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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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1. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
MSK - pulmonary - GI - or psychological
Rotator Cuff problem
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

2. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Furucnle
CBC
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
>3.5g of protein per 24hrs

3. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Scleroderma/polymyositis with secondary gastroesophageal reflux
Viral gastroenteritis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

4. Difference between Pneumonia and Bronchitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

5. What the consequences of decreased cardiac output?
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Cervical radiculopathy

6. Describes what occurs during squamous metaplasia of the cervix.
>150mg per 24hrs
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Other brainstem or cranial nerve findings
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

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

8. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Infectious esophagitis
Anticoag with warfarin to prevent thromboembolism

9. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

10. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Non-cardiac causes of palpitations
True
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

11. What are the features of nephrotic syndrome?
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.
Pain
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

12. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Echocardiogram
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
Streptococci

13. What type of imaging is need for chronic sinusitis?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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.
PVC or Premature atrial contraction (PAC)
CT

14. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Irregular bleeding between cycles
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

15. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Squamocolumnar junction=most common site of cervical cancer
Infectious esophagitis
HPV
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

16. What is the peripheral caUse of vertigo?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Cervical radiculopathy
LH surge triggers ovulation

17. What is afterload?
Variability in the time for follicle development during the proliferative phase
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

18. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
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
Albumin; low molecular weight proteins
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

19. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
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

20. When should invasive eletrophysiologic study should be considered?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

21. Why is the pap smear one of the most effective cancer screening tools?
Giardia
Slow progression of cervical cancer changes -Availability of effective early treatment
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Less than 80 ml of blood

22. Define nephrotic range proteinuria
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.
Scabies
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
>3.5g of protein per 24hrs

23. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Chest pain during pneumonia or PE
RBC casts and old to moderate HTN
Staphylococcal scalded skin syndrome

24. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Bence-Jones
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

25. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Rotator Cuff problem
S. aureus- beta hemolytic streptococcus
Candida albicans

26. What should blood work include for suspected heart failure?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Less than 80 ml of blood
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

27. Name types of laxatives
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
Cellulitis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Repeat Pap after infection treated

28. What does orthostatic positional changes that bring on dizziness suggest?
Hgb - Electrolytes - and TSH
Peptic ulcer disease or gastritis
Dehydration - anemia - cardiac causes
Rotator Cuff tendonitis

29. What should preconception counseling include?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Common problem that resolves spontaneously and is most often seen in children and young adults
Hypertension - CAD - valvular heart disease
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

30. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Impetigo
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

31. Describe the presentation of angina?
MSK - pulmonary - GI - or psychological
HPV
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

32. Pneumonia tx: suitable for healthy adults older than 60
A 24hr urine protein collection and urine creatinine clearance determination
Squamocolumnar junction=most common site of cervical cancer
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

33. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Pts with palpitations and dizziness - near syncope - or syncope
Molluscum contagiosum- pox virus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

34. Uterine bleeding between regular cycles
Diuretics -BB -CCB -ACEi
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
Intermenstrual bleeding
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

35. How do you define persistent protein uria?
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
Presence of proteinuria on at least two separate ocassion
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

36. What is the Barany maneuver?
Folliculitis
S. Aureus
RBC casts and old to moderate HTN
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

37. 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
Hypertension - CAD - valvular heart disease
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.
With a KOH wet mount preparation

38. Name the skin lesion: erythema - warmth - edema - pain - fever
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cellulitis

39. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Peptic ulcer disease or gastritis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Fever with frontal or maxillary tenderness

40. What are the signs of malignant hypertension?
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
High blood pressure - focal neurologic defecit - or papilledema
Serotypes 16 - 18 - 31 -52 -58
Squamocolumnar junction=most common site of cervical cancer

41. What is the difference between a Holter monitor or an event monitor?
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
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
Possibility of Ischemic colitis

42. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
E. Coli O157:H7
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Furucnle
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

43. Constipation: What are indications for lab testing?
Temporal arteritis-biopsy of the temporal artery
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
Non-cardiac causes of palpitations
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

44. What are the three types of lice?
Menorrhagia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

45. 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
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Scabies
Medication or chemical esophagitis

46. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
S. aureus- beta hemolytic streptococcus
Pleurisy

47. What is a markers of CNS vertigo?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Hgb - Electrolytes - and TSH
Other brainstem or cranial nerve findings

48. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
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
Cluster headache
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
A 24hr urine protein collection and urine creatinine clearance determination

49. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
MSK - pulmonary - GI - or psychological
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Lightheadedness - dizziness - syncope

50. How does CHF present on X-ray?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Analgesic headache
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport