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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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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 are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Viral infection of the semicircular apparatus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

2. How does systolic vs. diastolic heart failure present on the echocardiogram?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Acute headache - ataxia - profuse nausea - and vomiting
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
Infectious esophagitis

3. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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.
35 (exception for postmenopausal women who have recently been started on HRT)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

4. When should a patient get a stress test?
BB or CCB - catheter ablation of identified bypass tract
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Dehydration - anemia - cardiac causes
When the patient has symptoms in association with exercise or who describe chest pain or pressure

5. What is the goal of CHF treatment? What drugs should be used?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
DM - HTN - DVT - seizures - depression - or anxiety
Pancreatitis
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

6. What type of imaging is need for chronic sinusitis?
Fever with frontal or maxillary tenderness
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
GERD
CT

7. Describe the presentation of pneumonia
Molluscum contagiosum- pox virus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pts with palpitations and dizziness - near syncope - or syncope

8. Chronic pain and shoulder stiffness with limited motion
Molluscum contagiosum- pox virus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
ACEi
Giardia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

10. Things that need to be included in history of shoulder pain
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

11. Pneumonia tx: suitable for healthy adults older than 60
Dehydration - anemia - cardiac causes
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Echocardiogram
Cervical radiculopathy

12. How to NSAIDs contribute to gastritis and ulcer formation?
ACEi - ARBS - thiazide diuretics
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.
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.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

13. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Rotator Cuff tendonitis
Medication or chemical esophagitis
Rotator cuff tendonitis

14. What are the features of nephrotic syndrome?
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Infectious esophagitis
Rotator Cuff tendonitis

15. Clinical Manifestations of HTN
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Repeat Pap after infection treated

16. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Paroxysmal atrial fibrillation or supraventricular tachycardia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

17. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
35 (exception for postmenopausal women who have recently been started on HRT)
Furucnle
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Coronary artery disease/ angina

18. Oligomenorrhea
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Regular bleeding at intervals of more than 35 days
GERD

19. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Pancreatitis
Echocardiogram

20. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Echocardiogram
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

21. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
A 24hr urine protein collection and urine creatinine clearance determination
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
24 hour halter
Impetigo

22. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
E. Coli O157:H7
Colposcopy - Endocervical curettage - and directed cervical biopsy
Nonulcer dyspepsia
S. aureus- beta hemolytic streptococcus

23. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Lightheadedness - dizziness - syncope
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

24. What are the most common viral causes of diarrhea in kids and adults?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Kids: Rotavirus Adults: Norwalk Virus
Temporal arteritis-biopsy of the temporal artery
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

25. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Pleurisy

26. What are the secondly causes of glomerular disease?
Anticoag with warfarin to prevent thromboembolism
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
LH surge triggers ovulation

27. What is an acoustic neuroma?
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.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

28. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Coronary artery disease/ angina
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

29. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Polymenorrhea
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Adhesive capsulitis (frozen shoulder): most common in middle age women

30. What are the symptoms of palpitations?
Common problem that resolves spontaneously and is most often seen in children and young adults
35 (exception for postmenopausal women who have recently been started on HRT)
GERD
Lightheadedness - dizziness - syncope

31. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
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
Possibility of Ischemic colitis
Squamocolumnar junction=most common site of cervical cancer

32. 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
LH surge triggers ovulation
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
RBC casts and old to moderate HTN

33. Lab testing for heart palpitation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Hgb - Electrolytes - and TSH
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

34. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Tension headache
PVC or Premature atrial contraction (PAC)
>3.5g of protein per 24hrs

35. How is constipation clinically defined?
Upper sternal area burning pain - associated with a productive cough
Pleurisy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Less than 3 stools per week

36. Four muscles of rotator cuff
Viral infection of the semicircular apparatus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Kids: Rotavirus Adults: Norwalk Virus

37. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
>3.5g of protein per 24hrs

38. 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
True
Serotypes 16 - 18 - 31 -52 -58
PVC or Premature atrial contraction (PAC)
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

39. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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 80 ml of blood
Pts with palpitations and dizziness - near syncope - or syncope

40. What lab tests are recommended for newly diagnosed hypertensive patients?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Slow progression of cervical cancer changes -Availability of effective early treatment

41. What is the standard tool used for diagnosis of GERD?
>3.5g of protein per 24hrs
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
EGD
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

42. What are symptoms are CHF?
A 24hr urine protein collection and urine creatinine clearance determination
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Wolff-Parkinson-White syndrome
LH surge triggers ovulation

43. How does CHF present on X-ray?
DM - HTN - DVT - seizures - depression - or anxiety
Anticoag with warfarin to prevent thromboembolism
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

44. Natural history of cervical cancer
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Colposcopy - Endocervical curettage - and directed cervical biopsy
Possibility of Ischemic colitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

45. What test done in PE measures instability of shoulder?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
>3.5g of protein per 24hrs
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

46. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Pain
Less abrupt onset and cessation of palpitations
These patients are associated with low renin states=less likely to respond to medication

47. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Staphylococcal scalded skin syndrome
Anticoag with warfarin to prevent thromboembolism

48. Where does the development of abnormal cervical cells begin?
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
Squamocolumnar junction=most common site of cervical cancer
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

49. What are the indiciations for neuroimaging?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Lightheadedness - dizziness - syncope
Diuretics -BB -CCB -ACEi

50. Name 4 factors that predispose an individual to develop pneumonia.
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Fever with frontal or maxillary tenderness
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

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