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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. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Less than 80 ml of blood
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

2. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Other brainstem or cranial nerve findings
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

3. Carcinoma in situ is generally referred to a gynecologist and requires ______
Fever with frontal or maxillary tenderness
HPV
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
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

4. Describe the presentation tracheobronchitis
Impetigo
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Upper sternal area burning pain - associated with a productive cough
Menorrhagia

5. What test done in PE measures instability of shoulder?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
PE - MI - aortic dissection - pneumothorax
Warts

6. What does treatment for migrans include?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Intermenstrual bleeding

7. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Medication or chemical esophagitis
BB or CCB - catheter ablation of identified bypass tract
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

8. Cycle length variabilty is primarily due to what?
Serotypes 16 - 18 - 31 -52 -58
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
35 (exception for postmenopausal women who have recently been started on HRT)
Variability in the time for follicle development during the proliferative phase

9. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

10. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Other brainstem or cranial nerve findings

11. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Presence of proteinuria on at least two separate ocassion
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Echocardiogram

12. Who should have Xray testing for shoulder pain?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Staphylococcal scalded skin syndrome
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Albumin; low molecular weight proteins

13. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
High blood pressure - focal neurologic defecit - or papilledema
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Nonulcer dyspepsia
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

14. Name types of laxatives
Diuretics -BB -CCB -ACEi
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
24 hour halter
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

15. How do you know if heart palpitations are due to stimulant or medication use?
HIV and syphilis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Less abrupt onset and cessation of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals

16. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Bence-Jones
Possibility of Ischemic colitis

17. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

18. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HPV testing -Pos=colposcopy -Neg=repeat pap smear

19. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

20. 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.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Supraspinatus and bicipital tendons
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

21. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Other brainstem or cranial nerve findings
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

22. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Analgesic headache
RBC casts and old to moderate HTN
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.

23. What are the symptoms 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
Lightheadedness - dizziness - syncope
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

24. Diarrhea from custard filled pastries
Loop diuretics (Check serum K+ levels before drug admin)
Upper sternal area burning pain - associated with a productive cough
S. Aureus
Less than 80 ml of blood

25. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Hgb - Electrolytes - and TSH
Paroxysmal atrial fibrillation or supraventricular tachycardia
Loop diuretics (Check serum K+ levels before drug admin)
A 24hr urine protein collection and urine creatinine clearance determination

26. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
BB or CCB - catheter ablation of identified bypass tract
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

27. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
100mg; means patient can be trace protein positive and not be detected
Giardia

28. Discomfort with abducting the arm past 90 degress
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Rotator Cuff tendonitis
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

29. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Less abrupt onset and cessation of palpitations
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Dehydration - anemia - cardiac causes

30. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
24 hour halter
When the patient has symptoms in association with exercise or who describe chest pain or pressure
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

31. 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
Acute headache - ataxia - profuse nausea - and vomiting
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Temporal arteritis-biopsy of the temporal artery

32. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Coronary artery disease/ angina
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
PVC or Premature atrial contraction (PAC)

33. 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
>3.5g of protein per 24hrs
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
Medication or chemical esophagitis

34. Oligomenorrhea
Menorrhagia
Upper sternal area burning pain - associated with a productive cough
Regular bleeding at intervals of more than 35 days
Viral gastroenteritis

35. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Possibility of Ischemic colitis
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
Infectious esophagitis
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

36. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
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
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
Echocardiogram

37. Name the diagnosis of heartburn: severe constant mid abdominal pain
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Presence of proteinuria on at least two separate ocassion
Pancreatitis
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

38. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Less abrupt onset and cessation of palpitations
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Cellulitis
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

39. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Analgesic headache
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

40. Metrorrhagia
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.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Irregular bleeding between cycles
Acute headache - ataxia - profuse nausea - and vomiting

41. What are symptoms are CHF?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Increase; 200 g/day

42. Define proteinuria
Folliculitis
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
Supraspinatus and bicipital tendons
>150mg per 24hrs

43. When does troponin rise following myocardial injury or infarction?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Supraspinatus and bicipital tendons

44. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Staphylococcal scalded skin syndrome
Nonulcer dyspepsia
Squamocolumnar junction=most common site of cervical cancer

45. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pts with palpitations and dizziness - near syncope - or syncope
24 hour halter
Analgesic headache

46. What are the secondly causes of glomerular disease?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
HPV

47. What is considered normal blood loss during a menstrual cycle?
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
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
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.
Less than 80 ml of blood

48. What should preconception counseling include?
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
Viral infection of the semicircular apparatus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Associated with hypotension

49. History for Sinusitis

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50. What are the signs of acute sinusitis?
Menorrhagia
Fever with frontal or maxillary tenderness
CT
Generalized Anxiety disorder and panic disorder