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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 does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Albumin; low molecular weight proteins
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

2. When should invasive eletrophysiologic study should be considered?
Other brainstem or cranial nerve findings
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

3. Pneumothorax - sudden sharp chest pain - preceded by viral illness
HPV
Excessive bleeding in amount - duration - or both at irregular intervals
Lightheadedness - dizziness - syncope
Pleurisy

4. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Serotypes 16 - 18 - 31 -52 -58
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Echocardiogram

5. Tx of chronic or intermittent afibs
Paroxysmal atrial fibrillation or supraventricular tachycardia
Non-cardiac causes of palpitations
Anticoag with warfarin to prevent thromboembolism
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

6. Describe the presentation tracheobronchitis
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
EGD
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Upper sternal area burning pain - associated with a productive cough

7. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
24 hour halter
HPV
Peptic ulcer disease or gastritis
Furucnle

8. What is the mechanism of action for stimulant agents in treating constipation?
Presence of proteinuria on at least two separate ocassion
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
E. Coli O157:H7
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

9. 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
Wolff-Parkinson-White syndrome
Serotypes 16 - 18 - 31 -52 -58
These patients are associated with low renin states=less likely to respond to medication

10. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Increase; 200 g/day
MSK - pulmonary - GI - or psychological
Dehydration - anemia - cardiac causes
Infectious esophagitis

11. What is benign transient proteinuria?
LH surge triggers ovulation
Common problem that resolves spontaneously and is most often seen in children and young adults
True
Less than 80 ml of blood

12. Define proteinuria
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
>150mg per 24hrs
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

13. What is a markers of CNS vertigo?
Supraspinatus and bicipital tendons
Other brainstem or cranial nerve findings
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

14. At was quantity does urine dipstick test detect elevated protein?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
24 hour halter
100mg; means patient can be trace protein positive and not be detected
Rotator Cuff problem

15. Treatment for supraventricular tachycardias
Lightheadedness - dizziness - syncope
BB or CCB - catheter ablation of identified bypass tract
GERD
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

16. Complete the sentence: pericarditis can cause frictional rub and......
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Upper sternal area burning pain - associated with a productive cough
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

17. PE for a patient getting an abnormal vaginal bleeding work up
Common problem that resolves spontaneously and is most often seen in children and young adults
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Non-cardiac causes of palpitations

18. Uterine bleeding between regular cycles
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Intermenstrual bleeding
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

19. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
>3.5g of protein per 24hrs
Supraspinatus and bicipital tendons

20. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
RBC casts and old to moderate HTN
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

21. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Candida albicans
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

22. What are the three major risk factors for heart failure?
Less than 80 ml of blood
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Hypertension - CAD - valvular heart disease

23. Who should have Xray testing for shoulder pain?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Staphylococcal scalded skin syndrome
A central clear area

24. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Rotator Cuff tendonitis
BB or CCB - catheter ablation of identified bypass tract

25. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Varicella virus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

26. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

27. Name the skin lesion: erythema - warmth - edema - pain - fever
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
A central clear area
Cellulitis

28. Clinical Manifestations of HTN
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Temporal arteritis-biopsy of the temporal artery
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

29. 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
Varicella virus
Bence-Jones
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
ACEi

30. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Rotator Cuff problem
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Non-cardiac causes of palpitations

31. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Viral infection of the semicircular apparatus
Candida albicans

32. What are the most common viral causes of diarrhea in kids and adults?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Kids: Rotavirus Adults: Norwalk Virus
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
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.

33. What is the peripheral caUse of vertigo?
Cluster headache
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

34. What are the three types of lice?
Pancreatitis
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.
Less than 80 ml of blood
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

35. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Colposcopy - Endocervical curettage - and directed cervical biopsy

36. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
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
HIV and syphilis
Upper sternal area burning pain - associated with a productive cough

37. What is an acoustic neuroma?
HIV and syphilis
Coag disorders
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

38. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

39. Describes what occurs during squamous metaplasia of the cervix.
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Colposcopy - Endocervical curettage - and directed cervical biopsy

40. patients with herpes zoster may experience what symptom before the rash appear?
Wolff-Parkinson-White syndrome
Coag disorders
Pain
EGD

41. Shoulder pain with pain radiating to elbow
24 hour halter
Hgb - Electrolytes - and TSH
Cervical radiculopathy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

42. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Possibility of Ischemic colitis

43. How do you define persistent protein uria?
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)
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

44. What are symptoms are CHF?
E. Coli O157:H7
Subarachnoid hemorrhage
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

45. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Temporal arteritis-biopsy of the temporal artery
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

46. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
ACEi - ARBS - thiazide diuretics
Cellulitis
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

47. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

48. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Paroxysmal atrial fibrillation or supraventricular tachycardia
EGD

49. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
True
Less than 80 ml of blood

50. What are the signs of acute sinusitis?
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
Fever with frontal or maxillary tenderness
Non-cardiac causes of palpitations
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin