritis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
RBC casts and old to moderate HTN

37. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Presence of proteinuria on at least two separate ocassion
Albumin; low molecular weight proteins
Less abrupt onset and cessation of palpitations
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

38. What the consequences of decreased cardiac output?
Increase; 200 g/day
Rotator Cuff problem
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

39. Diagnosis of HTN
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Lightheadedness - dizziness - syncope
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Kids: Rotavirus Adults: Norwalk Virus

40. What is the role of LH in the menstrual cycle
Common problem that resolves spontaneously and is most often seen in children and young adults
LH surge triggers ovulation
Cluster headache
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

41. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
RBC casts and old to moderate HTN
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

42. How are fungal infections diagnosed?
With a KOH wet mount preparation
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
24 hour halter

43. 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
Cluster headache
Nonulcer dyspepsia
Scabies
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

44. What type of imaging is need for chronic sinusitis?
Possibility of Ischemic colitis
Echocardiogram
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
CT

45. Prenatal visit schedule for low-risk pregnancies
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hgb - Electrolytes - and TSH
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

46. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Pain
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
Cellulitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

47. Describe the presentation of angina?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
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
A central clear area

48. 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
Diuretics -BB -CCB -ACEi
Squamocolumnar junction=most common site of cervical cancer
Varicella virus
Tension headache

49. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Paroxysmal atrial fibrillation or supraventricular tachycardia

50. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
Molluscum contagiosum- pox virus
These patients are associated with low renin states=less likely to respond to medication
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