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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 is the Epley maneuver?
Other brainstem or cranial nerve findings
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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Hypertension - CAD - valvular heart disease

2. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Tension headache
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

3. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Generalized Anxiety disorder and panic disorder
Diuretics -BB -CCB -ACEi
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Possibility of Ischemic colitis

4. What are the features of nephrotic syndrome?
Chest pain during pneumonia or PE
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
S. Aureus
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

5. Describe the presentation of myocardial pain?
CBC
Non-cardiac causes of palpitations
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

6. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Pts with palpitations and dizziness - near syncope - or syncope
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

7. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Pts with palpitations and dizziness - near syncope - or syncope
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
S. aureus- beta hemolytic streptococcus

8. Carcinoma in situ is generally referred to a gynecologist and requires ______
Cluster headache
Fever with frontal or maxillary tenderness
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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

9. Pneumonia tx: suitable for healthy adults older than 60
24 hour halter
Associated with hypotension
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV testing -Pos=colposcopy -Neg=repeat pap smear

10. What is considered normal blood loss during a menstrual cycle?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Less than 80 ml of blood
Cervical radiculopathy

11. What medications can cause heart palpitations?
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
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

12. 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
S. Aureus
ACEi
Warts
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

13. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Intermenstrual bleeding
Giardia
LH surge triggers ovulation
Candida albicans

14. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Regular bleeding at intervals of more than 35 days
Bence-Jones
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

15. What is the preload?
Streptococci
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

16. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

17. Describe the presentation of pericardial pain
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

18. 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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV testing -Pos=colposcopy -Neg=repeat pap smear
100mg; means patient can be trace protein positive and not be detected

19. When should a patient get a stress test?
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
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Adhesive capsulitis (frozen shoulder): most common in middle age women

20. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

21. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Diuretics -BB -CCB -ACEi
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
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
Other brainstem or cranial nerve findings

22. Predictors of cardiac etiology
Loop diuretics (Check serum K+ levels before drug admin)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

23. What are the consequences of diastolic dysfunction?
Adhesive capsulitis (frozen shoulder): most common in middle age 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
Coag disorders
Higher filling presure - pulmonary congestion - and decreasd cardiac return

24. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Nonulcer dyspepsia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

25. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
MSK - pulmonary - GI - or psychological

26. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
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
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

27. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
With a KOH wet mount preparation
Less than 3 stools per week
24 hour halter

28. What are the most common causes for the common cold?
Peptic ulcer disease or gastritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

29. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Irregular bleeding between cycles
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
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

30. Tx of chronic or intermittent afibs
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
PVC or Premature atrial contraction (PAC)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Anticoag with warfarin to prevent thromboembolism

31. What are the features of glomerular nephritis
Diuretics -BB -CCB -ACEi
RBC casts and old to moderate HTN
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

32. Name types of laxatives
These patients are associated with low renin states=less likely to respond to medication
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

33. Where does the development of abnormal cervical cells begin?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Excessive bleeding in amount - duration - or both at irregular intervals
Squamocolumnar junction=most common site of cervical cancer

34. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

35. Diagnostic Evaluation of Abnoraml vaginal bleeding
High blood pressure - focal neurologic defecit - or papilledema
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

36. Things that need to be included in history of shoulder pain
ACEi - ARBS - thiazide diuretics
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Wolff-Parkinson-White syndrome

37. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Menorrhagia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cholelithiasis
CBC

38. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

39. 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
Warts
HIV and syphilis
Less abrupt onset and cessation of palpitations

40. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Rotator Cuff problem
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
LH surge triggers ovulation

41. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Infectious esophagitis
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

42. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
24 hour halter
MSK - pulmonary - GI - or psychological
Anticoag with warfarin to prevent thromboembolism

43. Prenatal visit schedule for low-risk pregnancies
Hgb - Electrolytes - and TSH
Rotator Cuff tendonitis
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

44. Uterine bleeding between regular cycles
Warts
Intermenstrual bleeding
Generalized Anxiety disorder and panic disorder
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

45. 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
Slow progression of cervical cancer changes -Availability of effective early treatment
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
A 24hr urine protein collection and urine creatinine clearance determination

46. What are the signs of cerebral hemorrhage?
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Acute headache - ataxia - profuse nausea - and vomiting

47. What the consequences of decreased cardiac output?
Increase; 200 g/day
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
Coag disorders
HPV testing -Pos=colposcopy -Neg=repeat pap smear

48. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
A 24hr urine protein collection and urine creatinine clearance determination
Regular bleeding at intervals of more than 35 days
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Nonulcer dyspepsia

49. 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
Furucnle
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
Dehydration - anemia - cardiac causes

50. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
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