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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 pericardial pain
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Coag disorders
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

2. When should invasive eletrophysiologic study should be considered?
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.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow - secretion of mucus - and bicarbonate. Without these protective factors - acid-induced inflammation and ulcers my result.
Possibility of Ischemic colitis

3. What test done in PE measures instability of shoulder?
Medication or chemical esophagitis
Increase; 200 g/day
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

4. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
Polymenorrhea
Cervical radiculopathy
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. 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.
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
Tension headache
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
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

6. What are the common causes for laryngitis?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Warts
Influenza - Rhinovirus - Adenovirus - Parainfluenza

7. What are the three types of lice?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

8. Predictors of cardiac etiology
Less abrupt onset and cessation of palpitations
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

9. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Diuretics -BB -CCB -ACEi
Echocardiogram
ACEi - ARBS - thiazide diuretics

10. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Squamocolumnar junction=most common site of cervical cancer
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
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.
Pleurisy

11. Difference between Pneumonia and Bronchitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Intermenstrual bleeding
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

12. 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
Nonulcer dyspepsia
Diuretics -BB -CCB -ACEi
True
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

13. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow - secretion of mucus - and bicarbonate. Without these protective factors - acid-induced inflammation and ulcers my result.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

14. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
HPV
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

15. What is the caUse of Meniere disease? What are the cardinal symptoms?
Pleurisy
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
MSK - pulmonary - GI - or psychological
Higher filling presure - pulmonary congestion - and decreasd cardiac return

16. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

17. What occurs after ovulation
Regular bleeding at intervals of more than 35 days
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Echocardiogram
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

18. PE for a patient getting an abnormal vaginal bleeding work up
Pancreatitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Cholelithiasis

19. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
35 (exception for postmenopausal women who have recently been started on HRT)
Giardia
>3.5g of protein per 24hrs

20. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

21. What are the signs of acute sinusitis?
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
Fever with frontal or maxillary tenderness
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

22. 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)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Hgb - Electrolytes - and TSH
Dehydration - anemia - cardiac causes

23. How does systolic vs. diastolic heart failure present on the echocardiogram?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

24. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Cluster headache
Viral infection of the semicircular apparatus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

25. What are the most common causes for the common cold?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Dehydration - anemia - cardiac causes
Viral gastroenteritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

26. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Warts
Rotator Cuff tendonitis

27. Define proteinuria
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
Menorrhagia
Higher filling presure - pulmonary congestion - and decreasd cardiac return
>150mg per 24hrs

28. Metrorrhagia
Pancreatitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Irregular bleeding between cycles
Varicella virus

29. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Folliculitis
Hypertension - CAD - valvular heart disease
Chest pain during pneumonia or PE
Medication or chemical esophagitis

30. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Medication or chemical esophagitis
Echocardiogram
Bulk forming: Psyllium - Methycellulose - Polycarbophil

31. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
EGD
Viral infection of the semicircular apparatus

32. Name the skin lesion: honey colored crusts
Impetigo
Folliculitis
Slow progression of cervical cancer changes -Availability of effective early treatment
Increase; 200 g/day

33. What are signs of pulmonary congestion?
Squamocolumnar junction=most common site of cervical cancer
Giardia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

34. What is the mechanism of action for stimulant agents in treating constipation?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

35. At was quantity does urine dipstick test detect elevated protein?
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
100mg; means patient can be trace protein positive and not be detected
Less abrupt onset and cessation of palpitations
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

36. What does orthostatic positional changes that bring on dizziness suggest?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Dehydration - anemia - cardiac causes
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
Regular bleeding at intervals of more than 35 days

37. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Variability in the time for follicle development during the proliferative phase
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

38. What drugs do you use to treat H.pylori + PUD?
Viral infection of the semicircular apparatus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Excessive bleeding in amount - duration - or both at irregular intervals
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

39. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Analgesic headache
Non-cardiac causes of palpitations
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pleurisy

40. Diarrhea from custard filled pastries
Irregular bleeding between cycles
S. Aureus
E. Coli O157:H7
Dehydration - anemia - cardiac causes

41. How are fungal infections diagnosed?
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
With a KOH wet mount preparation
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

42. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
35 (exception for postmenopausal women who have recently been started on HRT)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

43. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Irregular bleeding between cycles
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Upper sternal area burning pain - associated with a productive cough

44. What are the physical exam signs of CHF?
Cluster headache
Echocardiogram
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
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

45. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Warts
Pts with palpitations and dizziness - near syncope - or syncope
ACEi

46. What places women at higher risk of getting cervical cancer?
EGD
Analgesic headache
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

47. What is the preload?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Coronary artery disease/ angina
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Giardia

48. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Coag disorders
Non-cardiac causes of palpitations
S. aureus- beta hemolytic streptococcus
ACEi

49. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Varicella virus
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

50. What is the peripheral caUse of vertigo?
Folliculitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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