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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 indiciations for neuroimaging?
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
Repeat Pap after infection treated
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
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

2. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Pain
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
Echocardiogram
Infectious esophagitis

3. What are symptoms are CHF?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Intermenstrual bleeding
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

4. What is the caUse of benign positional vertigo?
LH surge triggers ovulation
Slow progression of cervical cancer changes -Availability of effective early treatment
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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.

5. How can GERD (or esophageal motility disorders) lead to chest pain?
Cervical radiculopathy
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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.

6. Things that need to be included in history of shoulder pain
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Medication or chemical esophagitis
Warts

7. At was quantity does urine dipstick test detect elevated protein?
S. Aureus
100mg; means patient can be trace protein positive and not be detected
>3.5g of protein per 24hrs
Generalized Anxiety disorder and panic disorder

8. MI - pericardial tamponade - PE - GI bleed - are...
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
True
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Associated with hypotension

9. What is the Barany maneuver?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

10. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Chest pain during pneumonia or PE
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV

11. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Acute headache - ataxia - profuse nausea - and vomiting
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

12. Carcinoma in situ is generally referred to a gynecologist and requires ______
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Excessive bleeding in amount - duration - or both at irregular intervals
Pain

13. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Molluscum contagiosum- pox virus
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
Repeat Pap after infection treated

14. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Cervical radiculopathy
S. aureus- beta hemolytic streptococcus
Echocardiogram
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

15. Describes what occurs during squamous metaplasia of the cervix.
Coag disorders
Giardia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

16. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Intermenstrual bleeding
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
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

17. What are the 2 psych disorders most commonly associated with palpitations?
Cholelithiasis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Generalized Anxiety disorder and panic disorder
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

18. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Streptococci
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

19. What HPV serotypes are most commonly associated with cervical cancer?
PE - MI - aortic dissection - pneumothorax
A 24hr urine protein collection and urine creatinine clearance determination
Serotypes 16 - 18 - 31 -52 -58
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

20. Name types of laxatives
Chest pain during pneumonia or PE
Less than 3 stools per week
Temporal arteritis-biopsy of the temporal artery
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

21. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
ACEi
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Diuretics -BB -CCB -ACEi
Irregular bleeding between cycles

22. How do you define persistent protein uria?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Presence of proteinuria on at least two separate ocassion
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

23. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
PVC or Premature atrial contraction (PAC)
24 hour halter
Hgb - Electrolytes - and TSH
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

24. What is the Epley maneuver?
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
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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.

25. When does troponin rise following myocardial injury or infarction?
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
Coag disorders
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Nonulcer dyspepsia

26. What does treatment for migrans include?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Slow progression of cervical cancer changes -Availability of effective early treatment

27. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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
Chest pain during pneumonia or PE
Influenza - Rhinovirus - Adenovirus - Parainfluenza
PE - MI - aortic dissection - pneumothorax

28. History and PE for Pneumonia
Hypertension - CAD - valvular heart disease
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

29. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Anticoag with warfarin to prevent thromboembolism
Irregular bleeding between cycles
Presence of proteinuria on at least two separate ocassion

30. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Streptococci
Albumin; low molecular weight proteins
Nonulcer dyspepsia
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

31. Metrorrhagia
Regular bleeding at intervals of more than 35 days
Irregular bleeding between cycles
Serotypes 16 - 18 - 31 -52 -58
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

32. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Paroxysmal atrial fibrillation or supraventricular tachycardia

33. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Albumin; low molecular weight proteins
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

34. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Kids: Rotavirus Adults: Norwalk Virus
Giardia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

35. Isolated - extra pounding beats
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
PVC or Premature atrial contraction (PAC)
Viral gastroenteritis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

36. Name 4 factors that predispose an individual to develop pneumonia.
Non-cardiac causes of palpitations
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Tension headache

37. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Cholelithiasis
Excessive bleeding in amount - duration - or both at irregular intervals
Lightheadedness - dizziness - syncope

38. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Echocardiogram
Presence of proteinuria on at least two separate ocassion

39. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
True
CT

40. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Molluscum contagiosum- pox virus
Cervical radiculopathy
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

41. What are the symptoms of palpitations?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Lightheadedness - dizziness - syncope
Furucnle
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

42. What is afterload?
CBC
Higher filling presure - pulmonary congestion - and decreasd cardiac return
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Less than 80 ml of blood

43. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Upper sternal area burning pain - associated with a productive cough
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Repeat Pap after infection treated
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

44. What is a markers of CNS vertigo?
Cholelithiasis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Other brainstem or cranial nerve findings

45. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
These patients are associated with low renin states=less likely to respond to medication
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

46. When is a lumbar puncture contraindicated?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Temporal arteritis-biopsy of the temporal artery
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
35 (exception for postmenopausal women who have recently been started on HRT)

47. What type of imaging is need for chronic sinusitis?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
S. aureus- beta hemolytic streptococcus
CT

48. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Influenza - Rhinovirus - Adenovirus - Parainfluenza

49. What is the goal of CHF treatment? What drugs should be used?
Other brainstem or cranial nerve findings
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

50. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Other brainstem or cranial nerve findings
Presence of proteinuria on at least two separate ocassion
Kids: Rotavirus Adults: Norwalk Virus