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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. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Viral infection of the semicircular apparatus
Rotator Cuff problem

2. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
RBC casts and old to moderate HTN
CT
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

3. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
MSK - pulmonary - GI - or psychological
Associated with hypotension
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

4. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Generalized Anxiety disorder and panic disorder
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Temporal arteritis-biopsy of the temporal artery

5. Complete the sentence: pericarditis can cause frictional rub and......
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

6. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
A central clear area
Wolff-Parkinson-White syndrome
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

7. What are the features of glomerular nephritis
Acute headache - ataxia - profuse nausea - and vomiting
Irregular bleeding between cycles
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
RBC casts and old to moderate HTN

8. What does orthostatic positional changes that bring on dizziness suggest?
24 hour halter
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Dehydration - anemia - cardiac causes
A central clear area

9. What are the common causes for laryngitis?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
GERD
Influenza - Rhinovirus - Adenovirus - Parainfluenza

10. Describes what occurs during squamous metaplasia of the cervix.
Coronary artery disease/ angina
HPV
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

11. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
35 (exception for postmenopausal women who have recently been started on HRT)

12. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Regular bleeding at intervals of more than 35 days
Diuretics -BB -CCB -ACEi
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

13. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Cellulitis
Intermenstrual bleeding
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

14. What is the peripheral caUse of vertigo?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Bence-Jones
BB or CCB - catheter ablation of identified bypass tract

15. Shoulder pain with pain radiating to elbow
Viral gastroenteritis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Associated with hypotension
Cervical radiculopathy

16. What are the three types of lice?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Anticoag with warfarin to prevent thromboembolism
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

17. 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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Staphylococcal scalded skin syndrome
Varicella virus

18. Regular bleeding at intervals of less than 21 days
Viral gastroenteritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Polymenorrhea
CT

19. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Streptococci
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
Hgb - Electrolytes - and TSH

20. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Coronary artery disease/ angina
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Kids: Rotavirus Adults: Norwalk Virus

21. Pneumonia tx: suitable for healthy adults older than 60
Scabies
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

22. At was quantity does urine dipstick test detect elevated protein?
Regular bleeding at intervals of more than 35 days
100mg; means patient can be trace protein positive and not be detected
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
Generalized Anxiety disorder and panic disorder

23. Treatment for supraventricular tachycardias
Paroxysmal atrial fibrillation or supraventricular tachycardia
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Dehydration - anemia - cardiac causes
BB or CCB - catheter ablation of identified bypass tract

24. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Cholelithiasis

25. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Fever with frontal or maxillary tenderness
Rotator cuff tendonitis

26. Why is the pap smear one of the most effective cancer screening tools?
Intermenstrual bleeding
Less abrupt onset and cessation of palpitations
Slow progression of cervical cancer changes -Availability of effective early treatment
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

27. 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.
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.
Repeat Pap after infection treated
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Squamocolumnar junction=most common site of cervical cancer

28. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
>150mg per 24hrs
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

29. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Lightheadedness - dizziness - syncope
CT
ACEi - ARBS - thiazide diuretics
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

30. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Cervical radiculopathy
Folliculitis
A 24hr urine protein collection and urine creatinine clearance determination

31. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Supraspinatus and bicipital tendons
Furucnle
CT
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

32. What are the consequences of diastolic dysfunction?
S. aureus- beta hemolytic streptococcus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Rotator Cuff problem

33. When should a patient get a stress test?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
When the patient has symptoms in association with exercise or who describe chest pain or pressure
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

34. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
BB or CCB - catheter ablation of identified bypass tract
Staphylococcal scalded skin syndrome
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

35. What should preconception counseling include?
Viral infection of the semicircular apparatus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

36. What does the classic ring worm lesion have?
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
Temporal arteritis-biopsy of the temporal artery
A central clear area
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

37. 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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Scabies

38. 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
Echocardiogram
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
Peptic ulcer disease or gastritis

39. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pleurisy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

40. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Peptic ulcer disease or gastritis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

41. patients with herpes zoster may experience what symptom before the rash appear?
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
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
Pain
Slow progression of cervical cancer changes -Availability of effective early treatment

42. What occurs after ovulation
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Giardia
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

43. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Non-cardiac causes of palpitations
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

44. Mainstay treatment for soft tissue inflammation (Shoulder)
Non-cardiac causes of palpitations
Possibility of Ischemic colitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Supraspinatus and bicipital tendons

45. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Echocardiogram

46. Name the diagnosis of heartburn: severe constant mid abdominal pain
HIV and syphilis
Serotypes 16 - 18 - 31 -52 -58
Pancreatitis
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

47. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Other brainstem or cranial nerve findings
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

48. What should blood work include for suspected heart failure?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Acute headache - ataxia - profuse nausea - and vomiting
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

49. Discomfort with abducting the arm past 90 degress
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Rotator Cuff tendonitis
Slow progression of cervical cancer changes -Availability of effective early treatment
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

50. Clinical Manifestations of HTN
These patients are associated with low renin states=less likely to respond to medication
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
Pancreatitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema