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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 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
Rotator cuff tendonitis
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
Giardia

2. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

3. Constipation: What are indications for lab testing?
Colposcopy - Endocervical curettage - and directed cervical biopsy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Tension headache
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

4. 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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Cluster headache
Generalized Anxiety disorder and panic disorder

5. What are the common causes for laryngitis?
Pancreatitis
Acute headache - ataxia - profuse nausea - and vomiting
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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.

6. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Pancreatitis
Nonulcer dyspepsia
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

7. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Variability in the time for follicle development during the proliferative phase
Irregular bleeding between cycles
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

8. Treatment for supraventricular tachycardias
Pancreatitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
BB or CCB - catheter ablation of identified bypass tract

9. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Nonulcer dyspepsia
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

10. Describe the history and PE of patient presenting with common cold
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
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

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Scleroderma/polymyositis with secondary gastroesophageal reflux
Staphylococcal scalded skin syndrome
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

12. What are the three types of lice?
Regular bleeding at intervals of more than 35 days
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Colposcopy - Endocervical curettage - and directed cervical biopsy

13. What are the signs of acute sinusitis?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Fever with frontal or maxillary tenderness
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

14. What is the Epley maneuver?
Pts with palpitations and dizziness - near syncope - or syncope
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
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
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.

15. What are the features of glomerular nephritis
Squamocolumnar junction=most common site of cervical cancer
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Regular bleeding at intervals of more than 35 days
RBC casts and old to moderate HTN

16. What places women at higher risk of getting cervical cancer?
CBC
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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

17. What is the next best step if a patient has two or more positive dipstick tests?
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
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
E. Coli O157:H7
A 24hr urine protein collection and urine creatinine clearance determination

18. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Less than 80 ml of blood
Possibility of Ischemic colitis
Pleurisy

19. Difference between Pneumonia and Bronchitis
Kids: Rotavirus Adults: Norwalk Virus
Hypertension - CAD - valvular heart disease
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
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

20. What are the three major risk factors for heart failure?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Scabies
Hypertension - CAD - valvular heart disease

21. At was quantity does urine dipstick test detect elevated protein?
Anticoag with warfarin to prevent thromboembolism
100mg; means patient can be trace protein positive and not be detected
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Medication or chemical esophagitis

22. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

23. Lab testing for heart palpitation
LH surge triggers ovulation
Hypertension - CAD - valvular heart disease
Hgb - Electrolytes - and TSH
Tension headache

24. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
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
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
A central clear area

25. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
EGD
ACEi - ARBS - thiazide diuretics
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
GERD

26. Complete the sentence: pericarditis can cause frictional rub and......
35 (exception for postmenopausal women who have recently been started on HRT)
Dehydration - anemia - cardiac causes
Peptic ulcer disease or gastritis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

27. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Impetigo
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
24 hour halter

28. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
PE - MI - aortic dissection - pneumothorax
BB or CCB - catheter ablation of identified bypass tract

29. Who should have Xray testing for shoulder pain?
MSK - pulmonary - GI - or psychological
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cholelithiasis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

30. Describe the presentation of angina?
CT
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
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
Increase; 200 g/day

31. What is the Barany maneuver?
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
Viral infection of the semicircular apparatus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

32. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
BB or CCB - catheter ablation of identified bypass tract
Paroxysmal atrial fibrillation or supraventricular tachycardia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

33. What are the secondly causes of glomerular disease?
Common problem that resolves spontaneously and is most often seen in children and young adults
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Irregular bleeding between cycles
LH surge triggers ovulation

34. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pancreatitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

35. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Non-cardiac causes of palpitations
Supraspinatus and bicipital tendons

36. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Wolff-Parkinson-White syndrome

37. 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
Irregular bleeding between cycles
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
>3.5g of protein per 24hrs

38. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Albumin; low molecular weight proteins

39. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
CBC
Scabies
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

40. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Possibility of Ischemic colitis
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
True

41. What is benign transient proteinuria?
LH surge triggers ovulation
Common problem that resolves spontaneously and is most often seen in children and young adults
Albumin; low molecular weight proteins
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

42. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
PVC or Premature atrial contraction (PAC)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

43. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
35 (exception for postmenopausal women who have recently been started on HRT)
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

44. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Menorrhagia
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
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

45. Uterine bleeding between regular cycles
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Intermenstrual bleeding
ACEi - ARBS - thiazide diuretics

46. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Presence of proteinuria on at least two separate ocassion
Slow progression of cervical cancer changes -Availability of effective early treatment

47. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Coag disorders
Subarachnoid hemorrhage
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Temporal arteritis-biopsy of the temporal artery

48. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Cellulitis
Supraspinatus and bicipital tendons
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

49. 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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Regular bleeding at intervals of more than 35 days

50. Discomfort with abducting the arm past 90 degress
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Rotator Cuff tendonitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool