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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. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
Medication or chemical esophagitis
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
Polymenorrhea

2. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Albumin; low molecular weight proteins
Possibility of Ischemic colitis

3. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
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
Furucnle
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

4. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Folliculitis
Giardia
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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.

5. How can GERD (or esophageal motility disorders) lead to chest pain?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
MSK - pulmonary - GI - or psychological
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Generalized Anxiety disorder and panic disorder

6. What is the caUse of benign positional vertigo?
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.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
GERD
Polymenorrhea

7. Name 4 factors that predispose an individual to develop pneumonia.
Anticoag with warfarin to prevent thromboembolism
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Cellulitis

8. How do you define persistent protein uria?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Presence of proteinuria on at least two separate ocassion
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

9. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
PE - MI - aortic dissection - pneumothorax
PVC or Premature atrial contraction (PAC)
S. aureus- beta hemolytic streptococcus

10. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Cervical radiculopathy
Furucnle
Diuretics -BB -CCB -ACEi

11. What is the next best step if a patient has two or more positive dipstick tests?
Chest pain during pneumonia or PE
A 24hr urine protein collection and urine creatinine clearance determination
Irregular bleeding between cycles
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

12. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
PVC or Premature atrial contraction (PAC)
Furucnle
A 24hr urine protein collection and urine creatinine clearance determination

13. What does orthostatic positional changes that bring on dizziness suggest?
35 (exception for postmenopausal women who have recently been started on HRT)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Dehydration - anemia - cardiac causes

14. Diarrhea is defined as an ____ in stool weight to more than ____g per day
A central clear area
Increase; 200 g/day
PE - MI - aortic dissection - pneumothorax
Non-cardiac causes of palpitations

15. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bence-Jones
Paroxysmal atrial fibrillation or supraventricular tachycardia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

16. What the consequences of decreased cardiac output?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
A 24hr urine protein collection and urine creatinine clearance determination
True

17. What is the Barany maneuver?
HPV
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Loop diuretics (Check serum K+ levels before drug admin)
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

18. Name the diagnosis of heartburn: severe constant mid abdominal pain
Temporal arteritis-biopsy of the temporal artery
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pancreatitis
Anticoag with warfarin to prevent thromboembolism

19. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

20. Name the skin lesion: erythema - warmth - edema - pain - fever
Cervical radiculopathy
Cellulitis
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

21. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
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
Hypertension - CAD - valvular heart disease
ACEi - ARBS - thiazide diuretics
Kids: Rotavirus Adults: Norwalk Virus

22. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Streptococci
Hypertension - CAD - valvular heart disease
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

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
Non-cardiac causes of palpitations
Dehydration - anemia - cardiac causes
Pancreatitis

24. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
A 24hr urine protein collection and urine creatinine clearance determination
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Menorrhagia

25. How does systolic vs. diastolic heart failure present on the echocardiogram?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

26. Describe the presentation of angina?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

27. What are the most common causes for the common cold?
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
>150mg per 24hrs

28. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Molluscum contagiosum- pox virus
PVC or Premature atrial contraction (PAC)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

29. What should blood work include for suspected heart failure?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Upper sternal area burning pain - associated with a productive cough
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

30. What is a markers of CNS vertigo?
Cholelithiasis
With a KOH wet mount preparation
Other brainstem or cranial nerve findings
Kids: Rotavirus Adults: Norwalk Virus

31. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
CBC
RBC casts and old to moderate HTN
A 24hr urine protein collection and urine creatinine clearance determination

32. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
S. Aureus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

33. Constipation: What are indications for lab testing?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Less abrupt onset and cessation 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
ACEi - ARBS - thiazide diuretics

34. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
24 hour halter

35. Natural history of cervical cancer
Colposcopy - Endocervical curettage - and directed cervical biopsy
Albumin; low molecular weight proteins
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
S. Aureus

36. What are the signs of cerebral hemorrhage?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Rotator Cuff tendonitis
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
Acute headache - ataxia - profuse nausea - and vomiting

37. Describe the presentation of myocardial pain?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

38. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Intermenstrual bleeding

39. Difference between Pneumonia and Bronchitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

40. What lab tests are recommended for newly diagnosed hypertensive patients?
Cluster headache
Staphylococcal scalded skin syndrome
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

41. 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
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
Loop diuretics (Check serum K+ levels before drug admin)
Viral infection of the semicircular apparatus

42. What is the mechanism of action for stimulant agents in treating constipation?
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
PVC or Premature atrial contraction (PAC)

43. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
E. Coli O157:H7
Presence of proteinuria on at least two separate ocassion
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

44. What is the role of LH in the menstrual cycle
Associated with hypotension
LH surge triggers ovulation
Scleroderma/polymyositis with secondary gastroesophageal reflux
Chest pain during pneumonia or PE

45. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Upper sternal area burning pain - associated with a productive cough
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.
Rotator Cuff problem

46. 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.
Fever with frontal or maxillary tenderness
Tension headache
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
Viral gastroenteritis

47. Describe the presentation of pericardial pain
Increase; 200 g/day
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

48. When should invasive eletrophysiologic study should be considered?
Cervical radiculopathy
ACEi - ARBS - thiazide diuretics
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

49. MI - pericardial tamponade - PE - GI bleed - are...
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Associated with hypotension
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

50. Irregular cycles with excessive flow - duration - or both
Adhesive capsulitis (frozen shoulder): most common in middle age women
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Menorrhagia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed