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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 are the two common clinical presentations of acute diarrhea?
Candida albicans
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pancreatitis
Warts

2. 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.
>150mg per 24hrs
Repeat Pap after infection treated
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
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

3. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Slow progression of cervical cancer changes -Availability of effective early treatment
Cluster headache
ACEi - ARBS - thiazide diuretics

4. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Infectious esophagitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

5. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
With a KOH wet mount preparation
Diuretics -BB -CCB -ACEi
Subarachnoid hemorrhage
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

6. What are the physical exam signs of CHF?
Temporal arteritis-biopsy of the temporal artery
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

7. Treatment for supraventricular tachycardias
Rotator Cuff tendonitis
BB or CCB - catheter ablation of identified bypass tract
Pleurisy
E. Coli O157:H7

8. What is the role of FSH in one's menstrual cycle
MSK - pulmonary - GI - or psychological
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

9. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
100mg; means patient can be trace protein positive and not be detected
Warts

10. What should be considered in younger patients with menorrhagia
Coag disorders
Viral infection of the semicircular apparatus
35 (exception for postmenopausal women who have recently been started on HRT)
Squamocolumnar junction=most common site of cervical cancer

11. What are the primary glomerular diseases?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
ACEi - ARBS - thiazide diuretics
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

12. patients with herpes zoster may experience what symptom before the rash appear?
S. Aureus
Pain
A central clear area
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

13. Define the patient population typically affected by orthostatic or postural proteinuria
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Slow progression of cervical cancer changes -Availability of effective early treatment
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
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

14. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Infectious esophagitis
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

15. What lab tests are recommended for newly diagnosed hypertensive patients?
Warts
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Common problem that resolves spontaneously and is most often seen in children and young adults
Albumin; low molecular weight proteins
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

17. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Peptic ulcer disease or gastritis
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
Diuretics -BB -CCB -ACEi

18. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
High blood pressure - focal neurologic defecit - or papilledema
Folliculitis
Rotator Cuff problem
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

19. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less abrupt onset and cessation of palpitations
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Medication or chemical esophagitis

20. What test done in PE measures instability of shoulder?
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
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

21. Difference between Pneumonia and Bronchitis
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
Squamocolumnar junction=most common site of cervical cancer
Serotypes 16 - 18 - 31 -52 -58
S. aureus- beta hemolytic streptococcus

22. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
CT
Candida albicans
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

23. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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.
These patients are associated with low renin states=less likely to respond to medication
Other brainstem or cranial nerve findings

24. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Staphylococcal scalded skin syndrome
Increase; 200 g/day
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Squamocolumnar junction=most common site of cervical cancer

25. Oligomenorrhea
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Regular bleeding at intervals of more than 35 days
Folliculitis

26. What should preconception counseling include?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Dehydration - anemia - cardiac causes
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

27. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Peptic ulcer disease or gastritis
Impetigo
HPV
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

28. Shoulder pain with pain radiating to elbow
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cervical radiculopathy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Other brainstem or cranial nerve findings

29. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
MSK - pulmonary - GI - or psychological

30. History for Sinusitis

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31. Describe the presentation tracheobronchitis
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Upper sternal area burning pain - associated with a productive cough

32. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Candida albicans
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.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

33. Name the diagnosis of heartburn: severe constant mid abdominal pain
BB or CCB - catheter ablation of identified bypass tract
S. aureus- beta hemolytic streptococcus
Diuretics -BB -CCB -ACEi
Pancreatitis

34. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pts with palpitations and dizziness - near syncope - or syncope
MSK - pulmonary - GI - or psychological
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

35. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Loop diuretics (Check serum K+ levels before drug admin)
Viral infection of the semicircular apparatus
Regular bleeding at intervals of more than 35 days
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

36. What is the goal of CHF treatment? What drugs should be used?
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

37. What are the secondly causes of glomerular disease?
High blood pressure - focal neurologic defecit - or papilledema
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Tension headache
Slow progression of cervical cancer changes -Availability of effective early treatment

38. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Diuretics -BB -CCB -ACEi
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

39. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Medication or chemical esophagitis
Impetigo
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

40. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less than 3 stools per week
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Wolff-Parkinson-White syndrome

41. What is the caUse of benign positional vertigo?
Folliculitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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.

42. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Colposcopy - Endocervical curettage - and directed cervical biopsy

43. name the 4 emergent causes of chest pain
Generalized Anxiety disorder and panic disorder
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
PE - MI - aortic dissection - pneumothorax

44. What are the consequences of diastolic dysfunction?
High blood pressure - focal neurologic defecit - or papilledema
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Candida albicans

45. What drugs do you use to treat H.pylori + PUD?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Cluster headache
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. Clinical Manifestations of HTN
These patients are associated with low renin states=less likely to respond to medication
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Echocardiogram

47. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Regular bleeding at intervals of more than 35 days
High blood pressure - focal neurologic defecit - or papilledema
Peptic ulcer disease or gastritis
24 hour halter

48. What is the next best step if a patient has two or more positive dipstick tests?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A 24hr urine protein collection and urine creatinine clearance determination
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

49. What are signs of pulmonary congestion?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough
Nonulcer dyspepsia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

50. History for Acute bronchitis
Giardia
Slow progression of cervical cancer changes -Availability of effective early treatment
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue