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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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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?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Echocardiogram

2. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Serotypes 16 - 18 - 31 -52 -58
Increase; 200 g/day
Polymenorrhea
Non-cardiac causes of palpitations

3. MI - pericardial tamponade - PE - GI bleed - are...
Menorrhagia
Associated with hypotension
GERD
These patients are associated with low renin states=less likely to respond to medication

4. At was quantity does urine dipstick test detect elevated protein?
PVC or Premature atrial contraction (PAC)
Common problem that resolves spontaneously and is most often seen in children and young adults
High blood pressure - focal neurologic defecit - or papilledema
100mg; means patient can be trace protein positive and not be detected

5. 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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Dehydration - anemia - cardiac causes
With a KOH wet mount preparation
Warts

6. Define the patient population typically affected by orthostatic or postural proteinuria
Irregular bleeding between cycles
Chest pain during pneumonia or PE
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

7. When does troponin rise following myocardial injury or infarction?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Associated with hypotension
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

8. Why don't ACEi work well for the elderly and African Americans when treating HTN?
BB or CCB - catheter ablation of identified bypass tract
These patients are associated with low renin states=less likely to respond to medication
Upper sternal area burning pain - associated with a productive cough
Scleroderma/polymyositis with secondary gastroesophageal reflux

9. Four muscles of rotator cuff
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
HPV testing -Pos=colposcopy -Neg=repeat pap smear
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

10. Natural history of cervical cancer
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
A central clear area

11. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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
HPV
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

12. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Impetigo
Furucnle
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Echocardiogram

13. name the 4 emergent causes of chest pain
Dehydration - anemia - cardiac causes
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Scleroderma/polymyositis with secondary gastroesophageal reflux
PE - MI - aortic dissection - pneumothorax

14. Tx of chronic or intermittent afibs
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
Anticoag with warfarin to prevent thromboembolism
Viral gastroenteritis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

15. What HPV serotypes are most commonly associated with cervical cancer?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Serotypes 16 - 18 - 31 -52 -58
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Hgb - Electrolytes - and TSH

16. Clinical Manifestations of HTN
Common problem that resolves spontaneously and is most often seen in children and young adults
Medication or chemical esophagitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

17. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Less than 3 stools per week
Regular bleeding at intervals of more than 35 days
Temporal arteritis-biopsy of the temporal artery

18. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Menorrhagia
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
Molluscum contagiosum- pox virus

19. Describe the presentation tracheobronchitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Upper sternal area burning pain - associated with a productive cough
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

20. Pneumonia tx: suitable for healthy adults older than 60
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
S. Aureus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

21. Menometrorrhagia
Hgb - Electrolytes - and TSH
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Excessive bleeding in amount - duration - or both at irregular intervals
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

22. How does CHF present on X-ray?
Giardia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

23. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
EGD
Common problem that resolves spontaneously and is most often seen in children and young adults
Less than 3 stools per week

24. What are the indiciations for neuroimaging?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

25. 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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
E. Coli O157:H7
Subarachnoid hemorrhage
Varicella virus

26. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Intermenstrual bleeding
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
Cholelithiasis

27. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scleroderma/polymyositis with secondary gastroesophageal reflux
S. aureus- beta hemolytic streptococcus

28. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
>150mg per 24hrs
MSK - pulmonary - GI - or psychological
True

29. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Infectious esophagitis
Analgesic headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

30. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Menorrhagia
A central clear area
Polymenorrhea
ACEi

31. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Cellulitis
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
Irregular bleeding between cycles

32. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Streptococci
Loop diuretics (Check serum K+ levels before drug admin)
BB or CCB - catheter ablation of identified bypass tract
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.

33. How do you define persistent protein uria?
True
Presence of proteinuria on at least two separate ocassion
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Scleroderma/polymyositis with secondary gastroesophageal reflux

34. Define nephrotic range proteinuria
E. Coli O157:H7
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
RBC casts and old to moderate HTN
>3.5g of protein per 24hrs

35. What are the three types of lice?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
HPV testing -Pos=colposcopy -Neg=repeat pap smear
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

36. What type of imaging is need for chronic sinusitis?
CT
A 24hr urine protein collection and urine creatinine clearance determination
Furucnle
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

37. History for Acute bronchitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Dehydration - anemia - cardiac causes
Rotator Cuff tendonitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

38. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Variability in the time for follicle development during the proliferative phase
DM - HTN - DVT - seizures - depression - or anxiety
Streptococci
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

39. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
A 24hr urine protein collection and urine creatinine clearance determination
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

40. What are the consequences of diastolic dysfunction?
Irregular bleeding between cycles
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Less than 80 ml of blood

41. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
Candida albicans
Staphylococcal scalded skin syndrome
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

42. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
CBC
Bence-Jones
DM - HTN - DVT - seizures - depression - or anxiety
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

43. History and PE for Pneumonia
Fever with frontal or maxillary tenderness
Candida albicans
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
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

44. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
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
35 (exception for postmenopausal women who have recently been started on HRT)
ACEi

45. When should invasive eletrophysiologic study should be considered?
Cellulitis
Lightheadedness - dizziness - syncope
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Hgb - Electrolytes - and TSH

46. Name some medications that can cause proteinuria
S. Aureus
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
BB or CCB - catheter ablation of identified bypass tract

47. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
MSK - pulmonary - GI - or psychological
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
RBC casts and old to moderate HTN

48. How does systolic vs. diastolic heart failure present on the echocardiogram?
Viral gastroenteritis
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
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

49. What are signs of pulmonary congestion?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Medication or chemical esophagitis
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

50. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Dehydration - anemia - cardiac causes
Molluscum contagiosum- pox virus
Cluster headache
HPV testing -Pos=colposcopy -Neg=repeat pap smear

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