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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. Describe the presentation of myocardial pain?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Tension headache
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

2. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
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
Lightheadedness - dizziness - syncope
ACEi - ARBS - thiazide diuretics
GERD

3. What are the physical exam signs of CHF?
Cholelithiasis
Tension headache
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

4. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

5. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Coag disorders
Colposcopy - Endocervical curettage - and directed cervical biopsy
Candida albicans
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

6. Carcinoma in situ is generally referred to a gynecologist and requires ______
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Candida albicans
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
LH surge triggers ovulation

7. Four muscles of rotator cuff
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Upper sternal area burning pain - associated with a productive cough
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

8. What are the signs of acute sinusitis?
Anticoag with warfarin to prevent thromboembolism
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Fever with frontal or maxillary tenderness

9. 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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Varicella virus
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

10. History and PE for Pneumonia
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Possibility of Ischemic colitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

11. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Rotator cuff tendonitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Coag disorders
Peptic ulcer disease or gastritis

12. How is constipation clinically defined?
EGD
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Less than 3 stools per week
With a KOH wet mount preparation

13. After treatment of dysplasia - women need Pap smears every...
Streptococci
Less than 3 stools per week
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Rotator Cuff tendonitis

14. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
GERD
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Nonulcer dyspepsia

15. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Cluster headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Analgesic headache

16. What is the caUse of Meniere disease? What are the cardinal symptoms?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Bence-Jones
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

17. What are the features of glomerular nephritis
Common problem that resolves spontaneously and is most often seen in children and young adults
Supraspinatus and bicipital tendons
RBC casts and old to moderate HTN
CBC

18. Treatment for supraventricular tachycardias
Cellulitis
Presence of proteinuria on at least two separate ocassion
BB or CCB - catheter ablation of identified bypass tract
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

19. What are the indiciations for neuroimaging?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
CT
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
A 24hr urine protein collection and urine creatinine clearance determination

20. How can GERD (or esophageal motility disorders) lead to chest pain?
Pleurisy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Giardia
Generalized Anxiety disorder and panic disorder

21. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Irregular bleeding between cycles
Associated with hypotension
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Bence-Jones

22. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dehydration - anemia - cardiac causes
Pancreatitis

23. History for Acute bronchitis
A central clear area
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
With a KOH wet mount preparation

24. Define nephrotic range proteinuria
S. Aureus
Adhesive capsulitis (frozen shoulder): most common in middle age women
>3.5g of protein per 24hrs
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

25. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Adhesive capsulitis (frozen shoulder): most common in middle age women
Coronary artery disease/ angina
True
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

26. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Cluster headache
Menorrhagia
Presence of proteinuria on at least two separate ocassion
Paroxysmal atrial fibrillation or supraventricular tachycardia

27. What are the secondly causes of glomerular disease?
Temporal arteritis-biopsy of the temporal artery
Folliculitis
Upper sternal area burning pain - associated with a productive cough
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

28. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Medication or chemical esophagitis

29. What is the Barany maneuver?
Increase; 200 g/day
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Possibility of Ischemic colitis
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

30. Chronic pain and shoulder stiffness with limited motion
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Folliculitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Adhesive capsulitis (frozen shoulder): most common in middle age women

31. Pneumonia tx: suitable for healthy adults less than 60
Anticoag with warfarin to prevent thromboembolism
Non-cardiac causes of palpitations
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Impetigo

32. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Rotator Cuff problem
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

33. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Impetigo
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

34. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

35. 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
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Common problem that resolves spontaneously and is most often seen in children and young adults

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
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
Rotator Cuff problem

37. What is the role of FSH in one's menstrual cycle
Analgesic headache
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Influenza - Rhinovirus - Adenovirus - Parainfluenza

38. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
HIV and syphilis
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
E. Coli O157:H7

39. What is the caUse of benign positional vertigo?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Less than 3 stools per week
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.
HIV and syphilis

40. What is the preload?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Medication or chemical esophagitis

41. What medications can cause heart palpitations?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Chest pain during pneumonia or PE
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Non-cardiac causes of palpitations

42. Initial treatment for Rhinosinusitis
Pain
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

43. Define proteinuria
LH surge triggers ovulation
>150mg per 24hrs
Fever with frontal or maxillary tenderness
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

44. What is considered normal blood loss during a menstrual cycle?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Less than 80 ml of blood
Slow progression of cervical cancer changes -Availability of effective early treatment

45. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
A central clear area
Analgesic headache
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

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

47. What lab tests are recommended for newly diagnosed hypertensive patients?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Kids: Rotavirus Adults: Norwalk Virus
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

48. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
With a KOH wet mount preparation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

49. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Analgesic headache
100mg; means patient can be trace protein positive and not be detected
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Furucnle

50. What are the signs of cerebral hemorrhage?
Presence of proteinuria on at least two separate ocassion
Pts with palpitations and dizziness - near syncope - or syncope
Intermenstrual bleeding
Acute headache - ataxia - profuse nausea - and vomiting