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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 4 factors that predispose an individual to develop pneumonia.
Upper sternal area burning pain - associated with a productive cough
Pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

2. Clinical Manifestations of HTN
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

3. patients with herpes zoster may experience what symptom before the rash appear?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

4. Lab testing for heart palpitation
Folliculitis
Hgb - Electrolytes - and TSH
Varicella virus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

5. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
>150mg per 24hrs
Scabies
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

6. 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.
Other brainstem or cranial nerve findings
HIV and syphilis
Tension headache
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

7. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Temporal arteritis-biopsy of the temporal artery
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

8. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Folliculitis

9. Describes what occurs during squamous metaplasia of the cervix.
Serotypes 16 - 18 - 31 -52 -58
Presence of proteinuria on at least two separate ocassion
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

10. When is a lumbar puncture contraindicated?
Loop diuretics (Check serum K+ levels before drug admin)
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
Temporal arteritis-biopsy of the temporal artery
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

11. How to NSAIDs contribute to gastritis and ulcer formation?
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.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
GERD
True

12. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Peptic ulcer disease or gastritis
Coronary artery disease/ angina

13. 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
Common problem that resolves spontaneously and is most often seen in children and young adults
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pain
Scabies

14. Pneumonia tx: suitable for healthy adults older than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Acute headache - ataxia - profuse nausea - and vomiting
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pancreatitis

15. What is the mechanism of action for stimulant agents in treating constipation?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

16. Things that need to be included in history of shoulder pain
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
PE - MI - aortic dissection - pneumothorax

17. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Nonulcer dyspepsia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
CT

18. Name the skin lesion: pustule in association with a hair follice
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Serotypes 16 - 18 - 31 -52 -58
Folliculitis

19. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Serotypes 16 - 18 - 31 -52 -58
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Non-cardiac causes of palpitations
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

20. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Common problem that resolves spontaneously and is most often seen in children and young adults

21. Name the diagnosis of heartburn: regurgitation - dysphagia
Rotator Cuff tendonitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Serotypes 16 - 18 - 31 -52 -58
GERD

22. What is a markers of CNS vertigo?
BB or CCB - catheter ablation of identified bypass tract
Other brainstem or cranial nerve findings
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

23. How do you know if heart palpitations are due to stimulant or medication use?
Non-cardiac causes of palpitations
Less abrupt onset and cessation of palpitations
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Coronary artery disease/ angina

24. What does the classic ring worm lesion have?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
A central clear area
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

25. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Analgesic headache
Variability in the time for follicle development during the proliferative phase

26. Vaccines that should be updated before planned pregnancy
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
Intermenstrual bleeding
Varicella virus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

27. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Giardia
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

28. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

29. Define proteinuria
>150mg per 24hrs
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Pleurisy

30. What is the caUse of benign positional vertigo?
Coronary artery disease/ angina
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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.
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

31. What are the most common causes for the common cold?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
CBC
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

32. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Colposcopy - Endocervical curettage - and directed cervical biopsy
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Less abrupt onset and cessation of palpitations
Wolff-Parkinson-White syndrome

33. What test done in PE measures instability of shoulder?
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

34. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Cervical radiculopathy
Streptococci
HPV
Scleroderma/polymyositis with secondary gastroesophageal reflux

35. How do you define persistent protein uria?
Molluscum contagiosum- pox virus
Presence of proteinuria on at least two separate ocassion
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Menorrhagia

36. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Less than 3 stools per week
ACEi - ARBS - thiazide diuretics
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. What is the caUse of Meniere disease? What are the cardinal symptoms?
Analgesic headache
GERD
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

38. What drugs do you use to treat H.pylori + PUD?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

39. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Viral infection of the semicircular apparatus
High blood pressure - focal neurologic defecit - or papilledema
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

40. What are the secondly causes of glomerular disease?
PVC or Premature atrial contraction (PAC)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

41. Mainstay treatment for soft tissue inflammation (Shoulder)
Variability in the time for follicle development during the proliferative phase
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Kids: Rotavirus Adults: Norwalk Virus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

42. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Peptic ulcer disease or gastritis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Rotator Cuff problem

43. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
S. Aureus
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
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

44. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

45. History for Sinusitis

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46. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
>150mg per 24hrs
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
ACEi

47. 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
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
Pleurisy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Cluster headache

48. What should preconception counseling include?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
HPV
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

49. Describe the history and PE of patient presenting with common cold
Paroxysmal atrial fibrillation or supraventricular tachycardia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

50. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Pleurisy
Colposcopy - Endocervical curettage - and directed cervical biopsy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia