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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. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Repeat Pap after infection treated
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

2. What are the signs of acute sinusitis?
Cluster headache
Irregular bleeding between cycles
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
Fever with frontal or maxillary tenderness

3. What is the goal of CHF treatment? What drugs should be used?
HIV and syphilis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Squamocolumnar junction=most common site of cervical cancer
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

4. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Viral gastroenteritis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
These patients are associated with low renin states=less likely to respond to medication
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

5. What occurs after ovulation
Regular bleeding at intervals of more than 35 days
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

6. Shoulder pain with pain radiating to elbow
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
HPV testing -Pos=colposcopy -Neg=repeat pap smear
BB or CCB - catheter ablation of identified bypass tract
Cervical radiculopathy

7. What should blood work include for suspected heart failure?
HIV and syphilis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Less than 3 stools per week
LH surge triggers ovulation

8. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Dehydration - anemia - cardiac causes
Cholelithiasis
E. Coli O157:H7
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

9. What is the role of FSH in one's menstrual cycle
Other brainstem or cranial nerve findings
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

10. 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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Repeat Pap after infection treated
Generalized Anxiety disorder and panic disorder
Colposcopy - Endocervical curettage - and directed cervical biopsy

11. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

12. Diarrhea from custard filled pastries
S. Aureus
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
Cholelithiasis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

13. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Possibility of Ischemic colitis
MSK - pulmonary - GI - or psychological
Impetigo
Excessive bleeding in amount - duration - or both at irregular intervals

14. 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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

15. What is the next best step if a patient has two or more positive dipstick tests?
With a KOH wet mount preparation
Rotator Cuff tendonitis
A 24hr urine protein collection and urine creatinine clearance determination
Regular bleeding at intervals of more than 35 days

16. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Coag disorders
Polymenorrhea
A central clear area
Giardia

17. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Viral gastroenteritis
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: 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

18. What treatments are the cornerstone for treating cases of functional constipation?
These patients are associated with low renin states=less likely to respond to medication
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

19. What diagnosis does the 'worse headache of my life' suggest?
PVC or Premature atrial contraction (PAC)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Subarachnoid hemorrhage

20. Name 4 factors that predispose an individual to develop pneumonia.
Non-cardiac causes of palpitations
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Less abrupt onset and cessation of palpitations
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

21. What is a markers of CNS vertigo?
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
Other brainstem or cranial nerve findings
Non-cardiac causes of palpitations
Kids: Rotavirus Adults: Norwalk Virus

22. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Molluscum contagiosum- pox virus
Less abrupt onset and cessation of palpitations
35 (exception for postmenopausal women who have recently been started on HRT)

23. What are the symptoms of palpitations?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Lightheadedness - dizziness - syncope
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

24. What are the primary glomerular diseases?
35 (exception for postmenopausal women who have recently been started on HRT)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Less than 80 ml of blood
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

25. Pain in shoulder when throwing - swimming - or serving a tennis ball
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Rotator cuff tendonitis
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
Pain

26. Pneumonia tx: suitable for healthy adults older than 60
A central clear area
Lightheadedness - dizziness - syncope
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

27. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
ACEi
Bence-Jones
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

28. Who should have Xray testing for shoulder pain?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Common problem that resolves spontaneously and is most often seen in children and young adults
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

29. How to NSAIDs contribute to gastritis and ulcer formation?
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
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.
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

30. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Furucnle
Upper sternal area burning pain - associated with a productive cough
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.

31. Where does the development of abnormal cervical cells begin?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Scabies
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Squamocolumnar junction=most common site of cervical cancer

32. What does treatment for migrans include?
Giardia
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

33. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
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
Increase; 200 g/day
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

34. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
LH surge triggers ovulation
Candida albicans

35. What does the classic ring worm lesion have?
A central clear area
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.
CBC
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

36. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Pts with palpitations and dizziness - near syncope - or syncope
Lightheadedness - dizziness - syncope
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

37. Metrorrhagia
Irregular bleeding between cycles
Lightheadedness - dizziness - syncope
35 (exception for postmenopausal women who have recently been started on HRT)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

38. Menometrorrhagia
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
Excessive bleeding in amount - duration - or both at irregular intervals
S. Aureus
PVC or Premature atrial contraction (PAC)

39. How is constipation clinically defined?
Candida albicans
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
Less than 3 stools per week
100mg; means patient can be trace protein positive and not be detected

40. Describe the presentation of myocardial pain?
High blood pressure - focal neurologic defecit - or papilledema
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Folliculitis
Associated with hypotension

41. What are the most common viral causes of diarrhea in kids and adults?
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
100mg; means patient can be trace protein positive and not be detected
Kids: Rotavirus Adults: Norwalk Virus
Less abrupt onset and cessation of palpitations

42. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
These patients are associated with low renin states=less likely to respond to medication
Loop diuretics (Check serum K+ levels before drug admin)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

43. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Regular bleeding at intervals of more than 35 days
Warts

44. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Subarachnoid hemorrhage
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
ACEi - ARBS - thiazide diuretics

45. Oligomenorrhea
Common problem that resolves spontaneously and is most often seen in children and young adults
Cluster headache
Regular bleeding at intervals of more than 35 days
Non-cardiac causes of palpitations

46. How do you know if heart palpitations are due to stimulant or medication use?
Warts
With a KOH wet mount preparation
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Less abrupt onset and cessation of palpitations

47. 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.
BB or CCB - catheter ablation of identified bypass tract
Coronary artery disease/ angina
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

48. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
ACEi - ARBS - thiazide diuretics
BB or CCB - catheter ablation of identified bypass tract

49. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Staphylococcal scalded skin syndrome
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

50. What is the mechanism of action for stimulant agents in treating constipation?
Variability in the time for follicle development during the proliferative phase
S. aureus- beta hemolytic streptococcus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
High blood pressure - focal neurologic defecit - or papilledema