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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 should be considered in younger patients with menorrhagia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Coag disorders
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

2. Name the skin lesion: honey colored crusts
Scabies
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
Impetigo
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

3. What is the next best step if a patient has two or more positive dipstick tests?
S. Aureus
Intermenstrual bleeding
A 24hr urine protein collection and urine creatinine clearance determination
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

4. Describe the presentation tracheobronchitis
Molluscum contagiosum- pox virus
>3.5g of protein per 24hrs
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Upper sternal area burning pain - associated with a productive cough

5. What test done in PE measures instability of shoulder?
Coronary artery disease/ angina
100mg; means patient can be trace protein positive and not be detected
Serotypes 16 - 18 - 31 -52 -58
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

6. What is afterload?
Medication or chemical esophagitis
Folliculitis
Pain
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

7. What are the 2 psych disorders most commonly associated with palpitations?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Giardia
Generalized Anxiety disorder and panic disorder

8. What are the two common clinical presentations of acute diarrhea?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Scabies
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

9. How can GERD (or esophageal motility disorders) lead to chest pain?
Dehydration - anemia - cardiac causes
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less than 3 stools per week

10. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

11. Four muscles of rotator cuff
Other brainstem or cranial nerve findings
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Rotator Cuff problem
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

12. Clinical Manifestations of HTN
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

13. Name the diagnosis of heartburn: severe constant mid abdominal pain
Cervical radiculopathy
Pancreatitis
Diuretics -BB -CCB -ACEi
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

14. Name types of laxatives
Wolff-Parkinson-White syndrome
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Non-cardiac causes of palpitations
DM - HTN - DVT - seizures - depression - or anxiety

15. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Pleurisy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Diuretics -BB -CCB -ACEi

16. What is a markers of CNS vertigo?
ACEi - ARBS - thiazide diuretics
Other brainstem or cranial nerve findings
24 hour halter
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

17. What are the signs of acute sinusitis?
Chest pain during pneumonia or PE
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Fever with frontal or maxillary tenderness

18. Complete the sentence: pericarditis can cause frictional rub and......
Echocardiogram
35 (exception for postmenopausal women who have recently been started on HRT)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

19. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
HPV
Anticoag with warfarin to prevent thromboembolism
Intermenstrual bleeding
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

20. Pain in shoulder when throwing - swimming - or serving a tennis ball
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
Rotator cuff tendonitis
Less than 3 stools per week
Generalized Anxiety disorder and panic disorder

21. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
RBC casts and old to moderate HTN

22. What is the Epley maneuver?
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.
Albumin; low molecular weight proteins
Coag disorders
Furucnle

23. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Menorrhagia
Impetigo
Wolff-Parkinson-White syndrome
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

24. Define nephrotic range proteinuria
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
>3.5g of protein per 24hrs
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

25. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
ACEi
S. aureus- beta hemolytic streptococcus
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

26. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
High blood pressure - focal neurologic defecit - or papilledema
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

27. What are the features of glomerular nephritis
E. Coli O157:H7
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
RBC casts and old to moderate HTN
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

28. name the 4 emergent causes of chest pain
Peptic ulcer disease or gastritis
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
PE - MI - aortic dissection - pneumothorax
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

29. Discomfort with abducting the arm past 90 degress
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Rotator Cuff tendonitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

30. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Less than 80 ml of blood
Medication or chemical esophagitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pts with palpitations and dizziness - near syncope - or syncope

31. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cholelithiasis

32. What is the mechanism of action for stimulant agents in treating constipation?
>150mg per 24hrs
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
EGD
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

33. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Polymenorrhea
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

34. When does troponin rise following myocardial injury or infarction?
Staphylococcal scalded skin syndrome
Possibility of Ischemic colitis
24 hour halter
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

35. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Less than 3 stools per week
Cervical radiculopathy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Giardia

36. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Adhesive capsulitis (frozen shoulder): most common in middle age women
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cholelithiasis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

37. Prenatal visit schedule for low-risk pregnancies
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Upper sternal area burning pain - associated with a productive cough
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

38. When should a patient get a stress test?
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
Presence of proteinuria on at least two separate ocassion
When the patient has symptoms in association with exercise or who describe chest pain or pressure
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

39. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Loop diuretics (Check serum K+ levels before drug admin)
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.
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

40. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Bence-Jones
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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

41. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
LH surge triggers ovulation
Pts with palpitations and dizziness - near syncope - or syncope
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
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

42. History for Sinusitis

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43. Name 4 factors that predispose an individual to develop pneumonia.
Rotator Cuff tendonitis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Regular bleeding at intervals of more than 35 days
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. Who should have Xray testing for shoulder pain?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Infectious esophagitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

45. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Upper sternal area burning pain - associated with a productive cough
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
35 (exception for postmenopausal women who have recently been started on HRT)

46. What diagnosis does the 'worse headache of my life' suggest?
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.
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
CT
Subarachnoid hemorrhage

47. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
MSK - pulmonary - GI - or psychological

48. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

49. What is the role of FSH in one's menstrual cycle
Hgb - Electrolytes - and TSH
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Other brainstem or cranial nerve findings
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

50. Constipation: What are indications for lab testing?
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
S. Aureus
S. aureus- beta hemolytic streptococcus
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