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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 does the classic ring worm lesion have?
A central clear area
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Giardia
Less abrupt onset and cessation of palpitations

2. How does CHF present on X-ray?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Cellulitis
Impetigo

3. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Hypertension - CAD - valvular heart disease
Anticoag with warfarin to prevent thromboembolism

4. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Paroxysmal atrial fibrillation or supraventricular tachycardia
Peptic ulcer disease or gastritis

5. What places women at higher risk of getting cervical cancer?
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Subarachnoid hemorrhage
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

6. Menometrorrhagia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Kids: Rotavirus Adults: Norwalk Virus
Excessive bleeding in amount - duration - or both at irregular intervals

7. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Analgesic headache
Chest pain during pneumonia or PE
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

8. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scabies
Hgb - Electrolytes - and TSH

9. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
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
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

10. Metrorrhagia
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
Hypertension - CAD - valvular heart disease
Excessive bleeding in amount - duration - or both at irregular intervals
Irregular bleeding between cycles

11. Four muscles of rotator cuff
MSK - pulmonary - GI - or psychological
Pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Lightheadedness - dizziness - syncope

12. Initial treatment for Rhinosinusitis
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

13. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
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
Menorrhagia
35 (exception for postmenopausal women who have recently been started on HRT)

14. History for Sinusitis

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15. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hgb - Electrolytes - and TSH
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.

16. How is constipation clinically defined?
Less than 3 stools per week
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.
CBC
Kids: Rotavirus Adults: Norwalk Virus

17. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Giardia
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
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.

18. 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
Less than 3 stools per week
Peptic ulcer disease or gastritis
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

19. Complete the sentence: pericarditis can cause frictional rub and......
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

20. Define proteinuria
>150mg per 24hrs
Hypertension - CAD - valvular heart disease
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

21. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Rotator Cuff tendonitis
Upper sternal area burning pain - associated with a productive cough
HPV

22. Describes what occurs during squamous metaplasia of the cervix.
S. aureus- beta hemolytic streptococcus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
EGD
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

23. Diarrhea from custard filled pastries
Slow progression of cervical cancer changes -Availability of effective early treatment
Intermenstrual bleeding
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
S. Aureus

24. What is an acoustic neuroma?
Less than 3 stools per week
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Folliculitis

25. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
True

26. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Intermenstrual bleeding
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
24 hour halter

27. What is the next best step if a patient has two or more positive dipstick tests?
CT
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A 24hr urine protein collection and urine creatinine clearance determination
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

28. What are the symptoms of palpitations?
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
>3.5g of protein per 24hrs
Lightheadedness - dizziness - syncope
Chest pain during pneumonia or PE

29. What medications can cause heart palpitations?
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.
Other brainstem or cranial nerve findings
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Fever with frontal or maxillary tenderness

30. Name the skin lesion: erythema - warmth - edema - pain - fever
Impetigo
EGD
Pts with palpitations and dizziness - near syncope - or syncope
Cellulitis

31. Predictors of cardiac etiology
Pleurisy
Increase; 200 g/day
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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.

32. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Excessive bleeding in amount - duration - or both at irregular intervals
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Analgesic headache

33. What should be considered in younger patients with menorrhagia
Paroxysmal atrial fibrillation or supraventricular tachycardia
Coag disorders
When the patient has symptoms in association with exercise or who describe chest pain or pressure
E. Coli O157:H7

34. What is considered normal blood loss during a menstrual cycle?
These patients are associated with low renin states=less likely to respond to medication
Anticoag with warfarin to prevent thromboembolism
Less than 80 ml of blood
Wolff-Parkinson-White syndrome

35. What are the primary glomerular diseases?
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Squamocolumnar junction=most common site of cervical cancer
Staphylococcal scalded skin syndrome

36. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Anticoag with warfarin to prevent thromboembolism
ACEi
A central clear area
Candida albicans

37. When should invasive eletrophysiologic study should be considered?
True
Serotypes 16 - 18 - 31 -52 -58
Polymenorrhea
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

38. What is the difference between a Holter monitor or an event monitor?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
With a KOH wet mount preparation
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

39. 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
Scabies
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Giardia
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

40. What does orthostatic positional changes that bring on dizziness suggest?
Chest pain during pneumonia or PE
Dehydration - anemia - cardiac causes
S. aureus- beta hemolytic streptococcus
Impetigo

41. Treatment for supraventricular tachycardias
Upper sternal area burning pain - associated with a productive cough
Furucnle
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
BB or CCB - catheter ablation of identified bypass tract

42. Prenatal visit schedule for low-risk pregnancies
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.
Repeat Pap after infection treated
With a KOH wet mount preparation
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

43. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Pleurisy
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

44. 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
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
100mg; means patient can be trace protein positive and not be detected
Cervical radiculopathy

45. How to NSAIDs contribute to gastritis and ulcer formation?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
These patients are associated with low renin states=less likely to respond to medication
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.
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

46. Difference between Pneumonia and Bronchitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
DM - HTN - DVT - seizures - depression - or anxiety
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
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

47. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Echocardiogram
Influenza - Rhinovirus - Adenovirus - Parainfluenza

48. Pneumonia tx: suitable for healthy adults older than 60
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
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

49. 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
LH surge triggers ovulation
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

50. 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.
These patients are associated with low renin states=less likely to respond to medication
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Folliculitis
Tension headache