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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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 diagnosis does the 'worse headache of my life' suggest?
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
Subarachnoid hemorrhage
A central clear area
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

2. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Slow progression of cervical cancer changes -Availability of effective early treatment
HPV testing -Pos=colposcopy -Neg=repeat pap smear

3. What are the primary glomerular diseases?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Kids: Rotavirus Adults: Norwalk Virus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Regular bleeding at intervals of more than 35 days

4. MI - pericardial tamponade - PE - GI bleed - are...
Rotator Cuff problem
Intermenstrual bleeding
Menorrhagia
Associated with hypotension

5. What are the three types of lice?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Increase; 200 g/day
Peptic ulcer disease or gastritis

6. 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
Intermenstrual bleeding
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
Varicella virus
Acute headache - ataxia - profuse nausea - and vomiting

7. How does CHF present on X-ray?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Folliculitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Pain

8. 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
Subarachnoid hemorrhage
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
These patients are associated with low renin states=less likely to respond to medication

9. Carcinoma in situ is generally referred to a gynecologist and requires ______
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
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

10. Define nephrotic range proteinuria
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
Serotypes 16 - 18 - 31 -52 -58
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
>3.5g of protein per 24hrs

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Pain
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

12. Pneumonia tx: suitable for healthy adults older than 60
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Repeat Pap after infection treated
Hgb - Electrolytes - and TSH

13. What are the most common causes for the common cold?
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
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

14. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Streptococci
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Candida albicans

15. What occurs after ovulation
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Loop diuretics (Check serum K+ levels before drug admin)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

16. Diarrhea from custard filled pastries
Varicella virus
S. Aureus
Folliculitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

17. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hgb - Electrolytes - and TSH
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Pain

18. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Paroxysmal atrial fibrillation or supraventricular tachycardia
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming: Psyllium - Methycellulose - Polycarbophil

19. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pleurisy

20. Predictors of cardiac etiology
Nonulcer dyspepsia
MSK - pulmonary - GI - or psychological
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

21. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Colposcopy - Endocervical curettage - and directed cervical biopsy

22. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

23. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Warts
Menorrhagia
Less than 3 stools per week
Possibility of Ischemic colitis

24. What places women at higher risk of getting cervical cancer?
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
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
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

25. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Coronary artery disease/ angina
Rotator Cuff problem
Upper sternal area burning pain - associated with a productive cough

26. Define proteinuria
>150mg per 24hrs
Supraspinatus and bicipital tendons
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

27. What are symptoms are CHF?
Variability in the time for follicle development during the proliferative phase
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
>3.5g of protein per 24hrs
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

28. 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
Polymenorrhea
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Furucnle

29. What are the signs of cerebral hemorrhage?
MSK - pulmonary - GI - or psychological
Peptic ulcer disease or gastritis
Acute headache - ataxia - profuse nausea - and vomiting
ACEi

30. What is the role of LH in the menstrual cycle
Warts
LH surge triggers ovulation
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
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

31. What are the signs of malignant hypertension?
E. Coli O157:H7
DM - HTN - DVT - seizures - depression - or anxiety
High blood pressure - focal neurologic defecit - or papilledema
Anticoag with warfarin to prevent thromboembolism

32. What is the preload?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cervical radiculopathy
Anticoag with warfarin to prevent thromboembolism

33. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Excessive bleeding in amount - duration - or both at irregular intervals
Anticoag with warfarin to prevent thromboembolism

34. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Pleurisy
Temporal arteritis-biopsy of the temporal artery
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

35. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Scleroderma/polymyositis with secondary gastroesophageal reflux
Folliculitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

36. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Pancreatitis
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Polymenorrhea

37. Describes what occurs during squamous metaplasia of the cervix.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

38. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
S. aureus- beta hemolytic streptococcus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Giardia

39. Describe the presentation of myocardial pain?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Viral gastroenteritis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

40. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
GERD
Chest pain during pneumonia or PE
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

41. What should be considered in younger patients with menorrhagia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cholelithiasis
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.
Coag disorders

42. What is benign transient proteinuria?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

43. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
DM - HTN - DVT - seizures - depression - or anxiety
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Variability in the time for follicle development during the proliferative phase
These patients are associated with low renin states=less likely to respond to medication

44. 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
Wolff-Parkinson-White syndrome
True
Peptic ulcer disease or gastritis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

45. What is the standard tool used for diagnosis of GERD?
Variability in the time for follicle development during the proliferative phase
EGD
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. What is afterload?
Less than 80 ml of blood
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

47. Difference between Pneumonia and Bronchitis
Excessive bleeding in amount - duration - or both at irregular intervals
Other brainstem or cranial nerve findings
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
Acute headache - ataxia - profuse nausea - and vomiting

48. Diagnostic Evaluation of Abnoraml vaginal bleeding
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

49. Vaccines that should be updated before planned pregnancy
Regular bleeding at intervals of more than 35 days
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

50. Chronic pain and shoulder stiffness with limited motion
HIV and syphilis
Adhesive capsulitis (frozen shoulder): most common in middle age women
PVC or Premature atrial contraction (PAC)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

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