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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. History for Acute bronchitis
Non-cardiac causes of palpitations
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
BB or CCB - catheter ablation of identified bypass tract
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

2. Difference between Pneumonia and Bronchitis
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

3. 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
Varicella virus
Supraspinatus and bicipital tendons
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

4. What are the symptoms of palpitations?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Lightheadedness - dizziness - syncope
Rotator cuff tendonitis
Excessive bleeding in amount - duration - or both at irregular intervals

5. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

6. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Rotator Cuff tendonitis
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
Variability in the time for follicle development during the proliferative phase

7. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Giardia
Medication or chemical esophagitis

8. Initial treatment for Rhinosinusitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hgb - Electrolytes - and TSH
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

9. What does treatment for migrans include?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
CT
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

10. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Molluscum contagiosum- pox virus
Serotypes 16 - 18 - 31 -52 -58
Dehydration - anemia - cardiac causes
Scleroderma/polymyositis with secondary gastroesophageal reflux

11. Pain in shoulder when throwing - swimming - or serving a tennis ball
Cervical radiculopathy
Scabies
Rotator cuff tendonitis
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

12. Name the diagnosis of heartburn: regurgitation - dysphagia
Serotypes 16 - 18 - 31 -52 -58
Polymenorrhea
Echocardiogram
GERD

13. Define proteinuria
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
>150mg per 24hrs
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.
Serotypes 16 - 18 - 31 -52 -58

14. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
High blood pressure - focal neurologic defecit - or papilledema

15. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
GERD
Infectious esophagitis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
>150mg per 24hrs

16. What are the signs of malignant hypertension?
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
High blood pressure - focal neurologic defecit - or papilledema
100mg; means patient can be trace protein positive and not be detected
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

17. How do you know if heart palpitations are due to stimulant or medication use?
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
Diuretics -BB -CCB -ACEi
Rotator Cuff problem
Less abrupt onset and cessation of palpitations

18. Things that need to be included in history of shoulder pain
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)
Cellulitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

19. Clinical Manifestations of HTN
Possibility of Ischemic colitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Pancreatitis

20. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

21. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
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
Rotator cuff tendonitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

22. Vaccines that should be updated before planned pregnancy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
HPV

23. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hypertension - CAD - valvular heart disease
True

24. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming: Psyllium - Methycellulose - Polycarbophil

25. What does orthostatic positional changes that bring on dizziness suggest?
Coag disorders
Irregular bleeding between cycles
Dehydration - anemia - cardiac causes
ACEi

26. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Polymenorrhea
Coronary artery disease/ angina

27. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

28. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Cholelithiasis
Rotator cuff tendonitis

29. 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
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
EGD
E. Coli O157:H7
Supraspinatus and bicipital tendons

30. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Warts
Non-cardiac causes of palpitations
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

31. What lab tests are recommended for newly diagnosed hypertensive patients?
Lightheadedness - dizziness - syncope
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Medication or chemical esophagitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

32. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Varicella virus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Anticoag with warfarin to prevent thromboembolism

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
RBC casts and old to moderate HTN
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Diuretics -BB -CCB -ACEi

34. How can GERD (or esophageal motility disorders) lead to chest pain?
Coag disorders
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hgb - Electrolytes - and TSH

35. 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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
RBC casts and old to moderate HTN
Impetigo

36. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
PE - MI - aortic dissection - pneumothorax

37. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
ACEi - ARBS - thiazide diuretics
Slow progression of cervical cancer changes -Availability of effective early treatment
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

38. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Anticoag with warfarin to prevent thromboembolism
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Giardia

39. What does the classic ring worm lesion have?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Paroxysmal atrial fibrillation or supraventricular tachycardia
A central clear area

40. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Viral gastroenteritis
Variability in the time for follicle development during the proliferative phase
24 hour halter

41. History and PE for Pneumonia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

42. Describe the presentation tracheobronchitis
BB or CCB - catheter ablation of identified bypass tract
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Molluscum contagiosum- pox virus
Upper sternal area burning pain - associated with a productive cough

43. When should invasive eletrophysiologic study should be considered?
Temporal arteritis-biopsy of the temporal artery
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Squamocolumnar junction=most common site of cervical cancer
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

44. MI - pericardial tamponade - PE - GI bleed - are...
GERD
Infectious esophagitis
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
Associated with hypotension

45. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
ACEi - ARBS - thiazide diuretics
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Temporal arteritis-biopsy of the temporal artery

46. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Less than 80 ml of blood
Other brainstem or cranial nerve findings
Temporal arteritis-biopsy of the temporal artery

47. What are the features of glomerular nephritis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
RBC casts and old to moderate HTN
CT
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

48. Define the patient population typically affected by orthostatic or postural proteinuria
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
Diuretics -BB -CCB -ACEi
GERD
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

49. Name 4 factors that predispose an individual to develop pneumonia.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Cluster headache
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

50. What is the difference between a Holter monitor or an event monitor?
Peptic ulcer disease or gastritis
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
Viral gastroenteritis
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