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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. Prenatal visit schedule for low-risk pregnancies
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Acute headache - ataxia - profuse nausea - and vomiting
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
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.

2. What are the signs of malignant hypertension?
Cellulitis
High blood pressure - focal neurologic defecit - or papilledema
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

3. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Upper sternal area burning pain - associated with a productive cough
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

4. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Cholelithiasis
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
PE - MI - aortic dissection - pneumothorax
ACEi - ARBS - thiazide diuretics

5. Difference between Pneumonia and Bronchitis
A 24hr urine protein collection and urine creatinine clearance determination
Scabies
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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. What are signs of pulmonary congestion?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
A central clear area
Paroxysmal atrial fibrillation or supraventricular tachycardia

7. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
S. Aureus
Giardia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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 type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Excessive bleeding in amount - duration - or both at irregular intervals
Varicella virus
Peptic ulcer disease or gastritis
ACEi

9. Who should have Xray testing for shoulder pain?
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cholelithiasis
Analgesic headache

10. What are the common causes for laryngitis?
HPV
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Paroxysmal atrial fibrillation or supraventricular tachycardia

11. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Coag disorders
Colposcopy - Endocervical curettage - and directed cervical biopsy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

12. When does troponin rise following myocardial injury or infarction?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scabies
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

13. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Candida albicans
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

14. What does the classic ring worm lesion have?
Candida albicans
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Chest pain during pneumonia or PE
A central clear area

15. After treatment of dysplasia - women need Pap smears every...
Warts
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

16. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Candida albicans
Non-cardiac causes of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals
Cluster headache

17. What are the features of nephrotic syndrome?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

18. What is the peripheral caUse of vertigo?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Acute headache - ataxia - profuse nausea - and vomiting

19. Describe the presentation tracheobronchitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Upper sternal area burning pain - associated with a productive cough
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

20. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
E. Coli O157:H7
Hgb - Electrolytes - and TSH

21. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
24 hour halter
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
E. Coli O157:H7
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

22. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Scabies
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
E. Coli O157:H7

23. Shoulder pain with pain radiating to elbow
S. Aureus
Cervical radiculopathy
Viral gastroenteritis
Adhesive capsulitis (frozen shoulder): most common in middle age women

24. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
S. aureus- beta hemolytic streptococcus
Presence of proteinuria on at least two separate ocassion
Furucnle

25. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Warts
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

26. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
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
100mg; means patient can be trace protein positive and not be detected
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

27. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Colposcopy - Endocervical curettage - and directed cervical biopsy
True
Menorrhagia

28. Describe the presentation of pneumonia
Less than 3 stools per week
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Subarachnoid hemorrhage
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

29. 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
S. Aureus
Non-cardiac causes of palpitations

30. Describe the presentation of myocardial pain?
Pancreatitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

31. What does orthostatic positional changes that bring on dizziness suggest?
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
DM - HTN - DVT - seizures - depression - or anxiety
Bence-Jones
Dehydration - anemia - cardiac causes

32. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
CBC
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Subarachnoid hemorrhage
Viral infection of the semicircular apparatus

33. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Non-cardiac causes of palpitations
Less than 80 ml of blood
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

34. What are the indiciations for neuroimaging?
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
EGD

35. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
HPV
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Infectious esophagitis

36. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Molluscum contagiosum- pox virus
CT
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

37. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Molluscum contagiosum- pox virus
Infectious esophagitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
These patients are associated with low renin states=less likely to respond to medication

38. What are the physical exam signs of CHF?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

39. History and PE for Pneumonia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Tension headache
CT
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

40. What the consequences of decreased cardiac output?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Molluscum contagiosum- pox virus
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

41. What should preconception counseling include?
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Influenza - Rhinovirus - Adenovirus - Parainfluenza

42. What is the mechanism of action for stimulant agents in treating constipation?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
PE - MI - aortic dissection - pneumothorax
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

43. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Viral gastroenteritis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

44. 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
LH surge triggers ovulation
PE - MI - aortic dissection - pneumothorax
Coronary artery disease/ angina
Warts

45. How do you define persistent protein uria?
HPV
Rotator cuff tendonitis
Presence of proteinuria on at least two separate ocassion
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

46. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
35 (exception for postmenopausal women who have recently been started on HRT)
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

47. Cycle length variabilty is primarily due to what?
35 (exception for postmenopausal women who have recently been started on HRT)
Variability in the time for follicle development during the proliferative phase
Slow progression of cervical cancer changes -Availability of effective early treatment
HPV testing -Pos=colposcopy -Neg=repeat pap smear

48. What medications can cause heart palpitations?
Slow progression of cervical cancer changes -Availability of effective early treatment
Loop diuretics (Check serum K+ levels before drug admin)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

49. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Cellulitis
Regular bleeding at intervals of more than 35 days
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

50. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Presence of proteinuria on at least two separate ocassion
Giardia
Bulk forming: Psyllium - Methycellulose - Polycarbophil