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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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 should be considered in younger patients with menorrhagia
Staphylococcal scalded skin syndrome
Coag disorders
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
Medication or chemical esophagitis

2. 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)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Rotator Cuff tendonitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

3. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
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.
Albumin; low molecular weight proteins
Rotator Cuff problem

4. Name the skin lesion: honey colored crusts
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
Impetigo
Albumin; low molecular weight proteins
ACEi - ARBS - thiazide diuretics

5. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Echocardiogram
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
100mg; means patient can be trace protein positive and not be detected

6. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HPV

7. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

8. Metrorrhagia
High blood pressure - focal neurologic defecit - or papilledema
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Irregular bleeding between cycles
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

9. patients with herpes zoster may experience what symptom before the rash appear?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Wolff-Parkinson-White syndrome
Intermenstrual bleeding
Pain

10. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Pain
Non-cardiac causes of palpitations
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
Temporal arteritis-biopsy of the temporal artery

11. How does CHF present on X-ray?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
PVC or Premature atrial contraction (PAC)
Temporal arteritis-biopsy of the temporal artery
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

12. What occurs after ovulation
E. Coli O157:H7
Streptococci
HPV
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

13. 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.
CT
Presence of proteinuria on at least two separate ocassion
Tension headache
Pts with palpitations and dizziness - near syncope - or syncope

14. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Presence of proteinuria on at least two separate ocassion
Albumin; low molecular weight proteins
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

15. Pneumonia tx: suitable for healthy adults less than 60
Diuretics -BB -CCB -ACEi
Fever with frontal or maxillary tenderness
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

16. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Serotypes 16 - 18 - 31 -52 -58
Medication or chemical esophagitis
35 (exception for postmenopausal women who have recently been started on HRT)
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

17. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Cellulitis

18. What is the goal of CHF treatment? What drugs should be used?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Subarachnoid hemorrhage
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

19. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
Impetigo
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

20. What is the caUse of Meniere disease? What are the cardinal symptoms?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Possibility of Ischemic colitis

21. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Staphylococcal scalded skin syndrome
Pleurisy
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

22. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Possibility of Ischemic colitis
With a KOH wet mount preparation
Acute headache - ataxia - profuse nausea - and vomiting

23. What does orthostatic positional changes that bring on dizziness suggest?
ACEi - ARBS - thiazide diuretics
Dehydration - anemia - cardiac causes
RBC casts and old to moderate HTN
Pleurisy

24. Why is the pap smear one of the most effective cancer screening tools?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Slow progression of cervical cancer changes -Availability of effective early treatment
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

25. How to NSAIDs contribute to gastritis and ulcer formation?
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
Coag disorders
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.
Tension headache

26. Clinical Manifestations of HTN
Streptococci
Possibility of Ischemic colitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

27. Oligomenorrhea
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

28. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Anticoag with warfarin to prevent thromboembolism
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
PE - MI - aortic dissection - pneumothorax
Analgesic headache

29. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Wolff-Parkinson-White syndrome
S. aureus- beta hemolytic streptococcus
Temporal arteritis-biopsy of the temporal artery

30. What are the indiciations for neuroimaging?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
A central clear area

31. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
S. aureus- beta hemolytic streptococcus
Pancreatitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Supraspinatus and bicipital tendons

32. 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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Scabies
Polymenorrhea
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

33. Name some medications that can cause proteinuria
Wolff-Parkinson-White syndrome
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

34. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Adhesive capsulitis (frozen shoulder): most common in middle age women
PE - MI - aortic dissection - pneumothorax

35. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Lightheadedness - dizziness - syncope
HPV testing -Pos=colposcopy -Neg=repeat pap smear
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

36. Name types of laxatives
Candida albicans
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

37. Cycle length variabilty is primarily due to what?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Variability in the time for follicle development during the proliferative phase
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.
Cellulitis

38. What are the features of nephrotic syndrome?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

39. How are fungal infections diagnosed?
With a KOH wet mount preparation
Non-cardiac causes of palpitations
Colposcopy - Endocervical curettage - and directed cervical biopsy
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

40. What are the signs of malignant hypertension?
ACEi
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

41. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Scleroderma/polymyositis with secondary gastroesophageal reflux
Nonulcer dyspepsia
Kids: Rotavirus Adults: Norwalk Virus
S. Aureus

42. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
These patients are associated with low renin states=less likely to respond to medication
Staphylococcal scalded skin syndrome

43. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Rotator Cuff problem
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator cuff tendonitis

44. What is afterload?
S. Aureus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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.
Peptic ulcer disease or gastritis

45. Name the skin lesion: erythema - warmth - edema - pain - fever
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Cellulitis
Presence of proteinuria on at least two separate ocassion
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

46. name the 4 emergent causes of chest pain
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
PE - MI - aortic dissection - pneumothorax
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

47. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Bence-Jones
LH surge triggers ovulation
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.

48. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral infection of the semicircular apparatus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Fever with frontal or maxillary tenderness

49. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Repeat Pap after infection treated
>150mg per 24hrs
DM - HTN - DVT - seizures - depression - or anxiety

50. What treatments are the cornerstone for treating cases of functional constipation?
LH surge triggers ovulation
Echocardiogram
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Scleroderma/polymyositis with secondary gastroesophageal reflux

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