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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 standard tool used for diagnosis of GERD?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
EGD
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

2. Pneumonia tx: suitable for healthy adults older than 60
Rotator cuff tendonitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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.
HPV testing -Pos=colposcopy -Neg=repeat pap smear

3. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Echocardiogram
CBC
When the patient has symptoms in association with exercise or who describe chest pain or pressure

4. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Repeat Pap after infection treated
Viral infection of the semicircular apparatus
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
Variability in the time for follicle development during the proliferative phase

5. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
35 (exception for postmenopausal women who have recently been started on HRT)
S. Aureus
Fever with frontal or maxillary tenderness

6. patients with herpes zoster may experience what symptom before the rash appear?
Pain
True
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Giardia

7. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Infectious esophagitis
Rotator Cuff tendonitis

8. What medications can cause heart palpitations?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
PVC or Premature atrial contraction (PAC)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Folliculitis

9. Name the diagnosis of heartburn: regurgitation - dysphagia
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
GERD
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

10. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Non-cardiac causes of palpitations
Associated with hypotension

11. What are the three major risk factors for heart failure?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Generalized Anxiety disorder and panic disorder
Hypertension - CAD - valvular heart disease

12. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Generalized Anxiety disorder and panic disorder

13. Oligomenorrhea
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
S. Aureus
Regular bleeding at intervals of more than 35 days
When the patient has symptoms in association with exercise or who describe chest pain or pressure

14. What are the primary glomerular diseases?
Lightheadedness - dizziness - syncope
BB or CCB - catheter ablation of identified bypass tract
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
HIV and syphilis

15. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

16. How can GERD (or esophageal motility disorders) lead to chest pain?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hypertension - CAD - valvular heart disease
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

17. What are the indiciations for neuroimaging?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

18. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Giardia
LH surge triggers ovulation
BB or CCB - catheter ablation of identified bypass tract

19. After treatment of dysplasia - women need Pap smears every...
Lightheadedness - dizziness - syncope
Less abrupt onset and cessation of palpitations
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

20. Metrorrhagia
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
Irregular bleeding between cycles
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Menorrhagia

21. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
A central clear area
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

22. How do you define persistent protein uria?
Giardia
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Presence of proteinuria on at least two separate ocassion
100mg; means patient can be trace protein positive and not be detected

23. What are the features of glomerular nephritis
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
Hypertension - CAD - valvular heart disease
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
RBC casts and old to moderate HTN

24. 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
Cluster headache
Varicella virus
Colposcopy - Endocervical curettage - and directed cervical biopsy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

25. How is constipation clinically defined?
Less than 3 stools per week
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Folliculitis

26. What is benign transient proteinuria?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
PVC or Premature atrial contraction (PAC)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Common problem that resolves spontaneously and is most often seen in children and young adults

27. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Analgesic headache
ACEi - ARBS - thiazide diuretics
Staphylococcal scalded skin syndrome
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

28. What are the physical exam signs of CHF?
Varicella virus
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
Hgb - Electrolytes - and TSH
A central clear area

29. What are the three types of lice?
Echocardiogram
Chest pain during pneumonia or PE
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Cervical radiculopathy

30. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Viral gastroenteritis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Tension headache

31. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Loop diuretics (Check serum K+ levels before drug admin)
A 24hr urine protein collection and urine creatinine clearance determination
Regular bleeding at intervals of more than 35 days
Coronary artery disease/ angina

32. What places women at higher risk of getting cervical cancer?
Fever with frontal or maxillary tenderness
Viral gastroenteritis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

33. Natural history of cervical cancer
Possibility of Ischemic colitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

34. What are symptoms are CHF?
Impetigo
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Warts

35. What are the common causes for laryngitis?
LH surge triggers ovulation
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

36. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
EGD
Subarachnoid hemorrhage
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

37. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
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.

38. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

39. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
Impetigo
HPV testing -Pos=colposcopy -Neg=repeat pap smear
35 (exception for postmenopausal women who have recently been started on HRT)

40. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Bence-Jones
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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

41. How are fungal infections diagnosed?
Pancreatitis
S. aureus- beta hemolytic streptococcus
With a KOH wet mount preparation
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

42. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Repeat Pap after infection treated
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

43. When should a patient get a stress test?
Warts
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

44. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
100mg; means patient can be trace protein positive and not be detected
Intermenstrual bleeding
Pancreatitis
ACEi - ARBS - thiazide diuretics

45. What are the most common viral causes of diarrhea in kids and adults?
Associated with hypotension
100mg; means patient can be trace protein positive and not be detected
Kids: Rotavirus Adults: Norwalk Virus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

46. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bulk forming: Psyllium - Methycellulose - Polycarbophil
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Folliculitis

47. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Colposcopy - Endocervical curettage - and directed cervical biopsy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

48. Who should have Xray testing for shoulder pain?
Pleurisy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

49. MI - pericardial tamponade - PE - GI bleed - are...
ACEi
Associated with hypotension
100mg; means patient can be trace protein positive and not be detected
Bulk forming: Psyllium - Methycellulose - Polycarbophil

50. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule