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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. What the consequences of decreased cardiac output?
Slow progression of cervical cancer changes -Availability of effective early treatment
RBC casts and old to moderate HTN
Supraspinatus and bicipital tendons
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

2. How to NSAIDs contribute to gastritis and ulcer formation?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Staphylococcal scalded skin syndrome
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

3. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Staphylococcal scalded skin syndrome

4. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

5. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Temporal arteritis-biopsy of the temporal artery
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

6. What drugs do you use to treat H.pylori + PUD?
CT
PE - MI - aortic dissection - pneumothorax
Wolff-Parkinson-White syndrome
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

7. Things that need to be included in history of shoulder pain
Warts
Viral gastroenteritis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

8. Define nephrotic range proteinuria
PE - MI - aortic dissection - pneumothorax
>3.5g of protein per 24hrs
Infectious esophagitis
Candida albicans

9. Chronic pain and shoulder stiffness with limited motion
Analgesic headache
Adhesive capsulitis (frozen shoulder): most common in middle age women
Possibility of Ischemic colitis
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

10. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
A central clear area
Possibility of Ischemic colitis
Hypertension - CAD - valvular heart disease
Irregular bleeding between cycles

11. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Presence of proteinuria on at least two separate ocassion
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

12. Lab testing for heart palpitation
E. Coli O157:H7
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
Hgb - Electrolytes - and TSH
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

13. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
S. aureus- beta hemolytic streptococcus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
These patients are associated with low renin states=less likely to respond to medication

14. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
100mg; means patient can be trace protein positive and not be detected
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
HPV
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

15. Describe the presentation of pericardial pain
Giardia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

16. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Intermenstrual bleeding
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
Albumin; low molecular weight proteins
Analgesic headache

17. HIgh risk pregnant patients should be evaluated for ____ and ____
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
100mg; means patient can be trace protein positive and not be detected
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HIV and syphilis

18. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
E. Coli O157:H7
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

19. 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
Excessive bleeding in amount - duration - or both at irregular intervals
HPV
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Warts

20. 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
35 (exception for postmenopausal women who have recently been started on HRT)
Candida albicans
Acute headache - ataxia - profuse nausea - and vomiting
Varicella virus

21. Describe the presentation of myocardial pain?
Giardia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pain
Medication or chemical esophagitis

22. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Squamocolumnar junction=most common site of cervical cancer
Scleroderma/polymyositis with secondary gastroesophageal reflux
PE - MI - aortic dissection - pneumothorax
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

23. What are the physical exam signs of CHF?
E. Coli O157:H7
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Irregular bleeding between cycles

24. 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
A 24hr urine protein collection and urine creatinine clearance determination
Pancreatitis
Molluscum contagiosum- pox virus
HPV

25. name the 4 emergent causes of chest pain
These patients are associated with low renin states=less likely to respond to medication
Analgesic headache
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
PE - MI - aortic dissection - pneumothorax

26. What type of imaging is need for chronic sinusitis?
CT
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
Temporal arteritis-biopsy of the temporal artery
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

27. What is afterload?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Dehydration - anemia - cardiac causes
Possibility of Ischemic colitis

28. What should blood work include for suspected heart failure?
Warts
Possibility of Ischemic colitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Dehydration - anemia - cardiac causes

29. What are the indiciations for neuroimaging?
A 24hr urine protein collection and urine creatinine clearance determination
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
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
Pleurisy

30. When should a patient get a stress test?
100mg; means patient can be trace protein positive and not be detected
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
CT

31. Define proteinuria
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
>150mg per 24hrs
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
35 (exception for postmenopausal women who have recently been started on HRT)

32. Carcinoma in situ is generally referred to a gynecologist and requires ______
>150mg per 24hrs
Hypertension - CAD - valvular heart disease
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
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

33. What is the standard tool used for diagnosis of GERD?
S. aureus- beta hemolytic streptococcus
Less abrupt onset and cessation of palpitations
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
EGD

34. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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.
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
HIV and syphilis

35. What should preconception counseling include?
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
PE - MI - aortic dissection - pneumothorax
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

36. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Furucnle
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

37. What medications can cause heart palpitations?
24 hour halter
Associated with hypotension
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

38. How is constipation clinically defined?
Less than 3 stools per week
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
A central clear area

39. What are the consequences of diastolic dysfunction?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV

40. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
24 hour halter
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

41. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Pain
Bence-Jones
Cholelithiasis
>150mg per 24hrs

42. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
DM - HTN - DVT - seizures - depression - or anxiety
Chest pain during pneumonia or PE
Subarachnoid hemorrhage
Cellulitis

43. History and PE for Pneumonia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Variability in the time for follicle development during the proliferative phase
Adhesive capsulitis (frozen shoulder): most common in middle age women

44. What are the symptoms of palpitations?
Cervical radiculopathy
Rotator cuff tendonitis
Less abrupt onset and cessation of palpitations
Lightheadedness - dizziness - syncope

45. What does orthostatic positional changes that bring on dizziness suggest?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Dehydration - anemia - cardiac causes
Presence of proteinuria on at least two separate ocassion
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

46. MI - pericardial tamponade - PE - GI bleed - are...
PVC or Premature atrial contraction (PAC)
Coag disorders
GERD
Associated with hypotension

47. Regular bleeding at intervals of less than 21 days
Polymenorrhea
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

48. Predictors of cardiac etiology
Molluscum contagiosum- pox virus
LH surge triggers ovulation
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

49. Uterine bleeding between regular cycles
Intermenstrual bleeding
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Less than 80 ml of blood
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

50. What does treatment for migrans include?
Folliculitis
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
Candida albicans
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