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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. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
MSK - pulmonary - GI - or psychological
Generalized Anxiety disorder and panic disorder

2. Mainstay treatment for soft tissue inflammation (Shoulder)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Squamocolumnar junction=most common site of cervical cancer
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Bulk forming: Psyllium - Methycellulose - Polycarbophil

3. What are the signs of acute sinusitis?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Colposcopy - Endocervical curettage - and directed cervical biopsy
Fever with frontal or maxillary tenderness
>3.5g of protein per 24hrs

4. When should invasive eletrophysiologic study should be considered?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
A 24hr urine protein collection and urine creatinine clearance determination
True
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

5. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Generalized Anxiety disorder and panic disorder
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

6. 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
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.
Echocardiogram
Variability in the time for follicle development during the proliferative phase

7. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Bence-Jones
Polymenorrhea
Generalized Anxiety disorder and panic disorder

8. Describe the presentation of pneumonia
Echocardiogram
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Menorrhagia
Squamocolumnar junction=most common site of cervical cancer

9. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
High blood pressure - focal neurologic defecit - or papilledema
Temporal arteritis-biopsy of the temporal artery
Colposcopy - Endocervical curettage - and directed cervical biopsy
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

10. Define proteinuria
>150mg per 24hrs
Irregular bleeding between cycles
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
CT

11. SE Of Beta blockers?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Menorrhagia
Acute headache - ataxia - profuse nausea - and vomiting
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

12. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Staphylococcal scalded skin syndrome
Coag disorders
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

13. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Less than 80 ml of blood
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.
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

14. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Adhesive capsulitis (frozen shoulder): most common in middle age women
Chest pain during pneumonia or PE
Hypertension - CAD - valvular heart disease
S. Aureus

15. After treatment of dysplasia - women need Pap smears every...
Impetigo
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
RBC casts and old to moderate HTN
Non-cardiac causes of palpitations

16. 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
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
100mg; means patient can be trace protein positive and not be detected
Tension headache
E. Coli O157:H7

17. What should be considered in younger patients with menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Rotator Cuff problem
Menorrhagia
Coag disorders

18. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
HIV and syphilis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

19. Predictors of cardiac etiology
Pleurisy
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Folliculitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

20. How are fungal infections diagnosed?
With a KOH wet mount preparation
Temporal arteritis-biopsy of the temporal artery
Generalized Anxiety disorder and panic disorder
Less than 80 ml of blood

21. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Hypertension - CAD - valvular heart disease
35 (exception for postmenopausal women who have recently been started on HRT)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

22. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Possibility of Ischemic colitis
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

23. How does CHF present on X-ray?
Squamocolumnar junction=most common site of cervical cancer
Peptic ulcer disease or gastritis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Common problem that resolves spontaneously and is most often seen in children and young adults

24. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
ACEi - ARBS - thiazide diuretics
Irregular bleeding between cycles
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

25. History for Sinusitis

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26. MI - pericardial tamponade - PE - GI bleed - are...
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
A 24hr urine protein collection and urine creatinine clearance determination
Associated with hypotension
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

27. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

28. What are the indiciations for neuroimaging?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Regular bleeding at intervals of more than 35 days
Scleroderma/polymyositis with secondary gastroesophageal reflux

29. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
A 24hr urine protein collection and urine creatinine clearance determination
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
HPV

30. Carcinoma in situ is generally referred to a gynecologist and requires ______
Streptococci
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
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

31. What are symptoms are CHF?
Furucnle
A 24hr urine protein collection and urine creatinine clearance determination
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

32. Describe the presentation tracheobronchitis
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
Upper sternal area burning pain - associated with a productive cough
Rotator cuff tendonitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

33. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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
Giardia
Streptococci
Adhesive capsulitis (frozen shoulder): most common in middle age women

34. Initial treatment for Rhinosinusitis
Menorrhagia
Candida albicans
Varicella virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

35. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Bulk forming: Psyllium - Methycellulose - Polycarbophil

36. What is the peripheral caUse of vertigo?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Upper sternal area burning pain - associated with a productive cough
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Tension headache

37. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Dehydration - anemia - cardiac causes
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Staphylococcal scalded skin syndrome
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

38. What does treatment for migrans include?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Upper sternal area burning pain - associated with a productive cough
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

39. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Generalized Anxiety disorder and panic disorder
Bulk forming: Psyllium - Methycellulose - Polycarbophil
DM - HTN - DVT - seizures - depression - or anxiety
Less than 3 stools per week

40. What drugs do you use to treat H.pylori + PUD?
Anticoag with warfarin to prevent thromboembolism
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
HPV
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

41. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
MSK - pulmonary - GI - or psychological
Analgesic headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. What are the signs of cerebral hemorrhage?
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
Acute headache - ataxia - profuse nausea - and vomiting
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Supraspinatus and bicipital tendons

43. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Less than 80 ml of blood
MSK - pulmonary - GI - or psychological
Wolff-Parkinson-White syndrome
Temporal arteritis-biopsy of the temporal artery

44. Isolated - extra pounding beats
Intermenstrual bleeding
Coronary artery disease/ angina
PVC or Premature atrial contraction (PAC)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

45. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Infectious esophagitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pancreatitis

46. What are the secondly causes of glomerular disease?
E. Coli O157:H7
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Folliculitis

47. What are the primary glomerular diseases?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Coronary artery disease/ angina
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
>150mg per 24hrs

48. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
PVC or Premature atrial contraction (PAC)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Presence of proteinuria on at least two separate ocassion

49. Pneumonia tx: suitable for healthy adults older than 60
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Furucnle
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

50. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Subarachnoid hemorrhage
Furucnle
Infectious esophagitis