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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 skin lesion: erythema - warmth - edema - pain - fever
RBC casts and old to moderate HTN
Hgb - Electrolytes - and TSH
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cellulitis

2. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
High blood pressure - focal neurologic defecit - or papilledema
Acute headache - ataxia - profuse nausea - and vomiting
Other brainstem or cranial nerve findings

3. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
S. aureus- beta hemolytic streptococcus
HPV
GERD

4. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

5. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Other brainstem or cranial nerve findings
Anticoag with warfarin to prevent thromboembolism
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

6. 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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Slow progression of cervical cancer changes -Availability of effective early treatment

7. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
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
Pts with palpitations and dizziness - near syncope - or syncope
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

8. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Chest pain during pneumonia or PE
Associated with hypotension
CBC

9. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Folliculitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

10. What is the preload?
Hypertension - CAD - valvular heart disease
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

11. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Coronary artery disease/ angina
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
Lightheadedness - dizziness - syncope

12. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
S. aureus- beta hemolytic streptococcus
Infectious esophagitis

13. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
DM - HTN - DVT - seizures - depression - or anxiety
Molluscum contagiosum- pox virus
MSK - pulmonary - GI - or psychological

14. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Medication or chemical esophagitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
CBC
Pain

15. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Coag disorders
HPV testing -Pos=colposcopy -Neg=repeat pap smear
24 hour halter
Rotator Cuff tendonitis

16. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Rotator Cuff tendonitis

17. Diagnosis of HTN
Viral infection of the semicircular apparatus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
>3.5g of protein per 24hrs
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

18. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Nonulcer dyspepsia
Molluscum contagiosum- pox virus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

19. Prenatal visit schedule for low-risk pregnancies
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

20. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Coronary artery disease/ angina
Varicella virus
Impetigo

21. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
S. Aureus
Supraspinatus and bicipital tendons
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

22. What is the difference between a Holter monitor or an event monitor?
ACEi
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
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
>150mg per 24hrs

23. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Less abrupt onset and cessation of palpitations
LH surge triggers ovulation
Anticoag with warfarin to prevent thromboembolism

24. Shoulder pain with pain radiating to elbow
Viral infection of the semicircular apparatus
Cervical radiculopathy
Associated with hypotension
Medication or chemical esophagitis

25. What is a markers of CNS vertigo?
Albumin; low molecular weight proteins
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
PE - MI - aortic dissection - pneumothorax
Other brainstem or cranial nerve findings

26. What should be considered in younger patients with menorrhagia
Common problem that resolves spontaneously and is most often seen in children and young adults
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Warts
Coag disorders

27. History for Sinusitis

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28. What lab tests are recommended for newly diagnosed hypertensive patients?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
High blood pressure - focal neurologic defecit - or papilledema

29. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Intermenstrual bleeding
Lightheadedness - dizziness - syncope
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
Presence of proteinuria on at least two separate ocassion

30. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
A central clear area
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

31. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cholelithiasis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
CBC

32. What are the primary glomerular diseases?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

33. What is the Epley maneuver?
24 hour halter
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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.
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

34. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
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
Tension headache
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

35. Lab testing for heart palpitation
Peptic ulcer disease or gastritis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Hypertension - CAD - valvular heart disease
Hgb - Electrolytes - and TSH

36. Difference between Pneumonia and Bronchitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Staphylococcal scalded skin syndrome
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.

37. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Other brainstem or cranial nerve findings
Giardia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

38. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Pain
Peptic ulcer disease or gastritis

39. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Nonulcer dyspepsia
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.
Non-cardiac causes of palpitations
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

40. Describe the presentation of pneumonia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days

41. What test done in PE measures instability of shoulder?
Giardia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Menorrhagia
Rotator Cuff tendonitis

42. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Kids: Rotavirus Adults: Norwalk Virus
Diuretics -BB -CCB -ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

43. What does orthostatic positional changes that bring on dizziness suggest?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
S. aureus- beta hemolytic streptococcus
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
Dehydration - anemia - cardiac causes

44. Name types of laxatives
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Diuretics -BB -CCB -ACEi

45. What is the mechanism of action for stimulant agents in treating constipation?
EGD
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Scabies
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

46. Pneumonia tx: suitable for healthy adults less than 60
Scabies
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
True
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

47. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral infection of the semicircular apparatus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
HPV testing -Pos=colposcopy -Neg=repeat pap smear

48. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
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
Squamocolumnar junction=most common site of cervical cancer
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

49. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
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
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
Intermenstrual bleeding

50. What is the standard tool used for diagnosis of GERD?
Lightheadedness - dizziness - syncope
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
EGD