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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. At was quantity does urine dipstick test detect elevated protein?
Repeat Pap after infection treated
Kids: Rotavirus Adults: Norwalk Virus
100mg; means patient can be trace protein positive and not be detected
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

2. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Cluster headache

3. Metrorrhagia
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
Irregular bleeding between cycles
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

4. When should a patient get a stress test?
A 24hr urine protein collection and urine creatinine clearance determination
When the patient has symptoms in association with exercise or who describe chest pain or pressure
S. Aureus
Rotator Cuff tendonitis

5. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
E. Coli O157:H7
Bulk forming: Psyllium - Methycellulose - Polycarbophil

6. Four muscles of rotator cuff
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Anticoag with warfarin to prevent thromboembolism

7. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Anticoag with warfarin to prevent thromboembolism
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Streptococci
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

8. 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
Cluster headache
Rotator Cuff problem
True
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

9. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Repeat Pap after infection treated
Molluscum contagiosum- pox virus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Cholelithiasis

10. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Irregular bleeding between cycles
100mg; means patient can be trace protein positive and not be detected

11. What test done in PE measures instability of shoulder?
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
Albumin; low molecular weight proteins
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

12. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Common problem that resolves spontaneously and is most often seen in children and young adults
Repeat Pap after infection treated
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

13. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
24 hour halter
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

14. Predictors of cardiac etiology
Coronary artery disease/ angina
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
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

15. History for Sinusitis

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

17. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
S. aureus- beta hemolytic streptococcus
Scabies
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

18. What is the standard tool used for diagnosis of GERD?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Less than 3 stools per week
EGD
Viral infection of the semicircular apparatus

19. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
35 (exception for postmenopausal women who have recently been started on HRT)
Analgesic headache
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

20. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Less than 3 stools per week
Warts
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

21. What is the peripheral caUse of vertigo?
Irregular bleeding between cycles
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Intermenstrual bleeding

22. Who should have Xray testing for shoulder pain?
Viral infection of the semicircular apparatus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Pleurisy
Furucnle

23. What are the indiciations for neuroimaging?
Molluscum contagiosum- pox virus
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
GERD
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

24. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Bence-Jones
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
ACEi - ARBS - thiazide diuretics

25. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
HPV

26. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Slow progression of cervical cancer changes -Availability of effective early treatment
BB or CCB - catheter ablation of identified bypass tract
Fever with frontal or maxillary tenderness

27. What does treatment for migrans include?
Diuretics -BB -CCB -ACEi
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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

28. Name the diagnosis of heartburn: severe constant mid abdominal pain
E. Coli O157:H7
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
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
Pancreatitis

29. What is benign transient proteinuria?
Rotator cuff tendonitis
Common problem that resolves spontaneously and is most often seen in children and young adults
Less abrupt onset and cessation of palpitations
With a KOH wet mount preparation

30. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Possibility of Ischemic colitis

31. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Repeat Pap after infection treated
Non-cardiac causes of palpitations
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

32. What are the signs of malignant hypertension?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi - ARBS - thiazide diuretics
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
High blood pressure - focal neurologic defecit - or papilledema

33. Discomfort with abducting the arm past 90 degress
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Rotator Cuff tendonitis
Albumin; low molecular weight proteins
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

34. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
35 (exception for postmenopausal women who have recently been started on HRT)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Streptococci
Albumin; low molecular weight proteins

35. Define the patient population typically affected by orthostatic or postural proteinuria
Cholelithiasis
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Rotator Cuff tendonitis

36. 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
Variability in the time for follicle development during the proliferative phase
Less than 80 ml of blood
>3.5g of protein per 24hrs
Varicella virus

37. Why is the pap smear one of the most effective cancer screening tools?
Diuretics -BB -CCB -ACEi
Cellulitis
Hypertension - CAD - valvular heart disease
Slow progression of cervical cancer changes -Availability of effective early treatment

38. What are the three types of lice?
Less abrupt onset and cessation of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
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

39. What should preconception counseling include?
Kids: Rotavirus Adults: Norwalk Virus
Folliculitis
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
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

40. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Other brainstem or cranial nerve findings
Coag disorders
A central clear area
Bence-Jones

41. Describe the presentation of pericardial pain
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fever with frontal or maxillary tenderness
S. Aureus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

42. Name some medications that can cause proteinuria
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Tension headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

43. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
A central clear area
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
GERD
CT
Temporal arteritis-biopsy of the temporal artery
Increasing fluid (8 - 8oz glasses of water/day) -fiber

45. How is constipation clinically defined?
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
Less than 3 stools per week
Presence of proteinuria on at least two separate ocassion
ACEi

46. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
These patients are associated with low renin states=less likely to respond to medication
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

47. Describes what occurs during squamous metaplasia of the cervix.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
A 24hr urine protein collection and urine creatinine clearance determination
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

48. 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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

49. What are the consequences of diastolic dysfunction?
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
24 hour halter
Higher filling presure - pulmonary congestion - and decreasd cardiac return

50. History for Acute bronchitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
EGD
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart