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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 lab tests are recommended for newly diagnosed hypertensive patients?
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Coag disorders

2. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
24 hour halter
Chest pain during pneumonia or PE
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.

3. What are the indiciations for neuroimaging?
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Colposcopy - Endocervical curettage - and directed cervical biopsy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

4. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Impetigo
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
GERD

5. Name the diagnosis of heartburn: severe constant mid abdominal pain
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Excessive bleeding in amount - duration - or both at irregular intervals
Pancreatitis

6. What is a markers of CNS vertigo?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Other brainstem or cranial nerve findings
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
When the patient has symptoms in association with exercise or who describe chest pain or pressure

7. Why is the pap smear one of the most effective cancer screening tools?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Variability in the time for follicle development during the proliferative phase
Slow progression of cervical cancer changes -Availability of effective early treatment
Bulk forming: Psyllium - Methycellulose - Polycarbophil

8. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Varicella virus

9. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Cluster headache
Cholelithiasis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

10. Define proteinuria
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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
>150mg per 24hrs
HIV and syphilis

11. What diagnosis does the 'worse headache of my life' suggest?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Subarachnoid hemorrhage
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

12. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Anticoag with warfarin to prevent thromboembolism
Common problem that resolves spontaneously and is most often seen in children and young adults
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

13. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Coronary artery disease/ angina

14. What is afterload?
Less than 3 stools per week
Generalized Anxiety disorder and panic disorder
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

15. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Rotator Cuff problem
Viral gastroenteritis

16. 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
A 24hr urine protein collection and urine creatinine clearance determination
Cluster headache
True
Scleroderma/polymyositis with secondary gastroesophageal reflux

17. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Paroxysmal atrial fibrillation or supraventricular tachycardia
A 24hr urine protein collection and urine creatinine clearance determination
Medication or chemical esophagitis

18. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Streptococci
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Presence of proteinuria on at least two separate ocassion
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

19. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Serotypes 16 - 18 - 31 -52 -58
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
Varicella virus

20. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Cholelithiasis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Viral infection of the semicircular apparatus

21. Constipation: What are indications for lab testing?
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
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.
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

22. Regular bleeding at intervals of less than 21 days
Furucnle
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Polymenorrhea
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

23. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
ACEi
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increasing fluid (8 - 8oz glasses of water/day) -fiber

24. History and PE for Pneumonia
Intermenstrual bleeding
Loop diuretics (Check serum K+ levels before drug admin)
Non-cardiac causes of palpitations
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

25. What places women at higher risk of getting cervical cancer?
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
With a KOH wet mount preparation
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

26. What are the most common viral causes of diarrhea in kids and adults?
Rotator cuff tendonitis
Common problem that resolves spontaneously and is most often seen in children and young adults
Generalized Anxiety disorder and panic disorder
Kids: Rotavirus Adults: Norwalk Virus

27. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less than 80 ml of blood
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

28. What are the three types of lice?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
BB or CCB - catheter ablation of identified bypass tract
PE - MI - aortic dissection - pneumothorax
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

29. What is benign transient proteinuria?
ACEi - ARBS - thiazide diuretics
Folliculitis
Common problem that resolves spontaneously and is most often seen in children and young adults
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

30. Describe the presentation tracheobronchitis
Echocardiogram
Upper sternal area burning pain - associated with a productive cough
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Giardia

31. What is the goal of CHF treatment? What drugs should be used?
Varicella virus
CT
Kids: Rotavirus Adults: Norwalk Virus
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

32. 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.
Scabies
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
Supraspinatus and bicipital tendons
Cholelithiasis

33. Things that need to be included in history of shoulder pain
Infectious esophagitis
Kids: Rotavirus Adults: Norwalk Virus
Rotator cuff tendonitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

34. Metrorrhagia
EGD
Irregular bleeding between cycles
Serotypes 16 - 18 - 31 -52 -58
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

35. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cluster headache
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Viral infection of the semicircular apparatus

36. Name the diagnosis of heartburn: regurgitation - dysphagia
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
S. aureus- beta hemolytic streptococcus
GERD
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

37. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Rotator Cuff problem
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

38. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CT
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

39. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Cluster headache
Chest pain during pneumonia or PE
These patients are associated with low renin states=less likely to respond to medication
Less than 3 stools per week

40. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

41. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Molluscum contagiosum- pox virus
Cervical radiculopathy
Associated with hypotension

42. Describe the presentation of angina?
Temporal arteritis-biopsy of the temporal artery
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
>150mg per 24hrs
Pleurisy

43. Treatment for supraventricular tachycardias
>3.5g of protein per 24hrs
Kids: Rotavirus Adults: Norwalk Virus
BB or CCB - catheter ablation of identified bypass tract
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

44. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Excessive bleeding in amount - duration - or both at irregular intervals
Serotypes 16 - 18 - 31 -52 -58
PVC or Premature atrial contraction (PAC)

45. What is an acoustic neuroma?
Hgb - Electrolytes - and TSH
Polymenorrhea
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Higher filling presure - pulmonary congestion - and decreasd cardiac return

46. Describe the history and PE of patient presenting with common cold
Impetigo
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Regular bleeding at intervals of more than 35 days

47. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

48. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Rotator cuff tendonitis
Adhesive capsulitis (frozen shoulder): most common in middle age women
RBC casts and old to moderate HTN
CBC

49. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pancreatitis
Nonulcer dyspepsia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

50. Cycle length variabilty is primarily due to what?
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
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
Variability in the time for follicle development during the proliferative phase
Squamocolumnar junction=most common site of cervical cancer