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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. What does treatment for migrans include?
Rotator Cuff tendonitis
Regular bleeding at intervals of more than 35 days
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
Presence of proteinuria on at least two separate ocassion

2. Who should have Xray testing for shoulder pain?
A central clear area
Menorrhagia
Temporal arteritis-biopsy of the temporal artery
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

3. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Rotator Cuff problem
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pleurisy
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

4. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Diuretics -BB -CCB -ACEi
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Cervical radiculopathy

5. What is the mechanism of action for stimulant agents in treating constipation?
Viral gastroenteritis
RBC casts and old to moderate HTN
Intermenstrual bleeding
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

6. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
GERD
Giardia
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

7. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Other brainstem or cranial nerve findings
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

8. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Varicella virus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

9. History and PE for Pneumonia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
Squamocolumnar junction=most common site of cervical cancer

10. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Irregular bleeding between cycles
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Nonulcer dyspepsia

11. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Cellulitis
Viral gastroenteritis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Impetigo

12. When is a lumbar puncture contraindicated?
Hgb - Electrolytes - and TSH
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

13. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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.
Intermenstrual bleeding
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

14. Diagnostic Evaluation of Abnoraml vaginal bleeding
Paroxysmal atrial fibrillation or supraventricular tachycardia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
HPV
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

15. What are the three major risk factors for heart failure?
LH surge triggers ovulation
Possibility of Ischemic colitis
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
Hypertension - CAD - valvular heart disease

16. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
EGD
Staphylococcal scalded skin syndrome
100mg; means patient can be trace protein positive and not be detected
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

17. 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)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Regular bleeding at intervals of more than 35 days
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

18. What are the most common causes for the common cold?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Chest pain during pneumonia or PE
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Viral infection of the semicircular apparatus

19. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Regular bleeding at intervals of more than 35 days
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

20. Natural history of cervical cancer
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Loop diuretics (Check serum K+ levels before drug admin)
Excessive bleeding in amount - duration - or both at irregular intervals

21. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Less abrupt onset and cessation of palpitations
Squamocolumnar junction=most common site of cervical cancer
HPV
Cholelithiasis

22. What is considered normal blood loss during a menstrual cycle?
LH surge triggers ovulation
Analgesic headache
Less than 80 ml of blood
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

23. What are the features of glomerular nephritis
These patients are associated with low renin states=less likely to respond to medication
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
RBC casts and old to moderate HTN

24. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
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
Fever with frontal or maxillary tenderness
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
True

25. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Giardia
MSK - pulmonary - GI - or psychological
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

26. What treatments are the cornerstone for treating cases of functional constipation?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cervical radiculopathy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increasing fluid (8 - 8oz glasses of water/day) -fiber

27. Regular bleeding at intervals of less than 21 days
Adhesive capsulitis (frozen shoulder): most common in middle age women
Polymenorrhea
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Kids: Rotavirus Adults: Norwalk Virus

28. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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)

29. 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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
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

30. Define the patient population typically affected by orthostatic or postural proteinuria
Loop diuretics (Check serum K+ levels before drug admin)
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
Giardia
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

31. What is an acoustic neuroma?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Polymenorrhea
True
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

32. Define proteinuria
>150mg per 24hrs
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Kids: Rotavirus Adults: Norwalk Virus
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

33. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Subarachnoid hemorrhage
Less abrupt onset and cessation of palpitations
These patients are associated with low renin states=less likely to respond to medication
Cluster headache

34. What are symptoms are CHF?
Temporal arteritis-biopsy of the temporal artery
Anticoag with warfarin to prevent thromboembolism
Furucnle
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

35. What type of imaging is need for chronic sinusitis?
>3.5g of protein per 24hrs
Coag disorders
CT
HPV

36. What are the features of nephrotic syndrome?
Chest pain during pneumonia or PE
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Common problem that resolves spontaneously and is most often seen in children and young adults
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

37. What are the three types of lice?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
PE - MI - aortic dissection - pneumothorax

38. What is the standard tool used for diagnosis of GERD?
EGD
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Polymenorrhea
Pleurisy

39. What diagnosis does the 'worse headache of my life' suggest?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
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
Subarachnoid hemorrhage

40. What are the two common clinical presentations of acute diarrhea?
Tension headache
Furucnle
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Infectious esophagitis

41. 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.
Tension headache
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
Excessive bleeding in amount - duration - or both at irregular intervals
BB or CCB - catheter ablation of identified bypass tract

42. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Folliculitis
Coronary artery disease/ angina
Repeat Pap after infection treated
Common problem that resolves spontaneously and is most often seen in children and young adults

43. Describe the presentation of pneumonia
Possibility of Ischemic colitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

44. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Wolff-Parkinson-White syndrome
Furucnle
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.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

45. Clinical Manifestations of HTN
>150mg per 24hrs
With a KOH wet mount preparation
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

46. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
HPV
Coronary artery disease/ angina
Nonulcer dyspepsia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

47. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Folliculitis

48. Define nephrotic range proteinuria
Folliculitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
>3.5g of protein per 24hrs
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

49. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Pts with palpitations and dizziness - near syncope - or syncope
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Diuretics -BB -CCB -ACEi
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

50. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Pain
Polymenorrhea
Pleurisy

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