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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. When should invasive eletrophysiologic study should be considered?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
Loop diuretics (Check serum K+ levels before drug admin)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

2. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Pleurisy

3. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

4. Pneumonia tx: suitable for healthy adults older than 60
Acute headache - ataxia - profuse nausea - and vomiting
A 24hr urine protein collection and urine creatinine clearance determination
CT
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

5. 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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Increase; 200 g/day

6. Pain in shoulder when throwing - swimming - or serving a tennis ball
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Rotator cuff tendonitis
Lightheadedness - dizziness - syncope
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

7. What is afterload?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
LH surge triggers ovulation
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

8. Constipation: What are indications for lab testing?
Viral gastroenteritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Echocardiogram
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

9. Clinical Manifestations of HTN
Wolff-Parkinson-White syndrome
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Less abrupt onset and cessation of palpitations
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

10. 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
Candida albicans
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Varicella virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

11. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

12. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Furucnle

13. Describe the presentation of pericardial pain
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Excessive bleeding in amount - duration - or both at irregular intervals
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

14. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Infectious esophagitis
Rotator Cuff tendonitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza

15. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
EGD
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Medication or chemical esophagitis

16. HIgh risk pregnant patients should be evaluated for ____ and ____
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
ACEi - ARBS - thiazide diuretics
HIV and syphilis

17. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Rotator Cuff problem
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
>3.5g of protein per 24hrs

18. What is the caUse of benign positional vertigo?
Excessive bleeding in amount - duration - or both at irregular intervals
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

19. What does the classic ring worm lesion have?
ACEi - ARBS - thiazide diuretics
A central clear area
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
Varicella virus

20. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Less than 3 stools per week
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Infectious esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

21. Shoulder pain with pain radiating to elbow
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Cervical radiculopathy
Excessive bleeding in amount - duration - or both at irregular intervals
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

22. Describe the presentation of pneumonia
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
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

23. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Dehydration - anemia - cardiac causes
A 24hr urine protein collection and urine creatinine clearance determination
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

24. What type of imaging is need for chronic sinusitis?
Warts
CT
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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

25. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Hypertension - CAD - valvular heart disease
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

26. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Impetigo
HPV
E. Coli O157:H7
Scleroderma/polymyositis with secondary gastroesophageal reflux

27. History and PE for Pneumonia
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
Rotator Cuff problem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Increase; 200 g/day

28. What should blood work include for suspected heart failure?
A 24hr urine protein collection and urine creatinine clearance determination
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pain
Adhesive capsulitis (frozen shoulder): most common in middle age women

29. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Hgb - Electrolytes - and TSH
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

30. What are the symptoms of palpitations?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Lightheadedness - dizziness - syncope
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

31. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Infectious esophagitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
100mg; means patient can be trace protein positive and not be detected

32. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Possibility of Ischemic colitis

33. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
These patients are associated with low renin states=less likely to respond to medication
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

34. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
Dehydration - anemia - cardiac causes
Upper sternal area burning pain - associated with a productive cough
HPV

35. What are the signs of cerebral hemorrhage?
Bence-Jones
Acute headache - ataxia - profuse nausea - and vomiting
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

36. What lab tests are recommended for newly diagnosed hypertensive patients?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Furucnle
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

37. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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
Diuretics -BB -CCB -ACEi
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure

38. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
PVC or Premature atrial contraction (PAC)
Scabies
HPV testing -Pos=colposcopy -Neg=repeat pap smear
CT

39. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

40. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Supraspinatus and bicipital tendons
Loop diuretics (Check serum K+ levels before drug admin)
Viral infection of the semicircular apparatus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

41. What is the goal of CHF treatment? What drugs should be used?
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

42. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi - ARBS - thiazide diuretics
Analgesic headache

43. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
>150mg per 24hrs
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
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

44. What does treatment for migrans include?
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
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
>3.5g of protein per 24hrs
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

45. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Other brainstem or cranial nerve findings

46. What test done in PE measures instability of shoulder?
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
Temporal arteritis-biopsy of the temporal artery
A 24hr urine protein collection and urine creatinine clearance determination
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

47. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
BB or CCB - catheter ablation of identified bypass tract
Acute headache - ataxia - profuse nausea - and vomiting
Pain

48. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Presence of proteinuria on at least two separate ocassion

49. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
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
Viral gastroenteritis
Acute headache - ataxia - profuse nausea - and vomiting
Non-cardiac causes of palpitations

50. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Albumin; low molecular weight proteins
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool