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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 is the caUse of Meniere disease? What are the cardinal symptoms?
HPV
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Colposcopy - Endocervical curettage - and directed cervical biopsy

2. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
PVC or Premature atrial contraction (PAC)

3. What are the primary glomerular diseases?
Pts with palpitations and dizziness - near syncope - or syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

4. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
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
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
Nonulcer dyspepsia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

5. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
ACEi

6. What type of imaging is need for chronic sinusitis?
CT
Pts with palpitations and dizziness - near syncope - or syncope
Upper sternal area burning pain - associated with a productive cough
Analgesic headache

7. What are the two common clinical presentations of acute diarrhea?
Squamocolumnar junction=most common site of cervical cancer
Presence of proteinuria on at least two separate ocassion
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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

8. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
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
Pleurisy
Warts
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

9. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
PE - MI - aortic dissection - pneumothorax

10. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Non-cardiac causes of palpitations
Intermenstrual bleeding
ACEi - ARBS - thiazide diuretics
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

11. What are the signs of malignant hypertension?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
High blood pressure - focal neurologic defecit - or papilledema
Repeat Pap after infection treated

12. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Temporal arteritis-biopsy of the temporal artery
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
Fever with frontal or maxillary tenderness

13. Treatment for supraventricular tachycardias
Squamocolumnar junction=most common site of cervical cancer
PE - MI - aortic dissection - pneumothorax
BB or CCB - catheter ablation of identified bypass tract
Generalized Anxiety disorder and panic disorder

14. 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.
Irregular bleeding between cycles
Repeat Pap after infection treated
Supraspinatus and bicipital tendons
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

15. 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.
Less than 80 ml of blood
Tension headache
Repeat Pap after infection treated
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

16. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Irregular bleeding between cycles
35 (exception for postmenopausal women who have recently been started on HRT)

17. Vaccines that should be updated before planned pregnancy
Other brainstem or cranial nerve findings
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Infectious esophagitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

18. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Cervical radiculopathy
35 (exception for postmenopausal women who have recently been started on HRT)
Coag disorders
Scabies

19. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
CT
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
These patients are associated with low renin states=less likely to respond to medication

20. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Supraspinatus and bicipital tendons
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bence-Jones

21. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Associated with hypotension
EGD

22. History and PE for Pneumonia
Streptococci
A 24hr urine protein collection and urine creatinine clearance determination
Supraspinatus and bicipital tendons
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

23. What medications can cause heart palpitations?
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
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
These patients are associated with low renin states=less likely to respond to medication

24. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

25. Describe the presentation of angina?
Repeat Pap after infection treated
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

26. What are the secondly causes of glomerular disease?
MSK - pulmonary - GI - or psychological
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Less abrupt onset and cessation of palpitations
With a KOH wet mount preparation

27. name the 4 emergent causes of chest pain
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
PE - MI - aortic dissection - pneumothorax
Associated with hypotension

28. Name the skin lesion: erythema - warmth - edema - pain - fever
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
CT
Cellulitis
Pancreatitis

29. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

30. What is benign transient proteinuria?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
BB or CCB - catheter ablation of identified bypass tract
Common problem that resolves spontaneously and is most often seen in children and young adults

31. Initial treatment for Rhinosinusitis
ACEi - ARBS - thiazide diuretics
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
>150mg per 24hrs

32. Name 4 factors that predispose an individual to develop pneumonia.
S. aureus- beta hemolytic streptococcus
>3.5g of protein per 24hrs
Pleurisy
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

33. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
HPV
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Folliculitis

34. What should be considered in younger patients with menorrhagia
Non-cardiac causes of palpitations
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Coag disorders
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

35. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Viral gastroenteritis

36. Metrorrhagia
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
Possibility of Ischemic colitis
Hypertension - CAD - valvular heart disease
Irregular bleeding between cycles

37. What is the difference between a Holter monitor or an event monitor?
Variability in the time for follicle development during the proliferative phase
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
E. Coli O157:H7
A 24hr urine protein collection and urine creatinine clearance determination

38. Mainstay treatment for soft tissue inflammation (Shoulder)
PVC or Premature atrial contraction (PAC)
Irregular bleeding between cycles
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

39. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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.
Other brainstem or cranial nerve findings

40. When should a patient get a stress test?
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
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

41. What is a markers of CNS vertigo?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Other brainstem or cranial nerve findings
MSK - pulmonary - GI - or psychological
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

42. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
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
E. Coli O157:H7
Varicella virus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

43. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Viral gastroenteritis
Pain
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Non-cardiac causes of palpitations

44. Diarrhea from custard filled pastries
100mg; means patient can be trace protein positive and not be detected
RBC casts and old to moderate HTN
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
S. Aureus

45. What places women at higher risk of getting cervical cancer?
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
Hgb - Electrolytes - and TSH
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
Repeat Pap after infection treated

46. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Irregular bleeding between cycles
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
LH surge triggers ovulation

47. What are the 2 psych disorders most commonly associated with palpitations?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Generalized Anxiety disorder and panic disorder

48. Diagnostic Evaluation of Abnoraml vaginal bleeding
S. aureus- beta hemolytic streptococcus
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
>3.5g of protein per 24hrs
Increasing fluid (8 - 8oz glasses of water/day) -fiber

49. Uterine bleeding between regular cycles
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Intermenstrual bleeding

50. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Lightheadedness - dizziness - syncope
Kids: Rotavirus Adults: Norwalk Virus
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

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