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

2. What treatments are the cornerstone for treating cases of functional constipation?
Chest pain during pneumonia or PE
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Loop diuretics (Check serum K+ levels before drug admin)
DM - HTN - DVT - seizures - depression - or anxiety

3. Four muscles of rotator cuff
Staphylococcal scalded skin syndrome
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

4. History for Acute bronchitis
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

5. Difference between Pneumonia and Bronchitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Subarachnoid hemorrhage
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

6. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Bulk forming: Psyllium - Methycellulose - Polycarbophil
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

7. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Staphylococcal scalded skin syndrome
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 are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Less abrupt onset and cessation of palpitations
Coronary artery disease/ angina
Folliculitis

9. What are the indiciations for neuroimaging?
Associated with hypotension
Menorrhagia
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

10. 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)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Squamocolumnar junction=most common site of cervical cancer
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

11. 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.
Less than 3 stools per week
Supraspinatus and bicipital tendons
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
Pancreatitis

12. 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
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
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
Scabies
>3.5g of protein per 24hrs

13. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

14. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
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
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
>3.5g of protein per 24hrs

15. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Impetigo
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
CBC
Varicella virus

16. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Loop diuretics (Check serum K+ levels before drug admin)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

17. What is the next best step if a patient has two or more positive dipstick tests?
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
A 24hr urine protein collection and urine creatinine clearance determination
Pts with palpitations and dizziness - near syncope - or syncope
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

18. Pneumothorax - sudden sharp chest pain - preceded by viral illness
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pleurisy
Candida albicans
RBC casts and old to moderate HTN

19. Define proteinuria
DM - HTN - DVT - seizures - depression - or anxiety
Folliculitis
>150mg per 24hrs
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

20. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
35 (exception for postmenopausal women who have recently been started on HRT)
Excessive bleeding in amount - duration - or both at irregular intervals
ACEi - ARBS - thiazide diuretics
Nonulcer dyspepsia

21. What are the 2 psych disorders most commonly associated with palpitations?
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
ACEi
Generalized Anxiety disorder and panic disorder
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

22. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

23. name the 4 emergent causes of chest pain
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
PE - MI - aortic dissection - pneumothorax
Cluster headache
With a KOH wet mount preparation

24. At was quantity does urine dipstick test detect elevated protein?
Less than 80 ml of blood
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
ACEi - ARBS - thiazide diuretics
100mg; means patient can be trace protein positive and not be detected

25. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Loop diuretics (Check serum K+ levels before drug admin)
Other brainstem or cranial nerve findings
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

26. 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
HPV
Pleurisy
True
24 hour halter

27. What are the two common clinical presentations of acute diarrhea?
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
24 hour halter
RBC casts and old to moderate HTN
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

28. How is constipation clinically defined?
LH surge triggers ovulation
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
Less than 3 stools per week
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

29. Describe the presentation of myocardial pain?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV
Common problem that resolves spontaneously and is most often seen in children and young adults

30. What are the primary glomerular diseases?
Bence-Jones
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

31. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Staphylococcal scalded skin syndrome
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

32. Name the diagnosis of heartburn: regurgitation - dysphagia
Associated with hypotension
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
Variability in the time for follicle development during the proliferative phase
GERD

33. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Coronary artery disease/ angina
Viral gastroenteritis
Loop diuretics (Check serum K+ levels before drug admin)

34. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Presence of proteinuria on at least two separate ocassion
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Bulk forming: Psyllium - Methycellulose - Polycarbophil

35. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Other brainstem or cranial nerve findings
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Hgb - Electrolytes - and TSH
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

36. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
ACEi - ARBS - thiazide diuretics
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
HPV

37. 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
GERD
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

38. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Temporal arteritis-biopsy of the temporal artery
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
CT

39. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Acute headache - ataxia - profuse nausea - and vomiting
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

40. 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
E. Coli O157:H7
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Impetigo
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

41. Chronic pain and shoulder stiffness with limited motion
Other brainstem or cranial nerve findings
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

42. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Serotypes 16 - 18 - 31 -52 -58
Menorrhagia
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

43. Why is the pap smear one of the most effective cancer screening tools?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Slow progression of cervical cancer changes -Availability of effective early treatment

44. Define the patient population typically affected by orthostatic or postural proteinuria
Warts
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

45. What is the Epley maneuver?
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
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.
Pleurisy

46. Name the skin lesion: honey colored crusts
Less than 80 ml of blood
S. aureus- beta hemolytic streptococcus
HIV and syphilis
Impetigo

47. Uterine bleeding between regular cycles
High blood pressure - focal neurologic defecit - or papilledema
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
100mg; means patient can be trace protein positive and not be detected
Intermenstrual bleeding

48. Menometrorrhagia
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Rotator cuff tendonitis
A central clear area
Excessive bleeding in amount - duration - or both at irregular intervals

49. Prenatal visit schedule for low-risk pregnancies
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
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
Medication or chemical esophagitis
Infectious esophagitis

50. How do you define persistent protein uria?
Anticoag with warfarin to prevent thromboembolism
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Presence of proteinuria on at least two separate ocassion
Diuretics -BB -CCB -ACEi