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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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Match each statement with the correct term.
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1. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
Scabies
CBC

2. What is benign transient proteinuria?
Non-cardiac causes of palpitations
Cluster headache
Common problem that resolves spontaneously and is most often seen in children and young adults
LH surge triggers ovulation

3. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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.
Analgesic headache
24 hour halter
When the patient has symptoms in association with exercise or who describe chest pain or pressure

4. What the consequences of decreased cardiac output?
MSK - pulmonary - GI - or psychological
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Kids: Rotavirus Adults: Norwalk Virus

5. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

6. What occurs after ovulation
Generalized Anxiety disorder and panic disorder
Common problem that resolves spontaneously and is most often seen in children and young adults
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

7. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Echocardiogram
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
High blood pressure - focal neurologic defecit - or papilledema

8. name the 4 emergent causes of chest pain
Medication or chemical esophagitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Squamocolumnar junction=most common site of cervical cancer
PE - MI - aortic dissection - pneumothorax

9. After treatment of dysplasia - women need Pap smears every...
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Dehydration - anemia - cardiac causes
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

10. PE for a patient getting an abnormal vaginal bleeding work up
CBC
24 hour halter
Pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

11. Name the diagnosis of heartburn: regurgitation - dysphagia
>150mg per 24hrs
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
GERD

12. SE Of Beta blockers?
Giardia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Slow progression of cervical cancer changes -Availability of effective early treatment
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

13. Diarrhea from custard filled pastries
Varicella virus
S. Aureus
LH surge triggers ovulation
Other brainstem or cranial nerve findings

14. When should invasive eletrophysiologic study should be considered?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hgb - Electrolytes - and TSH

15. Name some medications that can cause proteinuria
RBC casts and old to moderate HTN
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Albumin; low molecular weight proteins

16. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Associated with hypotension
Hypertension - CAD - valvular heart disease

17. Cycle length variabilty is primarily due to what?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Medication or chemical esophagitis
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
Variability in the time for follicle development during the proliferative phase

18. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

19. How does CHF present on X-ray?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Presence of proteinuria on at least two separate ocassion
Cervical radiculopathy

20. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Dehydration - anemia - cardiac causes
Common problem that resolves spontaneously and is most often seen in children and young adults

21. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Other brainstem or cranial nerve findings
Irregular bleeding between cycles
Increase; 200 g/day
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

22. What are the features of nephrotic syndrome?
Nonulcer dyspepsia
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.
Molluscum contagiosum- pox virus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

23. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
S. aureus- beta hemolytic streptococcus
Temporal arteritis-biopsy of the temporal artery
CBC
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

24. Metrorrhagia
Irregular bleeding between cycles
BB or CCB - catheter ablation of identified bypass tract
Wolff-Parkinson-White syndrome
Repeat Pap after infection treated

25. History and PE for Pneumonia
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Serotypes 16 - 18 - 31 -52 -58
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

26. Describe the presentation of myocardial pain?
Dehydration - anemia - cardiac causes
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
When the patient has symptoms in association with exercise or who describe chest pain or pressure

27. Diagnosis of HTN
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
Echocardiogram
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

28. Shoulder pain with pain radiating to elbow
Squamocolumnar junction=most common site of cervical cancer
Cervical radiculopathy
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Viral gastroenteritis

29. History for Sinusitis

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30. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
Coronary artery disease/ angina
Polymenorrhea
GERD

31. When should a patient get a stress test?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

32. What are the features of glomerular nephritis
Pain
RBC casts and old to moderate HTN
Candida albicans
Non-cardiac causes of palpitations

33. How do you know if heart palpitations are due to stimulant or medication use?
Acute headache - ataxia - profuse nausea - and vomiting
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Less abrupt onset and cessation of palpitations

34. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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 does orthostatic positional changes that bring on dizziness suggest?
Chest pain during pneumonia or PE
Menorrhagia
EGD
Dehydration - anemia - cardiac causes

36. Define the patient population typically affected by orthostatic or postural proteinuria
>3.5g of protein per 24hrs
Bence-Jones
Medication or chemical esophagitis
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

37. What drugs do you use to treat H.pylori + PUD?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Tension headache
Albumin; low molecular weight proteins
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

38. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Pleurisy
Fever with frontal or maxillary tenderness
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

39. MI - pericardial tamponade - PE - GI bleed - are...
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Associated with hypotension
Less than 3 stools per week
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

40. What is the role of FSH in one's menstrual cycle
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Echocardiogram
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Peptic ulcer disease or gastritis

41. What is the goal of CHF treatment? What drugs should be used?
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
High blood pressure - focal neurologic defecit - or papilledema
>3.5g of protein per 24hrs
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

42. 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
Pain
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

43. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

44. Pneumonia tx: suitable for healthy adults older than 60
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

45. Uterine bleeding between regular cycles
Slow progression of cervical cancer changes -Availability of effective early treatment
Intermenstrual bleeding
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. Mainstay treatment for soft tissue inflammation (Shoulder)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
PE - MI - aortic dissection - pneumothorax
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

47. At was quantity does urine dipstick test detect elevated protein?
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
Irregular bleeding between cycles
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
100mg; means patient can be trace protein positive and not be detected

48. Chronic pain and shoulder stiffness with limited motion
Diuretics -BB -CCB -ACEi
Adhesive capsulitis (frozen shoulder): most common in middle age women
Irregular bleeding between cycles
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

49. 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
DM - HTN - DVT - seizures - depression - or anxiety
Scabies
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Tension headache

50. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Kids: Rotavirus Adults: Norwalk Virus
Polymenorrhea
Staphylococcal scalded skin syndrome
Furucnle

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