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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 diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
RBC casts and old to moderate HTN
Temporal arteritis-biopsy of the temporal artery
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Common problem that resolves spontaneously and is most often seen in children and young adults

2. Describe the presentation of myocardial pain?
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.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Scleroderma/polymyositis with secondary gastroesophageal reflux
Paroxysmal atrial fibrillation or supraventricular tachycardia

3. What is the caUse of benign positional vertigo?
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
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.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

4. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
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
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
Pts with palpitations and dizziness - near syncope - or syncope

5. What are the three types of lice?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

6. What is the role of FSH in one's menstrual cycle
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Coronary artery disease/ angina
Presence of proteinuria on at least two separate ocassion
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

7. What is the Barany maneuver?
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
Staphylococcal scalded skin syndrome
Diuretics -BB -CCB -ACEi
Infectious esophagitis

8. What is the peripheral caUse of vertigo?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
35 (exception for postmenopausal women who have recently been started on HRT)

9. 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
Coag disorders
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Acute headache - ataxia - profuse nausea - and vomiting

10. 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. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Giardia

11. Discomfort with abducting the arm past 90 degress
Possibility of Ischemic colitis
Common problem that resolves spontaneously and is most often seen in children and young adults
Rotator Cuff tendonitis
Staphylococcal scalded skin syndrome

12. name the 4 emergent causes of chest pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
PE - MI - aortic dissection - pneumothorax
Streptococci
Less abrupt onset and cessation of palpitations

13. Clinical Manifestations of HTN
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

14. 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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Cluster headache
Colposcopy - Endocervical curettage - and directed cervical biopsy

15. 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
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
Giardia
Varicella virus

16. What is the standard tool used for diagnosis of GERD?
LH surge triggers ovulation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
EGD
>3.5g of protein per 24hrs

17. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A central clear area
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

18. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Wolff-Parkinson-White syndrome
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Analgesic headache

19. 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.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Peptic ulcer disease or gastritis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Tension headache

20. What are the two common clinical presentations of acute diarrhea?
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

21. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Colposcopy - Endocervical curettage - and directed cervical biopsy

22. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Viral infection of the semicircular apparatus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Scleroderma/polymyositis with secondary gastroesophageal reflux
Folliculitis

23. How to NSAIDs contribute to gastritis and ulcer formation?
CBC
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.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Irregular bleeding between cycles

24. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
Less than 80 ml of blood
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Less than 3 stools per week

25. What are the features of nephrotic syndrome?
Furucnle
Less abrupt onset and cessation of palpitations
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

26. SE Of Beta blockers?
Chest pain during pneumonia or PE
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
GERD
S. aureus- beta hemolytic streptococcus

27. Prenatal visit schedule for low-risk pregnancies
Cellulitis
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)
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

28. 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
Temporal arteritis-biopsy of the temporal artery
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
True
Analgesic headache

29. Name the skin lesion: pustule in association with a hair follice
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Folliculitis
Lightheadedness - dizziness - syncope
Temporal arteritis-biopsy of the temporal artery

30. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
>150mg per 24hrs
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

31. What is the next best step if a patient has two or more positive dipstick tests?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Variability in the time for follicle development during the proliferative phase
A 24hr urine protein collection and urine creatinine clearance determination

32. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Generalized Anxiety disorder and panic disorder
Diuretics -BB -CCB -ACEi
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

33. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
When the patient has symptoms in association with exercise or who describe chest pain or pressure

34. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Giardia
Folliculitis

35. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Hx: Scratchy throat - runny nose - nasal congestion - rhinorrhea - malaise - fever - hoarsenss - cough - low grade fever - headache PE: Swollen red nasal mucosa - fever - purulent discharge - facial tenderness
Coag disorders
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Higher filling presure - pulmonary congestion - and decreasd cardiac return

36. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Analgesic headache
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Rotator Cuff problem

37. How do you know if heart palpitations are due to stimulant or medication use?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
DM - HTN - DVT - seizures - depression - or anxiety
Less abrupt onset and cessation of palpitations

38. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Coag disorders
Kids: Rotavirus Adults: Norwalk Virus
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

39. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Viral infection of the semicircular apparatus
Candida albicans
Kids: Rotavirus Adults: Norwalk Virus

40. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Medication or chemical esophagitis
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
Associated with hypotension
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

41. Uterine bleeding between regular cycles
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Temporal arteritis-biopsy of the temporal artery
Intermenstrual bleeding
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

42. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Less than 80 ml of blood
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
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
Molluscum contagiosum- pox virus

43. History and PE for Pneumonia
S. aureus- beta hemolytic streptococcus
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
35 (exception for postmenopausal women who have recently been started on HRT)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

44. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
ACEi - ARBS - thiazide diuretics
Viral gastroenteritis
These patients are associated with low renin states=less likely to respond to medication

45. Describe the presentation of pericardial pain
Wolff-Parkinson-White syndrome
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

46. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Less than 80 ml of blood
Hypertension - CAD - valvular heart disease
These patients are associated with low renin states=less likely to respond to medication
RBC casts and old to moderate HTN

47. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Albumin; low molecular weight proteins

48. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
PE - MI - aortic dissection - pneumothorax
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

49. Pain in shoulder when throwing - swimming - or serving a tennis ball
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Scleroderma/polymyositis with secondary gastroesophageal reflux
Rotator cuff tendonitis
CBC

50. Pneumonia tx: suitable for healthy adults less than 60
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Echocardiogram
Dehydration - anemia - cardiac causes
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline