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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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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. How can GERD (or esophageal motility disorders) lead to chest pain?
Pain
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
True
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

2. History for Acute bronchitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Albumin; low molecular weight proteins
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Rotator Cuff problem

3. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
A 24hr urine protein collection and urine creatinine clearance determination
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

4. 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.
Tension headache
Increase; 200 g/day
Colposcopy - Endocervical curettage - and directed cervical biopsy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. History and PE for Pneumonia
Peptic ulcer disease or gastritis
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
CT
Bence-Jones

6. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Other brainstem or cranial nerve findings
Non-cardiac causes of palpitations

7. Name the skin lesion: erythema - warmth - edema - pain - fever
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cellulitis
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
Repeat Pap after infection treated

8. What is the peripheral caUse of vertigo?
E. Coli O157:H7
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Infectious esophagitis

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Rotator Cuff tendonitis
Giardia
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

10. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
HIV and syphilis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

11. What are the indiciations for neuroimaging?
E. Coli O157:H7
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

12. When should invasive eletrophysiologic study should be considered?
Rotator Cuff tendonitis
CT
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Typically brought on exercise - eating - emotional excitement; pain lasts 5 - 15mins - disappears with nitroglycerin or at rest; if the pain lasts <1 or >30mins it should not be considered anginal

13. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

14. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Giardia

15. 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
Coronary artery disease/ angina
PE - MI - aortic dissection - pneumothorax
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

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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. What is the mechanism of action for stimulant agents in treating constipation?
Infectious esophagitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Cellulitis

18. Name types of laxatives
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Intermenstrual bleeding

19. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Loop diuretics (Check serum K+ levels before drug admin)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
High blood pressure - focal neurologic defecit - or papilledema
Increase; 200 g/day

20. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

21. When does troponin rise following myocardial injury or infarction?
Squamocolumnar junction=most common site of cervical cancer
Less than 80 ml of blood
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Peptic ulcer disease or gastritis

22. What is considered normal blood loss during a menstrual cycle?
Generalized Anxiety disorder and panic disorder
Temporal arteritis-biopsy of the temporal artery
Less than 80 ml of blood
E. Coli O157:H7

23. What is the caUse of benign positional vertigo?
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
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

24. What does the classic ring worm lesion have?
Pain
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
CT
A central clear area

25. Constipation: What are indications for lab testing?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

26. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Higher filling presure - pulmonary congestion - and decreasd cardiac return
CBC

27. At was quantity does urine dipstick test detect elevated protein?
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.
CBC
Colposcopy - Endocervical curettage - and directed cervical biopsy
100mg; means patient can be trace protein positive and not be detected

28. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Wolff-Parkinson-White syndrome
Intermenstrual bleeding
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

29. Discomfort with abducting the arm past 90 degress
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
Rotator Cuff tendonitis
Diuretics -BB -CCB -ACEi
Rotator Cuff problem

30. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

31. What drugs do you use to treat H.pylori + PUD?
Menorrhagia
Adhesive capsulitis (frozen shoulder): most common in middle age women
Wolff-Parkinson-White syndrome
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

32. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Cholelithiasis
HPV
Scabies
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

33. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Chest pain during pneumonia or PE
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Colposcopy - Endocervical curettage - and directed cervical biopsy

34. What treatments are the cornerstone for treating cases of functional constipation?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
PVC or Premature atrial contraction (PAC)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

35. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi
Infectious esophagitis

36. Define the patient population typically affected by orthostatic or postural proteinuria
Bence-Jones
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
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
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.

37. 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
>3.5g of protein per 24hrs
Varicella virus
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

38. Menometrorrhagia
Rotator Cuff problem
Common problem that resolves spontaneously and is most often seen in children and young adults
Albumin; low molecular weight proteins
Excessive bleeding in amount - duration - or both at irregular intervals

39. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Less than 3 stools per week
Chest pain during pneumonia or PE
S. Aureus

40. Describes what occurs during squamous metaplasia of the cervix.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

41. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Cluster headache
PE - MI - aortic dissection - pneumothorax
Echocardiogram

42. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
DM - HTN - DVT - seizures - depression - or anxiety
Cellulitis
Coag disorders

43. Describe the presentation of angina?
Typically brought on exercise - eating - emotional excitement; pain lasts 5 - 15mins - disappears with nitroglycerin or at rest; if the pain lasts <1 or >30mins it should not be considered anginal
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
Pts with palpitations and dizziness - near syncope - or syncope
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

44. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Increase; 200 g/day
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

45. What is a markers of CNS vertigo?
Lightheadedness - dizziness - syncope
Other brainstem or cranial nerve findings
Albumin; low molecular weight proteins
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

46. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Scabies
Polymenorrhea

47. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
E. Coli O157:H7
Rotator cuff tendonitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

48. Name the diagnosis of heartburn: regurgitation - dysphagia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
>150mg per 24hrs
GERD
A central clear area

49. How does CHF present on X-ray?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Rotator Cuff tendonitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

50. What is the next best step if a patient has two or more positive dipstick tests?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination
CBC

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