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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. PE for a patient getting an abnormal vaginal bleeding work up
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

2. What are symptoms are CHF?
Kids: Rotavirus Adults: Norwalk Virus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

3. 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
Menorrhagia
Increase; 200 g/day
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

4. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Viral infection of the semicircular apparatus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Possibility of Ischemic colitis
ACEi - ARBS - thiazide diuretics

5. Name the skin lesion: erythema - warmth - edema - pain - fever
Increasing fluid (8 - 8oz glasses of water/day) -fiber
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Cellulitis
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.

6. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
CT
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
Furucnle

7. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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: 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

8. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
100mg; means patient can be trace protein positive and not be detected
Furucnle
Cellulitis
Fever with frontal or maxillary tenderness

9. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Cervical radiculopathy
Giardia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

10. Regular bleeding at intervals of less than 21 days
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Polymenorrhea
Rotator Cuff tendonitis
HIV and syphilis

11. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
BB or CCB - catheter ablation of identified bypass tract

12. How to NSAIDs contribute to gastritis and ulcer formation?
Rotator Cuff tendonitis
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 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.
>3.5g of protein per 24hrs

13. What is considered normal blood loss during a menstrual cycle?
Supraspinatus and bicipital tendons
S. Aureus
Less than 80 ml of blood
Fever with frontal or maxillary tenderness

14. Name the diagnosis of heartburn: regurgitation - dysphagia
Less than 3 stools per week
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
GERD
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

15. What should preconception counseling include?
Less abrupt onset and cessation of palpitations
Menorrhagia
Cholelithiasis
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

16. What is the next best step if a patient has two or more positive dipstick tests?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less abrupt onset and cessation of palpitations
A 24hr urine protein collection and urine creatinine clearance determination
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

17. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Peptic ulcer disease or gastritis
HIV and syphilis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

18. What is the preload?
Tension headache
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
CBC

19. Diagnostic Evaluation of Abnoraml vaginal bleeding
With a KOH wet mount preparation
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
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.
Pleurisy

20. What are the symptoms of palpitations?
BB or CCB - catheter ablation of identified bypass tract
Giardia
Viral gastroenteritis
Lightheadedness - dizziness - syncope

21. Clinical Manifestations of HTN
Coronary artery disease/ angina
Excessive bleeding in amount - duration - or both at irregular intervals
Intermenstrual bleeding
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

22. SE Of Beta blockers?
S. aureus- beta hemolytic streptococcus
Diuretics -BB -CCB -ACEi
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Other brainstem or cranial nerve findings

23. What is the difference between a Holter monitor or an event monitor?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

24. Predictors of cardiac etiology
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Serotypes 16 - 18 - 31 -52 -58
E. Coli O157:H7
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

25. Pneumonia tx: suitable for healthy adults less than 60
Coronary artery disease/ angina
A central clear area
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

26. How does CHF present on X-ray?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Loop diuretics (Check serum K+ levels before drug admin)

27. Describe the history and PE of patient presenting with common cold
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
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pleurisy

28. 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.
Possibility of Ischemic colitis
Excessive bleeding in amount - duration - or both at irregular intervals
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Repeat Pap after infection treated

29. 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
Medication or chemical esophagitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Cluster headache

30. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
Less than 80 ml of blood
Analgesic headache
Menorrhagia

31. Isolated - extra pounding beats
Chest pain during pneumonia or PE
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
PVC or Premature atrial contraction (PAC)

32. HIgh risk pregnant patients should be evaluated for ____ and ____
ACEi
Staphylococcal scalded skin syndrome
HIV and syphilis
Menorrhagia

33. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Repeat Pap after infection treated
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Viral gastroenteritis

34. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Pleurisy
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

35. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Irregular bleeding between cycles
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

36. What is afterload?
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
Generalized Anxiety disorder and panic disorder
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

37. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
EGD
Medication or chemical esophagitis
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

38. Prenatal visit schedule for low-risk pregnancies
Fever with frontal or maxillary tenderness
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Cholelithiasis
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

39. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
HIV and syphilis
Fever with frontal or maxillary tenderness
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

40. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Hypertension - CAD - valvular heart disease
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

41. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Possibility of Ischemic colitis

42. Describes what occurs during squamous metaplasia of the cervix.
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
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

43. Constipation: What are indications for lab testing?
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
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
Infectious esophagitis
Analgesic headache

44. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Polymenorrhea
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.
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

45. When should invasive eletrophysiologic study should be considered?
Non-cardiac causes of palpitations
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

46. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Hgb - Electrolytes - and TSH
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Subarachnoid hemorrhage

47. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Nonulcer dyspepsia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
35 (exception for postmenopausal women who have recently been started on HRT)

48. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Menorrhagia

49. How do you define persistent protein uria?
Regular bleeding at intervals of more than 35 days
MSK - pulmonary - GI - or psychological
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Presence of proteinuria on at least two separate ocassion

50. What is the role of FSH in one's menstrual cycle
Dehydration - anemia - cardiac causes
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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