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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 is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Common problem that resolves spontaneously and is most often seen in children and young adults
Giardia
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pancreatitis

2. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Acute headache - ataxia - profuse nausea - and vomiting
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

3. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Temporal arteritis-biopsy of the temporal artery
Diuretics -BB -CCB -ACEi
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

4. 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
Diuretics -BB -CCB -ACEi
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Medication or chemical esophagitis

5. What drugs do you use to treat H.pylori + PUD?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
A 24hr urine protein collection and urine creatinine clearance determination
DM - HTN - DVT - seizures - depression - or anxiety

6. Prenatal visit schedule for low-risk pregnancies
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Associated with hypotension
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

7. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Scabies
Viral infection of the semicircular apparatus
Common problem that resolves spontaneously and is most often seen in children and young adults
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

8. At was quantity does urine dipstick test detect elevated protein?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected
Cholelithiasis

9. Why is the pap smear one of the most effective cancer screening tools?
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Serotypes 16 - 18 - 31 -52 -58
Slow progression of cervical cancer changes -Availability of effective early treatment

10. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Loop diuretics (Check serum K+ levels before drug admin)
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

11. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
CBC

12. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Albumin; low molecular weight proteins
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
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

13. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Non-cardiac causes of palpitations
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
E. Coli O157:H7

14. What does the classic ring worm lesion have?
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Infectious esophagitis
A central clear area

15. What occurs after ovulation
Squamocolumnar junction=most common site of cervical cancer
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
ACEi
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

16. How do you define persistent protein uria?
Presence of proteinuria on at least two separate ocassion
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
HPV
Rotator Cuff problem

17. What are the secondly causes of glomerular disease?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Chest pain during pneumonia or PE
Tension headache

18. Metrorrhagia
Irregular bleeding between cycles
Nonulcer dyspepsia
Generalized Anxiety disorder and panic disorder
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

19. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Other brainstem or cranial nerve findings
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
Infectious esophagitis

20. What is the difference between a Holter monitor or an event monitor?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Medication or chemical esophagitis

21. What are the features of nephrotic syndrome?
A central clear area
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
Associated with hypotension
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

22. Lab testing for heart palpitation
High blood pressure - focal neurologic defecit - or papilledema
Hgb - Electrolytes - and TSH
Menorrhagia
Temporal arteritis-biopsy of the temporal artery

23. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
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
>150mg per 24hrs
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

24. 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.
Tension headache
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
Wolff-Parkinson-White syndrome
CT

25. History for Acute bronchitis
Upper sternal area burning pain - associated with a productive cough
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Dehydration - anemia - cardiac causes
ACEi - ARBS - thiazide diuretics

26. Describe the presentation tracheobronchitis
Anticoag with warfarin to prevent thromboembolism
A 24hr urine protein collection and urine creatinine clearance determination
Increase; 200 g/day
Upper sternal area burning pain - associated with a productive cough

27. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Variability in the time for follicle development during the proliferative phase
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Menorrhagia

28. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

29. Describe the presentation of myocardial pain?
Pancreatitis
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Serotypes 16 - 18 - 31 -52 -58

30. patients with herpes zoster may experience what symptom before the rash appear?
Cholelithiasis
Wolff-Parkinson-White syndrome
Pain
Scabies

31. What should preconception counseling include?
Pts with palpitations and dizziness - near syncope - or syncope
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
Cluster headache
S. Aureus

32. What are the two common clinical presentations of acute diarrhea?
Echocardiogram
Albumin; low molecular weight proteins
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Peptic ulcer disease or gastritis

33. Name the skin lesion: erythema - warmth - edema - pain - fever
Polymenorrhea
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pleurisy
Cellulitis

34. What type of imaging is need for chronic sinusitis?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
CT
Kids: Rotavirus Adults: Norwalk Virus
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

35. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
High blood pressure - focal neurologic defecit - or papilledema
35 (exception for postmenopausal women who have recently been started on HRT)
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

36. 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.
ACEi
Polymenorrhea
Supraspinatus and bicipital tendons
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

37. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Impetigo
HPV
35 (exception for postmenopausal women who have recently been started on HRT)

38. What is the preload?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Other brainstem or cranial nerve findings
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

39. What are the physical exam signs of CHF?
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
EGD
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

40. Chronic pain and shoulder stiffness with limited motion
S. aureus- beta hemolytic streptococcus
Loop diuretics (Check serum K+ levels before drug admin)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Adhesive capsulitis (frozen shoulder): most common in middle age women

41. Constipation: What are indications for lab testing?
LH surge triggers ovulation
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.
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
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

42. Define proteinuria
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
A central clear area
>150mg per 24hrs
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Candida albicans
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
CBC

44. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Pts with palpitations and dizziness - near syncope - or syncope
Hgb - Electrolytes - and TSH
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

45. Irregular cycles with excessive flow - duration - or both
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Menorrhagia
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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

46. What is the peripheral caUse of vertigo?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Peptic ulcer disease or gastritis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
DM - HTN - DVT - seizures - depression - or anxiety

47. When should a patient get a stress test?
Streptococci
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

48. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Staphylococcal scalded skin syndrome

49. What are the symptoms of palpitations?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Nonulcer dyspepsia
Lightheadedness - dizziness - syncope
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

50. What are the consequences of diastolic dysfunction?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Folliculitis
Peptic ulcer disease or gastritis