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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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Match each statement with the correct term.
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1. 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
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
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
Varicella virus
Polymenorrhea

2. Diarrhea from custard filled pastries
S. Aureus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
24 hour halter
Streptococci

3. What does treatment for migrans include?
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
EGD
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Loop diuretics (Check serum K+ levels before drug admin)

4. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
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
Anticoag with warfarin to prevent thromboembolism
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

5. History for Sinusitis

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6. Name the skin lesion: erythema - warmth - edema - pain - fever
Streptococci
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Cellulitis
Diuretics -BB -CCB -ACEi

7. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral gastroenteritis
Viral infection of the semicircular apparatus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

8. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Less abrupt onset and cessation of palpitations
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Rotator Cuff problem

9. Describe the presentation tracheobronchitis
True
Upper sternal area burning pain - associated with a productive cough
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

10. Prenatal visit schedule for low-risk pregnancies
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

11. How do you define persistent protein uria?
Candida albicans
Molluscum contagiosum- pox virus
Presence of proteinuria on at least two separate ocassion
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

12. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Coag disorders
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

13. What are the primary glomerular diseases?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Repeat Pap after infection treated
PVC or Premature atrial contraction (PAC)

14. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Albumin; low molecular weight proteins
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

15. What places women at higher risk of getting cervical cancer?
Loop diuretics (Check serum K+ levels before drug admin)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

16. What drugs do you use to treat H.pylori + PUD?
Peptic ulcer disease or gastritis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

17. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Staphylococcal scalded skin syndrome
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

18. What is the Barany maneuver?
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Serotypes 16 - 18 - 31 -52 -58
Candida albicans

19. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Less than 80 ml of blood

20. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Molluscum contagiosum- pox virus
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
Repeat Pap after infection treated

21. PE for a patient getting an abnormal vaginal bleeding work up
Rotator Cuff tendonitis
Staphylococcal scalded skin syndrome
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Viral infection of the semicircular apparatus

22. What are the three major risk factors for heart failure?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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.
>150mg per 24hrs
Hypertension - CAD - valvular heart disease

23. What are the symptoms of palpitations?
Medication or chemical esophagitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Lightheadedness - dizziness - syncope
Infectious esophagitis

24. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Diuretics -BB -CCB -ACEi
A central clear area
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
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

25. What are the most common viral causes of diarrhea in kids and adults?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Kids: Rotavirus Adults: Norwalk Virus

26. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
S. Aureus
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
Streptococci
EGD

27. Diagnostic Evaluation of Abnoraml vaginal bleeding
Chest pain during pneumonia or PE
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
These patients are associated with low renin states=less likely to respond to medication
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

28. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Polymenorrhea
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
High blood pressure - focal neurologic defecit - or papilledema
Generalized Anxiety disorder and panic disorder

29. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Chest pain during pneumonia or PE
Infectious esophagitis

30. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Chest pain during pneumonia or PE
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Coronary artery disease/ angina

31. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Supraspinatus and bicipital tendons
Increase; 200 g/day
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

32. Chronic pain and shoulder stiffness with limited motion
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Loop diuretics (Check serum K+ levels before drug admin)
Adhesive capsulitis (frozen shoulder): most common in middle age women

33. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Infectious esophagitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
S. aureus- beta hemolytic streptococcus

34. 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)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Temporal arteritis-biopsy of the temporal artery

35. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
GERD
Warts
24 hour halter

36. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Pleurisy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Non-cardiac causes of palpitations

37. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Variability in the time for follicle development during the proliferative phase
PE - MI - aortic dissection - pneumothorax
Diuretics -BB -CCB -ACEi

38. What is an acoustic neuroma?
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
Cellulitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

39. Metrorrhagia
E. Coli O157:H7
Loop diuretics (Check serum K+ levels before drug admin)
EGD
Irregular bleeding between cycles

40. Why is the pap smear one of the most effective cancer screening tools?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Non-cardiac causes of palpitations

41. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
LH surge triggers ovulation
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Bence-Jones

42. Where does the development of abnormal cervical cells begin?
HIV and syphilis
Squamocolumnar junction=most common site of cervical cancer
CBC
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

43. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
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.
Echocardiogram
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

44. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Other brainstem or cranial nerve findings
Loop diuretics (Check serum K+ levels before drug admin)
Impetigo
Albumin; low molecular weight proteins

45. Lab testing for heart palpitation
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Hgb - Electrolytes - and TSH
With a KOH wet mount preparation

46. What are the signs of malignant hypertension?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Irregular bleeding between cycles
High blood pressure - focal neurologic defecit - or papilledema
HIV and syphilis

47. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
True
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Colposcopy - Endocervical curettage - and directed cervical biopsy

48. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Lightheadedness - dizziness - syncope
Non-cardiac causes of palpitations
Warts
Loop diuretics (Check serum K+ levels before drug admin)

49. How do you know if heart palpitations are due to stimulant or medication use?
Excessive bleeding in amount - duration - or both at irregular intervals
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Increase; 200 g/day
Less abrupt onset and cessation of palpitations

50. Difference between Pneumonia and Bronchitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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.
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
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

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