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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 type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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.
100mg; means patient can be trace protein positive and not be detected
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
ACEi

2. 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
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
CBC
A central clear area

3. What does treatment for migrans include?
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
Albumin; low molecular weight proteins
Diuretics -BB -CCB -ACEi
Colposcopy - Endocervical curettage - and directed cervical biopsy

4. Name 4 factors that predispose an individual to develop pneumonia.
Associated with hypotension
100mg; means patient can be trace protein positive and not be detected
Rotator Cuff tendonitis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

5. When should a patient get a stress test?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Varicella virus
When the patient has symptoms in association with exercise or who describe chest pain or pressure

6. How are fungal infections diagnosed?
GERD
Polymenorrhea
Associated with hypotension
With a KOH wet mount preparation

7. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Fever with frontal or maxillary tenderness
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Chest pain during pneumonia or PE
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

8. Diagnostic Evaluation of Abnoraml vaginal bleeding
Coronary artery disease/ angina
Albumin; low molecular weight proteins
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
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

9. Four muscles of rotator cuff
Menorrhagia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

10. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Pain
Temporal arteritis-biopsy of the temporal artery
Furucnle
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

11. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Supraspinatus and bicipital tendons
Viral infection of the semicircular apparatus

12. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Generalized Anxiety disorder and panic disorder
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

13. How does systolic vs. diastolic heart failure present on the echocardiogram?
Upper sternal area burning pain - associated with a productive cough
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

14. Difference between Pneumonia and Bronchitis
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.
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

15. What is the goal of CHF treatment? What drugs should be used?
Polymenorrhea
Medication or chemical esophagitis
Chest pain during pneumonia or PE
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

16. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Repeat Pap after infection treated
100mg; means patient can be trace protein positive and not be detected
Rotator Cuff problem

17. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Less than 3 stools per week
Non-cardiac causes of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
HPV

18. Complete the sentence: pericarditis can cause frictional rub and......
Chest pain during pneumonia or PE
Acute headache - ataxia - profuse nausea - and vomiting
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

19. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Increase; 200 g/day
>150mg per 24hrs
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

20. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
24 hour halter
GERD
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
Polymenorrhea

21. Where does the development of abnormal cervical cells begin?
A central clear area
Squamocolumnar junction=most common site of cervical cancer
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
High blood pressure - focal neurologic defecit - or papilledema

22. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
>150mg per 24hrs
24 hour halter
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

23. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Coag disorders
Nonulcer dyspepsia
Common problem that resolves spontaneously and is most often seen in children and young adults

24. What is the difference between a Holter monitor or an event monitor?
Cellulitis
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
EGD
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

25. Pneumonia tx: suitable for healthy adults older than 60
Candida albicans
Kids: Rotavirus Adults: Norwalk Virus
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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

26. What the consequences of decreased cardiac output?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

27. What are signs of pulmonary congestion?
Non-cardiac causes of palpitations
Pancreatitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

28. What is a markers of CNS vertigo?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Generalized Anxiety disorder and panic disorder
RBC casts and old to moderate HTN
Other brainstem or cranial nerve findings

29. What are the three types of lice?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Analgesic headache
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

30. What is the Epley maneuver?
Cervical radiculopathy
With a KOH wet mount preparation
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.
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

31. What is the caUse of benign positional vertigo?
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
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.
Adhesive capsulitis (frozen shoulder): most common in middle age women
Wolff-Parkinson-White syndrome

32. What are the two common clinical presentations of acute diarrhea?
PE - MI - aortic dissection - pneumothorax
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

33. Clinical Manifestations of HTN
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hypertension - CAD - valvular heart disease
Anticoag with warfarin to prevent thromboembolism

34. Carcinoma in situ is generally referred to a gynecologist and requires ______
Rotator Cuff tendonitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Peptic ulcer disease or gastritis
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

35. What should preconception counseling include?
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
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.
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
Pts with palpitations and dizziness - near syncope - or syncope

36. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
>3.5g of protein per 24hrs
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
A 24hr urine protein collection and urine creatinine clearance determination

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

38. What are the physical exam signs of CHF?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Staphylococcal scalded skin syndrome
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

39. What are the features of nephrotic syndrome?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
True
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

40. 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
Warts
DM - HTN - DVT - seizures - depression - or anxiety
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
HPV testing -Pos=colposcopy -Neg=repeat pap smear

41. Mainstay treatment for soft tissue inflammation (Shoulder)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Less abrupt onset and cessation of palpitations
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

42. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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

43. Pneumonia tx: suitable for healthy adults less than 60
>150mg per 24hrs
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Variability in the time for follicle development during the proliferative phase

44. What are the 2 psych disorders most commonly associated with palpitations?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Generalized Anxiety disorder and panic disorder
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

45. What test done in PE measures instability of shoulder?
DM - HTN - DVT - seizures - depression - or anxiety
Scabies
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

46. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
CBC
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

47. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pancreatitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pleurisy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

48. 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
True
Warts
Common problem that resolves spontaneously and is most often seen in children and young adults
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

49. Chronic pain and shoulder stiffness with limited motion
Nonulcer dyspepsia
Echocardiogram
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

50. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Hypertension - CAD - valvular heart disease
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
Analgesic headache
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule