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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 role of LH in the menstrual cycle
Diuretics -BB -CCB -ACEi
LH surge triggers ovulation
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Slow progression of cervical cancer changes -Availability of effective early treatment

2. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
>3.5g of protein per 24hrs
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
PE - MI - aortic dissection - pneumothorax

3. History for Sinusitis

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4. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
E. Coli O157:H7
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cholelithiasis

5. What does the classic ring worm lesion have?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A central clear area

6. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Furucnle
Viral gastroenteritis
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

7. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
ACEi - ARBS - thiazide diuretics
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
Hgb - Electrolytes - and TSH

8. Diagnostic Evaluation of Abnoraml vaginal bleeding
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
S. aureus- beta hemolytic streptococcus

9. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Kids: Rotavirus Adults: Norwalk Virus

10. Name types of laxatives
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

11. Regular bleeding at intervals of less than 21 days
Polymenorrhea
True
High blood pressure - focal neurologic defecit - or papilledema
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

12. How does CHF present on X-ray?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Furucnle
Nonulcer dyspepsia

13. Natural history of cervical cancer
S. aureus- beta hemolytic streptococcus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Albumin; low molecular weight proteins
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

14. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Less abrupt onset and cessation of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Viral infection of the semicircular apparatus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

15. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Anticoag with warfarin to prevent thromboembolism
LH surge triggers ovulation
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

16. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

17. 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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Colposcopy - Endocervical curettage - and directed cervical biopsy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

18. How do you know if heart palpitations are due to stimulant or medication use?
Furucnle
Chest pain during pneumonia or PE
Less abrupt onset and cessation of palpitations
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

19. Name the skin lesion: honey colored crusts
Excessive bleeding in amount - duration - or both at irregular intervals
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Impetigo
Less than 80 ml of blood

20. When does troponin rise following myocardial injury or infarction?
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
Bence-Jones
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

21. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

22. At was quantity does urine dipstick test detect elevated protein?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
100mg; means patient can be trace protein positive and not be detected
Paroxysmal atrial fibrillation or supraventricular tachycardia

23. Chronic pain and shoulder stiffness with limited motion
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Adhesive capsulitis (frozen shoulder): most common in middle age women

24. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
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
Echocardiogram
100mg; means patient can be trace protein positive and not be detected

25. What is afterload?
Acute headache - ataxia - profuse nausea - and vomiting
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
S. aureus- beta hemolytic streptococcus
E. Coli O157:H7

26. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

27. Things that need to be included in history of shoulder pain
>150mg per 24hrs
CT
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

28. Constipation: What are indications for lab testing?
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
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
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
GERD

29. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Kids: Rotavirus Adults: Norwalk Virus
Loop diuretics (Check serum K+ levels before drug admin)
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

30. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Medication or chemical esophagitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
MSK - pulmonary - GI - or psychological
Loop diuretics (Check serum K+ levels before drug admin)

31. Initial treatment for Rhinosinusitis
Streptococci
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
GERD

32. What are the most common causes for the common cold?
True
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

33. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
True
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Diuretics -BB -CCB -ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

34. 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
Intermenstrual bleeding
Molluscum contagiosum- pox virus
Possibility of Ischemic colitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

35. 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
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
Squamocolumnar junction=most common site of cervical cancer
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

36. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
100mg; means patient can be trace protein positive and not be detected

37. What treatments are the cornerstone for treating cases of functional constipation?
24 hour halter
MSK - pulmonary - GI - or psychological
Fever with frontal or maxillary tenderness
Increasing fluid (8 - 8oz glasses of water/day) -fiber

38. name the 4 emergent causes of chest pain
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
PE - MI - aortic dissection - pneumothorax
Polymenorrhea
Upper sternal area burning pain - associated with a productive cough

39. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Common problem that resolves spontaneously and is most often seen in children and young adults
GERD
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

40. What the consequences of decreased cardiac output?
Associated with hypotension
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Hgb - Electrolytes - and TSH

41. What does treatment for migrans include?
Dehydration - anemia - cardiac causes
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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

42. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Molluscum contagiosum- pox virus
Serotypes 16 - 18 - 31 -52 -58
Bence-Jones

43. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Peptic ulcer disease or gastritis
Colposcopy - Endocervical curettage - and directed cervical biopsy
ACEi - ARBS - thiazide diuretics

44. PE for a patient getting an abnormal vaginal bleeding work up
With a KOH wet mount preparation
Rotator cuff tendonitis
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

45. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Less than 80 ml of blood
Non-cardiac causes of palpitations
ACEi
Loop diuretics (Check serum K+ levels before drug admin)

46. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Bence-Jones
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Irregular bleeding between cycles

47. Why is the pap smear one of the most effective cancer screening tools?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Furucnle
Intermenstrual bleeding
Slow progression of cervical cancer changes -Availability of effective early treatment

48. Describe the presentation of pneumonia
Candida albicans
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

49. Prenatal visit schedule for low-risk pregnancies
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Candida albicans
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

50. After treatment of dysplasia - women need Pap smears every...
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually