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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 the role of FSH in one's menstrual cycle
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
High blood pressure - focal neurologic defecit - or papilledema
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

2. What medications can cause heart palpitations?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Other brainstem or cranial nerve findings
BB or CCB - catheter ablation of identified bypass tract
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

3. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
HIV and syphilis
BB or CCB - catheter ablation of identified bypass tract
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
A 24hr urine protein collection and urine creatinine clearance determination

4. How to NSAIDs contribute to gastritis and ulcer formation?
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
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.
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Slow progression of cervical cancer changes -Availability of effective early treatment

5. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
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

6. Diagnosis of HTN
Rotator Cuff tendonitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
S. aureus- beta hemolytic streptococcus
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

7. What are the features of nephrotic syndrome?
Viral gastroenteritis
Rotator Cuff tendonitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

8. Carcinoma in situ is generally referred to a gynecologist and requires ______
MSK - pulmonary - GI - or psychological
GERD
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
Coronary artery disease/ angina

9. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Increase; 200 g/day

10. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Polymenorrhea
Irregular bleeding between cycles
True

11. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Intermenstrual bleeding
Upper sternal area burning pain - associated with a productive cough

12. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Echocardiogram
ACEi

13. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Pancreatitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
DM - HTN - DVT - seizures - depression - or anxiety
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

14. 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
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
Varicella virus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

15. What are the most common causes for the common cold?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

16. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
>150mg per 24hrs
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Pts with palpitations and dizziness - near syncope - or syncope
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

17. What are symptoms are CHF?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

18. 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
These patients are associated with low renin states=less likely to respond to medication
Tension headache
Nonulcer dyspepsia

19. Difference between Pneumonia and Bronchitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
HIV and syphilis
CT

20. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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)
Coag disorders

21. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
>150mg per 24hrs
A central clear area
S. aureus- beta hemolytic streptococcus

22. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Scabies
Polymenorrhea
High blood pressure - focal neurologic defecit - or papilledema
ACEi

23. History and PE for Pneumonia
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
Diuretics -BB -CCB -ACEi
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

24. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral gastroenteritis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

25. Metrorrhagia
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Irregular bleeding between cycles
Regular bleeding at intervals of more than 35 days

26. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Non-cardiac causes of palpitations
Molluscum contagiosum- pox virus
Less abrupt onset and cessation of palpitations

27. What is the peripheral caUse of vertigo?
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Serotypes 16 - 18 - 31 -52 -58

28. What type of imaging is need for chronic sinusitis?
CT
Rotator Cuff tendonitis
A 24hr urine protein collection and urine creatinine clearance determination
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

29. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Kids: Rotavirus Adults: Norwalk Virus
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

30. What is the role of LH in the menstrual cycle
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
LH surge triggers ovulation
S. aureus- beta hemolytic streptococcus

31. Define the patient population typically affected by orthostatic or postural proteinuria
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Rotator Cuff tendonitis

32. Describe the presentation of myocardial pain?
Pain
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Peptic ulcer disease or gastritis
Furucnle

33. History for Acute bronchitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Kids: Rotavirus Adults: Norwalk 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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

34. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Wolff-Parkinson-White syndrome
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

35. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
PVC or Premature atrial contraction (PAC)
Bence-Jones
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

36. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Kids: Rotavirus Adults: Norwalk Virus
Pleurisy
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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.

37. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Candida albicans
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
Presence of proteinuria on at least two separate ocassion
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

38. What are the two common clinical presentations of acute diarrhea?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral gastroenteritis
Cervical radiculopathy
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

39. What are the physical exam signs of CHF?
Lightheadedness - dizziness - syncope
Coag disorders
Peptic ulcer disease or gastritis
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

40. Diarrhea from custard filled pastries
Presence of proteinuria on at least two separate ocassion
S. Aureus
35 (exception for postmenopausal women who have recently been started on HRT)
BB or CCB - catheter ablation of identified bypass tract

41. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
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
Pts with palpitations and dizziness - near syncope - or syncope
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

42. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Cellulitis
Candida albicans

43. What is afterload?
Possibility of Ischemic colitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

44. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Intermenstrual bleeding
Slow progression of cervical cancer changes -Availability of effective early treatment
Diuretics -BB -CCB -ACEi

45. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Chest pain during pneumonia or PE

46. Cycle length variabilty is primarily due to what?
Scabies
Variability in the time for follicle development during the proliferative phase
Rotator Cuff tendonitis
A 24hr urine protein collection and urine creatinine clearance determination

47. Things that need to be included in history of shoulder pain
Hgb - Electrolytes - and TSH
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

48. 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
Rotator cuff tendonitis
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

49. Why is the pap smear one of the most effective cancer screening tools?
Temporal arteritis-biopsy of the temporal artery
Slow progression of cervical cancer changes -Availability of effective early treatment
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

50. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral gastroenteritis
Pleurisy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM