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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 are the signs of acute sinusitis?
Chest pain during pneumonia or PE
Fever with frontal or maxillary tenderness
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Wolff-Parkinson-White syndrome

2. How to NSAIDs contribute to gastritis and ulcer formation?
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Chest pain during pneumonia or PE
Diuretics -BB -CCB -ACEi

3. What is the goal of CHF treatment? What drugs should be used?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
LH surge triggers ovulation
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

4. What are the physical exam signs of CHF?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
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

5. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Cluster headache
Bence-Jones
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Chest pain during pneumonia or PE

6. What is the caUse of benign positional vertigo?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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.
Bulk forming: Psyllium - Methycellulose - Polycarbophil

7. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Staphylococcal scalded skin syndrome
Impetigo
Hgb - Electrolytes - and TSH

8. 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
Rotator Cuff tendonitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Scleroderma/polymyositis with secondary gastroesophageal reflux

9. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Repeat Pap after infection treated
GERD

10. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
ACEi
DM - HTN - DVT - seizures - depression - or anxiety
Adhesive capsulitis (frozen shoulder): most common in middle age women
100mg; means patient can be trace protein positive and not be detected

11. What the consequences of decreased cardiac output?
EGD
Albumin; low molecular weight proteins
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

12. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Cholelithiasis
High blood pressure - focal neurologic defecit - or papilledema
Echocardiogram
Excessive bleeding in amount - duration - or both at irregular intervals

13. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Pts with palpitations and dizziness - near syncope - or syncope
PVC or Premature atrial contraction (PAC)
Medication or chemical esophagitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

14. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Rotator Cuff tendonitis
35 (exception for postmenopausal women who have recently been started on HRT)

15. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
PE - MI - aortic dissection - pneumothorax
Temporal arteritis-biopsy of the temporal artery
PVC or Premature atrial contraction (PAC)
Nonulcer dyspepsia

16. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Hgb - Electrolytes - and TSH
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

17. What is a markers of CNS vertigo?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
PE - MI - aortic dissection - pneumothorax
Other brainstem or cranial nerve findings

18. What are the consequences of diastolic dysfunction?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Non-cardiac causes of palpitations

19. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Hypertension - CAD - valvular heart disease
Peptic ulcer disease or gastritis
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

20. What are the signs of cerebral hemorrhage?
Staphylococcal scalded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Acute headache - ataxia - profuse nausea - and vomiting
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

21. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
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.
Regular bleeding at intervals of more than 35 days
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
True

22. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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

23. What does orthostatic positional changes that bring on dizziness suggest?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Variability in the time for follicle development during the proliferative phase
Dehydration - anemia - cardiac causes
Loop diuretics (Check serum K+ levels before drug admin)

24. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
GERD
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
HPV
Scleroderma/polymyositis with secondary gastroesophageal reflux

25. History for Sinusitis

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26. What is considered normal blood loss during a menstrual cycle?
Hypertension - CAD - valvular heart disease
Less than 80 ml of blood
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
Scleroderma/polymyositis with secondary gastroesophageal reflux

27. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Bence-Jones
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

28. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Generalized Anxiety disorder and panic disorder
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

29. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Chest pain during pneumonia or PE
Less than 3 stools per week

30. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Peptic ulcer disease or gastritis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Scleroderma/polymyositis with secondary gastroesophageal reflux

31. Natural history of cervical cancer
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Upper sternal area burning pain - associated with a productive cough

32. patients with herpes zoster may experience what symptom before the rash appear?
E. Coli O157:H7
Chest pain during pneumonia or PE
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pain

33. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
>3.5g of protein per 24hrs
Impetigo
Cholelithiasis

34. What are the most common causes for the common cold?
Echocardiogram
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

35. Name the skin lesion: erythema - warmth - edema - pain - fever
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
Cellulitis
Wolff-Parkinson-White syndrome
Increasing fluid (8 - 8oz glasses of water/day) -fiber

36. PE for a patient getting an abnormal vaginal bleeding work up
PVC or Premature atrial contraction (PAC)
Muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures
LH surge triggers ovulation
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

37. What is the Epley maneuver?
Anticoag with warfarin to prevent thromboembolism
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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.
Dehydration - anemia - cardiac causes

38. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Staphylococcal scalded skin syndrome
Loop diuretics (Check serum K+ levels before drug admin)
These patients are associated with low renin states=less likely to respond to medication

39. What is the role of LH in the menstrual cycle
Temporal arteritis-biopsy of the temporal artery
LH surge triggers ovulation
S. aureus- beta hemolytic streptococcus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

40. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Temporal arteritis-biopsy of the temporal artery
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

41. When should a patient get a stress test?
Folliculitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
When the patient has symptoms in association with exercise or who describe chest pain or pressure

42. Mainstay treatment for soft tissue inflammation (Shoulder)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pleurisy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Excessive bleeding in amount - duration - or both at irregular intervals

43. Uterine bleeding between regular cycles
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Intermenstrual bleeding
Scleroderma/polymyositis with secondary gastroesophageal reflux
Muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures

44. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Candida albicans
Increasing fluid (8 - 8oz glasses of water/day) -fiber
With a KOH wet mount preparation

45. Prenatal visit schedule for low-risk pregnancies
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
Cluster headache
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

46. What is an acoustic neuroma?
Excessive bleeding in amount - duration - or both at irregular intervals
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Squamocolumnar junction=most common site of cervical cancer
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

47. What occurs after ovulation
Rotator Cuff problem
Analgesic headache
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

48. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Impetigo
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Other brainstem or cranial nerve findings

49. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
S. Aureus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Loop diuretics (Check serum K+ levels before drug admin)

50. What should blood work include for suspected heart failure?
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
>3.5g of protein per 24hrs
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF