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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. 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
Coronary artery disease/ angina
Hypertension - CAD - valvular heart disease
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
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
Variability in the time for follicle development during the proliferative phase
24 hour halter

3. What drugs do you use to treat H.pylori + PUD?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Paroxysmal atrial fibrillation or supraventricular tachycardia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

4. HIgh risk pregnant patients should be evaluated for ____ and ____
Kids: Rotavirus Adults: Norwalk Virus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
HIV and syphilis

5. What are the physical exam signs of CHF?
RBC casts and old to moderate HTN
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
Infectious esophagitis
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

6. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Coag disorders
Staphylococcal scalded skin syndrome
Giardia

7. Diagnosis of HTN
Presence of proteinuria on at least two separate ocassion
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

8. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Cervical radiculopathy

9. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
PE - MI - aortic dissection - pneumothorax
Cluster headache
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
E. Coli O157:H7

10. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
EGD
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

11. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Kids: Rotavirus Adults: Norwalk Virus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Loop diuretics (Check serum K+ levels before drug admin)
Bence-Jones

12. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Intermenstrual bleeding
Viral infection of the semicircular apparatus

13. What are the most common causes for the common cold?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Influenza - Rhinovirus - Adenovirus - Parainfluenza

14. What occurs after ovulation
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Coag disorders
LH surge triggers ovulation

15. Discomfort with abducting the arm past 90 degress
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Furucnle
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Rotator Cuff tendonitis

16. How is constipation clinically defined?
Less than 80 ml of blood
EGD
Less than 3 stools per week
MSK - pulmonary - GI - or psychological

17. Uterine bleeding between regular cycles
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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.
Intermenstrual bleeding
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

18. What HPV serotypes are most commonly associated with cervical cancer?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Serotypes 16 - 18 - 31 -52 -58
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
Generalized Anxiety disorder and panic disorder

19. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Pts with palpitations and dizziness - near syncope - or syncope
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Albumin; low molecular weight proteins

20. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Paroxysmal atrial fibrillation or supraventricular tachycardia
S. Aureus

21. Difference between Pneumonia and Bronchitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
S. Aureus
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
Less than 80 ml of blood

22. 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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
True
Loop diuretics (Check serum K+ levels before drug admin)
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

23. Menometrorrhagia
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
Irregular bleeding between cycles
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.
Excessive bleeding in amount - duration - or both at irregular intervals

24. Regular bleeding at intervals of less than 21 days
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Polymenorrhea
Coronary artery disease/ angina

25. Metrorrhagia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Irregular bleeding between cycles
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

26. How do you define persistent protein uria?
Supraspinatus and bicipital tendons
Impetigo
Presence of proteinuria on at least two separate ocassion
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

27. Who should have Xray testing for shoulder pain?
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.
True
CT
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

28. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Excessive bleeding in amount - duration - or both at irregular intervals

29. What does orthostatic positional changes that bring on dizziness suggest?
These patients are associated with low renin states=less likely to respond to medication
Dehydration - anemia - cardiac causes
MSK - pulmonary - GI - or psychological
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

30. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Presence of proteinuria on at least two separate ocassion

31. What is the Barany maneuver?
Loop diuretics (Check serum K+ levels before drug admin)
Possibility of Ischemic colitis
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
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. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Warts
Echocardiogram

33. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
EGD
Colposcopy - Endocervical curettage - and directed cervical biopsy
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

34. Clinical Manifestations of HTN
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
A central clear area
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

35. Describes what occurs during squamous metaplasia of the cervix.
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

36. What should blood work include for suspected heart failure?
Varicella virus
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Intermenstrual bleeding

37. What treatments are the cornerstone for treating cases of functional constipation?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A 24hr urine protein collection and urine creatinine clearance determination
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
E. Coli O157:H7
Coronary artery disease/ angina

39. When does troponin rise following myocardial injury or infarction?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Other brainstem or cranial nerve findings
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Impetigo

40. What are the indiciations for neuroimaging?
Varicella virus
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
These patients are associated with low renin states=less likely to respond to medication

41. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Associated with hypotension
Non-cardiac causes of palpitations
Viral infection of the semicircular apparatus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

42. What is a markers of CNS vertigo?
S. Aureus
Infectious esophagitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Other brainstem or cranial nerve findings

43. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
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.
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
MSK - pulmonary - GI - or psychological

44. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
CBC
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Increase; 200 g/day

45. How does CHF present on X-ray?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Tension headache
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Candida albicans

46. Chronic pain and shoulder stiffness with limited motion
>150mg per 24hrs
Adhesive capsulitis (frozen shoulder): most common in middle age women
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

47. When is a lumbar puncture contraindicated?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
HIV and syphilis

48. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increasing fluid (8 - 8oz glasses of water/day) -fiber
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

49. Predictors of cardiac etiology
Folliculitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Non-cardiac causes of palpitations

50. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Impetigo
Cholelithiasis