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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. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Colposcopy - Endocervical curettage - and directed cervical biopsy
Furucnle
Staphylococcal scalded skin syndrome

2. What are the symptoms of palpitations?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Lightheadedness - dizziness - syncope
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

3. What lab tests are recommended for newly diagnosed hypertensive patients?
Furucnle
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Peptic ulcer disease or gastritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

4. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Squamocolumnar junction=most common site of cervical cancer
Possibility of Ischemic colitis
MSK - pulmonary - GI - or psychological

5. What is the role of LH in the menstrual cycle
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Albumin; low molecular weight proteins
LH surge triggers ovulation

6. Diagnostic Evaluation of Abnoraml vaginal bleeding
S. Aureus
ACEi - ARBS - thiazide diuretics
Diuretics -BB -CCB -ACEi
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

7. 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
Less than 80 ml of blood
Associated with hypotension
Rotator cuff tendonitis

8. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Echocardiogram

9. What drugs do you use to treat H.pylori + PUD?
Fever with frontal or maxillary tenderness
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Intermenstrual bleeding

10. Shoulder pain with pain radiating to elbow
Fever with frontal or maxillary tenderness
Varicella virus
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Cervical radiculopathy

11. What occurs after ovulation
Echocardiogram
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A 24hr urine protein collection and urine creatinine clearance determination
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

12. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Loop diuretics (Check serum K+ levels before drug admin)

13. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Hypertension - CAD - valvular heart disease
Furucnle
ACEi - ARBS - thiazide diuretics

14. Define nephrotic range proteinuria
Supraspinatus and bicipital tendons
35 (exception for postmenopausal women who have recently been started on HRT)
Giardia
>3.5g of protein per 24hrs

15. What HPV serotypes are most commonly associated with cervical cancer?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 3 stools per week
Serotypes 16 - 18 - 31 -52 -58
Higher filling presure - pulmonary congestion - and decreasd cardiac return

16. Diarrhea from custard filled pastries
S. Aureus
Giardia
24 hour halter
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

17. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Staphylococcal scalded skin syndrome
BB or CCB - catheter ablation of identified bypass tract
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

18. History and PE for Pneumonia
Hypertension - CAD - valvular heart disease
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
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
Subarachnoid hemorrhage

19. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Subarachnoid hemorrhage
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
Rotator Cuff tendonitis

20. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per 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
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
Staphylococcal scalded skin syndrome

21. Natural history of cervical cancer
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
Squamocolumnar junction=most common site of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

22. What medications can cause heart palpitations?
LH surge triggers ovulation
PVC or Premature atrial contraction (PAC)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

23. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
S. Aureus
Chest pain during pneumonia or PE
Infectious esophagitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

24. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Irregular bleeding between cycles
MSK - pulmonary - GI - or psychological
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

25. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
ACEi
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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.

26. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Pts with palpitations and dizziness - near syncope - or syncope
Viral infection of the semicircular apparatus
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

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.
Less abrupt onset and cessation of palpitations
Tension headache
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
GERD

28. What is an acoustic neuroma?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Generalized Anxiety disorder and panic disorder

29. patients with herpes zoster may experience what symptom before the rash appear?
Pain
GERD
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

30. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Albumin; low molecular weight proteins
CT
S. aureus- beta hemolytic streptococcus
Non-cardiac causes of palpitations

31. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Viral infection of the semicircular apparatus
Analgesic headache
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

32. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Serotypes 16 - 18 - 31 -52 -58
With a KOH wet mount preparation
Loop diuretics (Check serum K+ levels before drug admin)
Polymenorrhea

33. What are the 2 psych disorders most commonly associated with palpitations?
E. Coli O157:H7
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Generalized Anxiety disorder and panic disorder
Cluster headache

34. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
PVC or Premature atrial contraction (PAC)
Impetigo
BB or CCB - catheter ablation of identified bypass tract

35. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Candida albicans
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. aureus- beta hemolytic streptococcus

36. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Furucnle
Scabies
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

37. Where does the development of abnormal cervical cells begin?
Tension headache
Viral infection of the semicircular apparatus
With a KOH wet mount preparation
Squamocolumnar junction=most common site of cervical cancer

38. What does the classic ring worm lesion have?
HIV and syphilis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
A central clear area
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

39. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Albumin; low molecular weight proteins
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
ACEi
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

40. 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
Analgesic headache
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

41. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Other brainstem or cranial nerve findings
Viral gastroenteritis

42. What is the mechanism of action for stimulant agents in treating constipation?
>150mg per 24hrs
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

43. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

44. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
24 hour halter

45. Things that need to be included in history of shoulder pain
CT
Nonulcer dyspepsia
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

46. How is constipation clinically defined?
Pancreatitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 3 stools per week
Hypertension - CAD - valvular heart disease

47. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
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
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
Menorrhagia

48. Name the skin lesion: honey colored crusts
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Variability in the time for follicle development during the proliferative phase
Impetigo

49. Pneumonia tx: suitable for healthy adults older than 60
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
EGD

50. What type of imaging is need for chronic sinusitis?
Adhesive capsulitis (frozen shoulder): most common in middle age women
EGD
CT
Cellulitis