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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 are the signs of cerebral hemorrhage?
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
Albumin; low molecular weight proteins
Possibility of Ischemic colitis
Acute headache - ataxia - profuse nausea - and vomiting

2. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Wolff-Parkinson-White syndrome
Viral gastroenteritis
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

3. How does systolic vs. diastolic heart failure present on the echocardiogram?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
ACEi
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

4. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
>150mg per 24hrs
Peptic ulcer disease or gastritis
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

5. Predictors of cardiac etiology
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

6. What should be considered in younger patients with menorrhagia
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
Coag disorders
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
These patients are associated with low renin states=less likely to respond to medication

7. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Temporal arteritis-biopsy of the temporal artery
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

8. Uterine bleeding between regular cycles
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Molluscum contagiosum- pox virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Intermenstrual bleeding

9. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Tension headache
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

10. What diagnosis does the 'worse headache of my life' suggest?
Slow progression of cervical cancer changes -Availability of effective early treatment
Subarachnoid hemorrhage
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

11. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Analgesic headache
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

12. 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
Loop diuretics (Check serum K+ levels before drug admin)
Molluscum contagiosum- pox virus
Other brainstem or cranial nerve findings
100mg; means patient can be trace protein positive and not be detected

13. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
These patients are associated with low renin states=less likely to respond to medication
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

14. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
RBC casts and old to moderate HTN
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

15. Name types of laxatives
BB or CCB - catheter ablation of identified bypass tract
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

16. What does the classic ring worm lesion have?
Temporal arteritis-biopsy of the temporal artery
Giardia
Furucnle
A central clear area

17. What are the indiciations for neuroimaging?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
A 24hr urine protein collection and urine creatinine clearance determination
Polymenorrhea

18. History for Acute bronchitis
Warts
HIV and syphilis
Chest pain during pneumonia or PE
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

19. Metrorrhagia
Less than 3 stools per week
CT
Irregular bleeding between cycles
Cervical radiculopathy

20. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Warts
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Peptic ulcer disease or gastritis
Rotator Cuff problem

21. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
LH surge triggers ovulation
Loop diuretics (Check serum K+ levels before drug admin)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Subarachnoid hemorrhage

22. What is the Epley maneuver?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Warts
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.
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

23. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Chest pain during pneumonia or PE
ACEi
Diuretics -BB -CCB -ACEi

24. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Cholelithiasis
Squamocolumnar junction=most common site of cervical cancer
Loop diuretics (Check serum K+ levels before drug admin)
Medication or chemical esophagitis

25. What HPV serotypes are most commonly associated with cervical cancer?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Serotypes 16 - 18 - 31 -52 -58
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

26. How is constipation clinically defined?
Variability in the time for follicle development during the proliferative phase
>3.5g of protein per 24hrs
Varicella virus
Less than 3 stools per week

27. What is the goal of CHF treatment? What drugs should be used?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Folliculitis
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
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

28. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
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
S. aureus- beta hemolytic streptococcus
Varicella virus

29. Diarrhea from custard filled pastries
Presence of proteinuria on at least two separate ocassion
S. Aureus
MSK - pulmonary - GI - or psychological
Pts with palpitations and dizziness - near syncope - or syncope

30. What drugs do you use to treat H.pylori + PUD?
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Upper sternal area burning pain - associated with a productive cough

31. What is the next best step if a patient has two or more positive dipstick tests?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
A 24hr urine protein collection and urine creatinine clearance determination
RBC casts and old to moderate HTN
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

32. 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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
ACEi
Repeat Pap after infection treated
Viral infection of the semicircular apparatus

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

34. Describe the presentation of angina?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
High blood pressure - focal neurologic defecit - or papilledema
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
Generalized Anxiety disorder and panic disorder

35. How does CHF present on X-ray?
Rotator Cuff tendonitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

36. History for Sinusitis

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37. Regular bleeding at intervals of less than 21 days
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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi
Polymenorrhea

38. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

39. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

40. Name the diagnosis of heartburn: regurgitation - dysphagia
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
Scabies
Repeat Pap after infection treated
GERD

41. Name the diagnosis of heartburn: severe constant mid abdominal pain
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Pancreatitis
Generalized Anxiety disorder and panic disorder
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

42. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Nonulcer dyspepsia
>150mg per 24hrs

43. What does treatment for migrans include?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

44. How do you know if heart palpitations are due to stimulant or medication use?
35 (exception for postmenopausal women who have recently been started on HRT)
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Less abrupt onset and cessation of palpitations

45. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Scabies

46. What are the most common causes for the common cold?
Dehydration - anemia - cardiac causes
Lightheadedness - dizziness - syncope
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Cellulitis

47. Chronic pain and shoulder stiffness with limited motion
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Cholelithiasis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Adhesive capsulitis (frozen shoulder): most common in middle age women

48. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

49. How can GERD (or esophageal motility disorders) lead to chest pain?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Paroxysmal atrial fibrillation or supraventricular tachycardia

50. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Pts with palpitations and dizziness - near syncope - or syncope
True
High blood pressure - focal neurologic defecit - or papilledema
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis