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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 pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
DM - HTN - DVT - seizures - depression - or anxiety
Nonulcer dyspepsia
These patients are associated with low renin states=less likely to respond to medication

2. What are the physical exam signs of CHF?
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

3. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
MSK - pulmonary - GI - or psychological
With a KOH wet mount preparation
Non-cardiac causes of palpitations

4. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Polymenorrhea
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

5. What treatments are the cornerstone for treating cases of functional constipation?
A central clear area
With a KOH wet mount preparation
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Diuretics -BB -CCB -ACEi

6. SE Of Beta blockers?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
DM - HTN - DVT - seizures - depression - or anxiety

7. What type of imaging is need for chronic sinusitis?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
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
CT

8. Uterine bleeding between regular cycles
Intermenstrual bleeding
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

9. 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
S. aureus- beta hemolytic streptococcus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Molluscum contagiosum- pox virus
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

10. Irregular cycles with excessive flow - duration - or both
Pleurisy
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
Hgb - Electrolytes - and TSH
Menorrhagia

11. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

12. What are the two common clinical presentations of acute diarrhea?
A central clear area
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

13. How can GERD (or esophageal motility disorders) lead to chest pain?
Repeat Pap after infection treated
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
35 (exception for postmenopausal women who have recently been started on HRT)

14. Complete the sentence: pericarditis can cause frictional rub and......
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
Medication or chemical esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

15. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
E. Coli O157:H7

16. Name the skin lesion: erythema - warmth - edema - pain - fever
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.
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
Candida albicans
Cellulitis

17. Cycle length variabilty is primarily due to what?
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
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
Variability in the time for follicle development during the proliferative phase
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

18. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Less abrupt onset and cessation of palpitations
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

19. Diagnosis of HTN
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
These patients are associated with low renin states=less likely to respond to medication
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

20. Name 4 factors that predispose an individual to develop pneumonia.
Fever with frontal or maxillary tenderness
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

21. Describe the history and PE of patient presenting with common cold
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
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
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
BB or CCB - catheter ablation of identified bypass tract

22. What is the Barany maneuver?
Pts with palpitations and dizziness - near syncope - or syncope
EGD
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
RBC casts and old to moderate HTN

23. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
High blood pressure - focal neurologic defecit - or papilledema
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
CBC

24. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
PE - MI - aortic dissection - pneumothorax
LH surge triggers ovulation
Bence-Jones
GERD

25. 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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

26. At was quantity does urine dipstick test detect elevated protein?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase; 200 g/day
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
100mg; means patient can be trace protein positive and not be detected

27. 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.
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
Tension headache
Coag disorders
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

28. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
>3.5g of protein per 24hrs
LH surge triggers ovulation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

29. What are the symptoms of palpitations?
Infectious esophagitis
Non-cardiac causes of palpitations
Lightheadedness - dizziness - syncope
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

30. Four muscles of rotator cuff
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

31. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Polymenorrhea

32. Oligomenorrhea
Supraspinatus and bicipital tendons
Regular bleeding at intervals of more than 35 days
Rotator Cuff tendonitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

33. How do you know if heart palpitations are due to stimulant or medication use?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Less abrupt onset and cessation of palpitations
PE - MI - aortic dissection - pneumothorax
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

34. How do you define persistent protein uria?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Presence of proteinuria on at least two separate ocassion
Cluster headache
Squamocolumnar junction=most common site of cervical cancer

35. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Infectious esophagitis
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

36. Diarrhea from custard filled pastries
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. Aureus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

37. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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
Chest pain during pneumonia or PE
Temporal arteritis-biopsy of the temporal artery
With a KOH wet mount preparation

38. Vaccines that should be updated before planned pregnancy
>3.5g of protein per 24hrs
Folliculitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
GERD

39. Name some medications that can cause proteinuria
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
HPV
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

40. Things that need to be included in history of shoulder pain
Molluscum contagiosum- pox virus
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

41. When should invasive eletrophysiologic study should be considered?
35 (exception for postmenopausal women who have recently been started on HRT)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Echocardiogram
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

42. When should a patient get a stress test?
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
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Rotator Cuff tendonitis

43. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Cholelithiasis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
LH surge triggers ovulation

44. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Loop diuretics (Check serum K+ levels before drug admin)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

45. What is the standard tool used for diagnosis of GERD?
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Paroxysmal atrial fibrillation or supraventricular tachycardia
EGD

46. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
ACEi
BB or CCB - catheter ablation of identified bypass tract
Possibility of Ischemic colitis

47. History for Sinusitis

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48. What is afterload?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Echocardiogram
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

49. Define nephrotic range proteinuria
Other brainstem or cranial nerve findings
>3.5g of protein per 24hrs
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.
BB or CCB - catheter ablation of identified bypass tract

50. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions