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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 are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Tension headache
Kids: Rotavirus Adults: Norwalk Virus

2. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
100mg; means patient can be trace protein positive and not be detected
Hgb - Electrolytes - and TSH
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.

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bence-Jones

4. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Wolff-Parkinson-White syndrome
>3.5g of protein per 24hrs
Anticoag with warfarin to prevent thromboembolism
Infectious esophagitis

5. HIgh risk pregnant patients should be evaluated for ____ and ____
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Hgb - Electrolytes - and TSH
HIV and syphilis

6. PE for a patient getting an abnormal vaginal bleeding work up
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Coag disorders
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

7. After treatment of dysplasia - women need Pap smears every...
Cervical radiculopathy
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

8. 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.
EGD
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Paroxysmal atrial fibrillation or supraventricular tachycardia
Tension headache

9. Pain in shoulder when throwing - swimming - or serving a tennis ball
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
>3.5g of protein per 24hrs
Rotator cuff tendonitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

10. What is the next best step if a patient has two or more positive dipstick tests?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pleurisy
HIV and syphilis
A 24hr urine protein collection and urine creatinine clearance determination

11. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Candida albicans
ACEi
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

12. What diagnosis does the 'worse headache of my life' suggest?
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Subarachnoid hemorrhage

13. What are the features of nephrotic syndrome?
Squamocolumnar junction=most common site of cervical cancer
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

14. What is the Epley maneuver?
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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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.
Cellulitis

15. What are the common causes for laryngitis?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Infectious esophagitis
PE - MI - aortic dissection - pneumothorax

16. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

17. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Less than 3 stools per week
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
RBC casts and old to moderate HTN

18. What are the 2 psych disorders most commonly associated with palpitations?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Generalized Anxiety disorder and panic disorder
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

19. What the consequences of decreased cardiac output?
Generalized Anxiety disorder and panic disorder
Varicella virus
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

20. Why is the pap smear one of the most effective cancer screening tools?
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
Warts
Slow progression of cervical cancer changes -Availability of effective early treatment
Cluster headache

21. What is the goal of CHF treatment? What drugs should be used?
Molluscum contagiosum- pox virus
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
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
Giardia

22. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Anticoag with warfarin to prevent thromboembolism
MSK - pulmonary - GI - or psychological
Chest pain during pneumonia or PE
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

23. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
24 hour halter
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
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.

24. Name 4 factors that predispose an individual to develop pneumonia.
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
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

25. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
DM - HTN - DVT - seizures - depression - or anxiety
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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

26. Who should have Xray testing for shoulder pain?
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Supraspinatus and bicipital tendons

27. Natural history of cervical cancer
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.
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pts with palpitations and dizziness - near syncope - or syncope

28. Constipation: What are indications for lab testing?
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
Pts with palpitations and dizziness - near syncope - or syncope
With a KOH wet mount preparation
ACEi - ARBS - thiazide diuretics

29. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Increase; 200 g/day

30. Uterine bleeding between regular cycles
Cholelithiasis
These patients are associated with low renin states=less likely to respond to medication
Intermenstrual bleeding
High blood pressure - focal neurologic defecit - or papilledema

31. Irregular cycles with excessive flow - duration - or both
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Menorrhagia
Pleurisy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

32. Name types of laxatives
Furucnle
E. Coli O157:H7
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

33. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Intermenstrual bleeding
EGD
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

34. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Regular bleeding at intervals of more than 35 days
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
35 (exception for postmenopausal women who have recently been started on HRT)
Varicella virus

35. 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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Warts
A 24hr urine protein collection and urine creatinine clearance determination

36. Name the diagnosis of heartburn: severe constant mid abdominal pain
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
High blood pressure - focal neurologic defecit - or papilledema
Pancreatitis
Echocardiogram

37. What is the mechanism of action for stimulant agents in treating constipation?
Temporal arteritis-biopsy of the temporal artery
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

38. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Non-cardiac causes of palpitations
Diuretics -BB -CCB -ACEi

39. Describe the presentation of angina?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

40. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Fever with frontal or maxillary tenderness
Cluster headache
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Staphylococcal scalded skin syndrome

41. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
RBC casts and old to moderate HTN
Supraspinatus and bicipital tendons
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

42. Describe the presentation tracheobronchitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Wolff-Parkinson-White syndrome
Upper sternal area burning pain - associated with a productive cough
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

43. What HPV serotypes are most commonly associated with cervical cancer?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Subarachnoid hemorrhage
Cervical radiculopathy
Serotypes 16 - 18 - 31 -52 -58

44. How can GERD (or esophageal motility disorders) lead to chest pain?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pleurisy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Cellulitis

45. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Folliculitis
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

46. What should be considered in younger patients with menorrhagia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Coag disorders
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Analgesic headache

47. What is the role of FSH in one's menstrual cycle
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
CBC
Scleroderma/polymyositis with secondary gastroesophageal reflux

48. SE Of Beta blockers?
>3.5g of protein per 24hrs
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
Rotator cuff tendonitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

49. Define the patient population typically affected by orthostatic or postural proteinuria
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
EGD
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

50. How do you define persistent protein uria?
Hypertension - CAD - valvular heart disease
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Presence of proteinuria on at least two separate ocassion
Fever with frontal or maxillary tenderness