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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 symptoms are CHF?
>150mg per 24hrs
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

2. History for Sinusitis

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3. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
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
Generalized Anxiety disorder and panic disorder
Rotator Cuff problem
Molluscum contagiosum- pox virus

4. Predictors of cardiac etiology
Menorrhagia
100mg; means patient can be trace protein positive and not be detected
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

5. Initial treatment for Rhinosinusitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
100mg; means patient can be trace protein positive and not be detected

6. What are the three types of lice?
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.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Pain

7. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
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

8. What are the most common viral causes of diarrhea in kids and adults?
Generalized Anxiety disorder and panic disorder
Kids: Rotavirus Adults: Norwalk Virus
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.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

9. What treatments are the cornerstone for treating cases of functional constipation?
BB or CCB - catheter ablation of identified bypass tract
Intermenstrual bleeding
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Common problem that resolves spontaneously and is most often seen in children and young adults

10. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
35 (exception for postmenopausal women who have recently been started on HRT)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

11. What is the next best step if a patient has two or more positive dipstick tests?
Giardia
A 24hr urine protein collection and urine creatinine clearance determination
Chest pain during pneumonia or PE
Adhesive capsulitis (frozen shoulder): most common in middle age women

12. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
True
Fever with frontal or maxillary tenderness
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

13. Metrorrhagia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Possibility of Ischemic colitis
Irregular bleeding between cycles
ACEi - ARBS - thiazide diuretics

14. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
>3.5g of protein per 24hrs
MSK - pulmonary - GI - or psychological
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

15. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
PVC or Premature atrial contraction (PAC)
Coag disorders
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Diuretics -BB -CCB -ACEi

16. What does orthostatic positional changes that bring on dizziness suggest?
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.
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Dehydration - anemia - cardiac causes

17. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Bence-Jones
Scabies
Giardia
Less than 3 stools per week

18. Name types of laxatives
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cholelithiasis
Rotator Cuff tendonitis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
35 (exception for postmenopausal women who have recently been started on HRT)
Warts

20. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cholelithiasis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Acute headache - ataxia - profuse nausea - and vomiting

21. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
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

22. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Other brainstem or cranial nerve findings
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pleurisy

23. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Loop diuretics (Check serum K+ levels before drug admin)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hgb - Electrolytes - and TSH

24. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
>150mg per 24hrs
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Less abrupt onset and cessation of palpitations
HPV

25. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
ACEi
Menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

26. 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
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
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
Viral gastroenteritis

27. Pain in shoulder when throwing - swimming - or serving a tennis ball
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Scabies
Rotator cuff tendonitis

28. History for Acute bronchitis
Analgesic headache
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

29. What should preconception counseling include?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Wolff-Parkinson-White syndrome
Increase; 200 g/day
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

30. 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
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
Repeat Pap after infection treated
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

31. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Candida albicans
Furucnle
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

32. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Acute headache - ataxia - profuse nausea - and vomiting
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Viral infection of the semicircular apparatus

33. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Wolff-Parkinson-White syndrome

34. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Less than 80 ml of blood
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Less than 3 stools per week
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

35. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
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
BB or CCB - catheter ablation of identified bypass tract
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

36. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
100mg; means patient can be trace protein positive and not be detected
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

37. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Dehydration - anemia - cardiac causes
ACEi - ARBS - thiazide diuretics

38. Describe the presentation tracheobronchitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Upper sternal area burning pain - associated with a productive cough
LH surge triggers ovulation

39. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Coag disorders
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

40. Name the skin lesion: honey colored crusts
S. aureus- beta hemolytic streptococcus
Impetigo
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
Scabies

41. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Pleurisy
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

42. Constipation: What are indications for lab testing?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

43. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Less than 3 stools per week
Cellulitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

44. Describe the presentation of pericardial pain
Excessive bleeding in amount - duration - or both at irregular intervals
Scleroderma/polymyositis with secondary gastroesophageal reflux
PVC or Premature atrial contraction (PAC)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

45. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Supraspinatus and bicipital tendons
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Staphylococcal scalded skin syndrome
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

46. What is the standard tool used for diagnosis of GERD?
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.
Adhesive capsulitis (frozen shoulder): most common in middle age women
EGD
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

47. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Squamocolumnar junction=most common site of cervical cancer
Folliculitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

48. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Hypertension - CAD - valvular heart disease
Generalized Anxiety disorder and panic disorder
Albumin; low molecular weight proteins
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

49. 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.
Echocardiogram
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Tension headache

50. When is a lumbar puncture contraindicated?
Echocardiogram
PE - MI - aortic dissection - pneumothorax
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation