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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. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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.

2. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Warts
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Influenza - Rhinovirus - Adenovirus - Parainfluenza

3. What are the most common viral causes of diarrhea in kids and adults?
Increase; 200 g/day
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Kids: Rotavirus Adults: Norwalk Virus
HPV

4. Pain in shoulder when throwing - swimming - or serving a tennis ball
Pts with palpitations and dizziness - near syncope - or syncope
Hgb - Electrolytes - and TSH
A central clear area
Rotator cuff tendonitis

5. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
These patients are associated with low renin states=less likely to respond to medication
Varicella virus
Temporal arteritis-biopsy of the temporal artery

6. 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
Warts
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Rotator cuff tendonitis

7. Diarrhea is defined as an ____ in stool weight to more than ____g per day
A 24hr urine protein collection and urine creatinine clearance determination
Supraspinatus and bicipital tendons
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Increase; 200 g/day

8. When is a lumbar puncture contraindicated?
Staphylococcal scalded skin syndrome
E. Coli O157:H7
ACEi
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

9. What are the consequences of diastolic dysfunction?
S. Aureus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Less than 80 ml of blood
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

10. What is the next best step if a patient has two or more positive dipstick tests?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
A 24hr urine protein collection and urine creatinine clearance determination
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

11. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Furucnle
RBC casts and old to moderate HTN
Dehydration - anemia - cardiac causes

12. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Cholelithiasis
Streptococci

13. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
100mg; means patient can be trace protein positive and not be detected
Candida albicans
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

14. Describe the presentation of myocardial pain?
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.
A 24hr urine protein collection and urine creatinine clearance determination
Streptococci
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

15. What diagnosis does the 'worse headache of my life' suggest?
Bence-Jones
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Subarachnoid hemorrhage
Lightheadedness - dizziness - syncope

16. What is the Barany maneuver?
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
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
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
Streptococci

17. What is the mechanism of action for stimulant agents in treating constipation?
>150mg per 24hrs
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Subarachnoid hemorrhage

18. Define proteinuria
>150mg per 24hrs
Hypertension - CAD - valvular heart disease
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Anticoag with warfarin to prevent thromboembolism

19. 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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
E. Coli O157:H7
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

20. What should be considered in younger patients with menorrhagia
Coag disorders
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Varicella virus
Cellulitis

21. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Subarachnoid hemorrhage
Nonulcer dyspepsia
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
Anticoag with warfarin to prevent thromboembolism

22. When does troponin rise following myocardial injury or infarction?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

23. What are the features of nephrotic syndrome?
Rotator Cuff problem
Molluscum contagiosum- pox virus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

24. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pts with palpitations and dizziness - near syncope - or syncope
LH surge triggers ovulation

25. What are the physical exam signs of CHF?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
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
GERD

26. What treatments are the cornerstone for treating cases of functional constipation?
Viral gastroenteritis
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increasing fluid (8 - 8oz glasses of water/day) -fiber

27. Uterine bleeding between regular 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
Repeat Pap after infection treated
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Intermenstrual bleeding

28. What are the two common clinical presentations of acute diarrhea?
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
Echocardiogram
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
>150mg per 24hrs

29. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Streptococci
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

30. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Albumin; low molecular weight proteins
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Giardia

31. What are the signs of acute sinusitis?
Streptococci
CT
Colposcopy - Endocervical curettage - and directed cervical biopsy
Fever with frontal or maxillary tenderness

32. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Cervical radiculopathy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
24 hour halter
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

33. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
MSK - pulmonary - GI - or psychological
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

34. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
MSK - pulmonary - GI - or psychological
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

35. Initial treatment for Rhinosinusitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Candida albicans
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

36. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Acute headache - ataxia - profuse nausea - and vomiting
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

37. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

38. History for Sinusitis

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39. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Irregular bleeding between cycles
Dehydration - anemia - cardiac causes

40. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Kids: Rotavirus Adults: Norwalk Virus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
CBC

41. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
These patients are associated with low renin states=less likely to respond to medication
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
Coag disorders
Albumin; low molecular weight proteins

42. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Serotypes 16 - 18 - 31 -52 -58
Squamocolumnar junction=most common site of cervical cancer

43. What is afterload?
Pleurisy
Adhesive capsulitis (frozen shoulder): most common in middle age women
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
CBC

44. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
ACEi
Folliculitis
Pleurisy

45. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Analgesic headache
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
Varicella virus
Tension headache

46. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Pancreatitis
Fever with frontal or maxillary tenderness

47. What are the features of glomerular nephritis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
RBC casts and old to moderate HTN
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
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.

48. What is the caUse of benign positional vertigo?
LH surge triggers ovulation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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.

49. 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
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
Chest pain during pneumonia or PE
Varicella virus
Variability in the time for follicle development during the proliferative phase

50. What places women at higher risk of getting cervical cancer?
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
Nonulcer dyspepsia
Temporal arteritis-biopsy of the temporal artery
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot