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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 type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Loop diuretics (Check serum K+ levels before drug admin)
Slow progression of cervical cancer changes -Availability of effective early treatment
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

2. Define the patient population typically affected by orthostatic or postural proteinuria
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
Increase; 200 g/day
Streptococci
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

3. What are the signs of acute sinusitis?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Adhesive capsulitis (frozen shoulder): most common in middle age women
With a KOH wet mount preparation
Fever with frontal or maxillary tenderness

4. Metrorrhagia
35 (exception for postmenopausal women who have recently been started on HRT)
Upper sternal area burning pain - associated with a productive cough
Squamocolumnar junction=most common site of cervical cancer
Irregular bleeding between cycles

5. What is the role of FSH in one's menstrual cycle
S. Aureus
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

6. What are the symptoms of palpitations?
Less abrupt onset and cessation of palpitations
True
Paroxysmal atrial fibrillation or supraventricular tachycardia
Lightheadedness - dizziness - syncope

7. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
These patients are associated with low renin states=less likely to respond to medication
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

8. MI - pericardial tamponade - PE - GI bleed - are...
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Associated with hypotension
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Chest pain during pneumonia or PE

9. What is the difference between a Holter monitor or an event monitor?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Increase; 200 g/day
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

10. History for Sinusitis

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11. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
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

12. SE Of Beta blockers?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Dehydration - anemia - cardiac causes

13. Name the diagnosis of heartburn: severe constant mid abdominal pain
DM - HTN - DVT - seizures - depression - or anxiety
Rotator cuff tendonitis
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
Pancreatitis

14. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Regular bleeding at intervals of more than 35 days
Higher filling presure - pulmonary congestion - and decreasd cardiac return

15. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Possibility of Ischemic colitis

16. Initial treatment for Rhinosinusitis
Acute headache - ataxia - profuse nausea - and vomiting
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A 24hr urine protein collection and urine creatinine clearance determination
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

17. What is the caUse of Meniere disease? What are the cardinal symptoms?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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.
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

18. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Excessive bleeding in amount - duration - or both at irregular intervals
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
High blood pressure - focal neurologic defecit - or papilledema
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

19. What are the 2 psych disorders most commonly associated with palpitations?
Coag disorders
Kids: Rotavirus Adults: Norwalk Virus
Generalized Anxiety disorder and panic disorder
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

20. Who should have Xray testing for shoulder pain?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
24 hour halter
RBC casts and old to moderate HTN

21. Cycle length variabilty is primarily due to what?
Infectious esophagitis
Repeat Pap after infection treated
Scleroderma/polymyositis with secondary gastroesophageal reflux
Variability in the time for follicle development during the proliferative phase

22. Chronic pain and shoulder stiffness with limited motion
Regular bleeding at intervals of more than 35 days
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Adhesive capsulitis (frozen shoulder): most common in middle age women
Hypertension - CAD - valvular heart disease

23. Regular bleeding at intervals of less than 21 days
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Polymenorrhea
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

24. What are the three types of lice?
Loop diuretics (Check serum K+ levels before drug admin)
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
>150mg per 24hrs
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

25. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HPV testing -Pos=colposcopy -Neg=repeat pap smear
PVC or Premature atrial contraction (PAC)

26. What is the caUse of benign positional vertigo?
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.
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Supraspinatus and bicipital tendons
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

27. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Wolff-Parkinson-White syndrome
Impetigo
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

28. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

29. What are the physical exam signs of CHF?
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
Pleurisy
CBC
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

30. Uterine bleeding between regular cycles
Excessive bleeding in amount - duration - or both at irregular intervals
Intermenstrual bleeding
Cholelithiasis
Scabies

31. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Pleurisy
Albumin; low molecular weight proteins
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

32. 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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
ACEi
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

33. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Furucnle
Nonulcer dyspepsia

34. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Rotator cuff tendonitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
100mg; means patient can be trace protein positive and not be detected

35. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Medication or chemical esophagitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Intermenstrual bleeding

36. What are signs of pulmonary congestion?
S. aureus- beta hemolytic streptococcus
Diuretics -BB -CCB -ACEi
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

37. What are the signs of cerebral hemorrhage?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Acute headache - ataxia - profuse nausea - and vomiting

38. How does systolic vs. diastolic heart failure present on the echocardiogram?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

39. What occurs after ovulation
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

40. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
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
MSK - pulmonary - GI - or psychological

41. Things that need to be included in history of shoulder pain
PE - MI - aortic dissection - pneumothorax
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

42. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Other brainstem or cranial nerve findings
Staphylococcal scalded skin syndrome
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

43. Menometrorrhagia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Excessive bleeding in amount - duration - or both at irregular intervals
Albumin; low molecular weight proteins
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
E. Coli O157:H7
Medication or chemical esophagitis
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.

45. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Coag disorders
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
Kids: Rotavirus Adults: Norwalk Virus

46. Mainstay treatment for soft tissue inflammation (Shoulder)
Loop diuretics (Check serum K+ levels before drug admin)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
BB or CCB - catheter ablation of identified bypass tract

47. 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
DM - HTN - DVT - seizures - depression - or anxiety
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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. What does orthostatic positional changes that bring on dizziness suggest?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
PE - MI - aortic dissection - pneumothorax
RBC casts and old to moderate HTN
Dehydration - anemia - cardiac causes

49. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Giardia
Temporal arteritis-biopsy of the temporal artery
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

50. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
24 hour halter
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
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