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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. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Anticoag with warfarin to prevent thromboembolism

2. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Upper sternal area burning pain - associated with a productive cough
Giardia
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

3. What does orthostatic positional changes that bring on dizziness suggest?
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
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
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
Dehydration - anemia - cardiac causes

4. 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
S. aureus- beta hemolytic streptococcus
Subarachnoid hemorrhage
100mg; means patient can be trace protein positive and not be detected

5. Define the patient population typically affected by orthostatic or postural proteinuria
A 24hr urine protein collection and urine creatinine clearance determination
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

6. Mainstay treatment for soft tissue inflammation (Shoulder)
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
Irregular bleeding between cycles
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Adhesive capsulitis (frozen shoulder): most common in middle age women

7. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Adhesive capsulitis (frozen shoulder): most common in middle age women
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Supraspinatus and bicipital tendons
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

8. Name the skin lesion: erythema - warmth - edema - pain - fever
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.
Acute headache - ataxia - profuse nausea - and vomiting
Cellulitis
S. aureus- beta hemolytic streptococcus

9. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
A central clear area
Colposcopy - Endocervical curettage - and directed cervical biopsy
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

10. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Supraspinatus and bicipital tendons
Peptic ulcer disease or gastritis
Cellulitis

11. Where does the development of abnormal cervical cells begin?
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
100mg; means patient can be trace protein positive and not be detected
Squamocolumnar junction=most common site of cervical cancer
Pancreatitis

12. Prenatal visit schedule for low-risk pregnancies
Rotator Cuff problem
Pts with palpitations and dizziness - near syncope - or syncope
Lightheadedness - dizziness - syncope
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

13. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Diuretics -BB -CCB -ACEi
Nonulcer dyspepsia
Menorrhagia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

14. How does CHF present on X-ray?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Lightheadedness - dizziness - syncope
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

15. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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. SE Of Beta blockers?
With a KOH wet mount preparation
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.

17. What are the most common causes for the common cold?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Fever with frontal or maxillary tenderness

18. What should preconception counseling include?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
True
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

19. What is the goal of CHF treatment? What drugs should be used?
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
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
Albumin; low molecular weight proteins
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

20. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
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
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

21. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Bence-Jones
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
Excessive bleeding in amount - duration - or both at irregular intervals

22. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
High blood pressure - focal neurologic defecit - or papilledema
ACEi
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

23. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Polymenorrhea

24. Vaccines that should be updated before planned pregnancy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
PE - MI - aortic dissection - pneumothorax

25. Name types of laxatives
Viral infection of the semicircular apparatus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

26. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
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.
PVC or Premature atrial contraction (PAC)
Intermenstrual bleeding
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

27. Describes what occurs during squamous metaplasia of the cervix.
Intermenstrual bleeding
Pain
PVC or Premature atrial contraction (PAC)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

28. Complete the sentence: pericarditis can cause frictional rub and......
Tension headache
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Intermenstrual bleeding
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

29. Diagnosis of HTN
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

30. Constipation: What are indications for lab testing?
Molluscum contagiosum- pox 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
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
Dehydration - anemia - cardiac causes

31. Cycle length variabilty is primarily due to what?
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
Variability in the time for follicle development during the proliferative phase
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Rotator cuff tendonitis

32. What is the mechanism of action for stimulant agents in treating constipation?
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
>3.5g of protein per 24hrs
Infectious esophagitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

33. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Folliculitis
Cholelithiasis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Increase; 200 g/day

34. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
PVC or Premature atrial contraction (PAC)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

35. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Bence-Jones
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

36. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

37. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
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
Peptic ulcer disease or gastritis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

38. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Candida albicans
HPV
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
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

39. What HPV serotypes are most commonly associated with cervical cancer?
High blood pressure - focal neurologic defecit - or papilledema
Serotypes 16 - 18 - 31 -52 -58
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Giardia

40. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Associated with hypotension
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

41. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Temporal arteritis-biopsy of the temporal artery
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Pleurisy

42. 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
ACEi - ARBS - thiazide diuretics
Cluster headache
E. Coli O157:H7
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. What type of imaging is need for chronic sinusitis?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
CT
Rotator cuff tendonitis
Pleurisy

44. What are the features of glomerular nephritis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Coag disorders
RBC casts and old to moderate HTN

45. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pancreatitis
S. aureus- beta hemolytic streptococcus

46. Pneumonia tx: suitable for healthy adults less than 60
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Impetigo

47. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Loop diuretics (Check serum K+ levels before drug admin)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

48. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Generalized Anxiety disorder and panic disorder
Cluster headache
Temporal arteritis-biopsy of the temporal artery
ACEi - ARBS - thiazide diuretics

49. Menometrorrhagia
Infectious esophagitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Excessive bleeding in amount - duration - or both at irregular intervals
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

50. What is the caUse of benign positional vertigo?
PE - MI - aortic dissection - pneumothorax
True
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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.