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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. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Loop diuretics (Check serum K+ levels before drug admin)
Pts with palpitations and dizziness - near syncope - or syncope
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

2. What medications can cause heart palpitations?
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
MSK - pulmonary - GI - or psychological
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

3. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
A 24hr urine protein collection and urine creatinine clearance determination
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
MSK - pulmonary - GI - or psychological
S. aureus- beta hemolytic streptococcus

4. 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)
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.
Anticoag with warfarin to prevent thromboembolism
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

5. Complete the sentence: pericarditis can cause frictional rub and......
Variability in the time for follicle development during the proliferative phase
Anticoag with warfarin to prevent thromboembolism
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

6. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
CT
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Albumin; low molecular weight proteins

7. Isolated - extra pounding beats
Intermenstrual bleeding
PVC or Premature atrial contraction (PAC)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

8. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Impetigo
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Coag disorders
Chest pain during pneumonia or PE

9. What does orthostatic positional changes that bring on dizziness suggest?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less than 3 stools per week
Dehydration - anemia - cardiac causes
100mg; means patient can be trace protein positive and not be detected

10. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Acute headache - ataxia - profuse nausea - and vomiting
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

11. Irregular cycles with excessive flow - duration - or both
Analgesic headache
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Bence-Jones
Menorrhagia

12. What is a markers of CNS vertigo?
Other brainstem or cranial nerve findings
ACEi
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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.

13. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

14. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Supraspinatus and bicipital tendons
EGD
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

15. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
HPV
Impetigo
GERD

16. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Diuretics -BB -CCB -ACEi
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

17. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
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

18. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Less than 3 stools per week

19. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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

20. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Less abrupt onset and cessation of palpitations
Cervical radiculopathy
BB or CCB - catheter ablation of identified bypass tract

21. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
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
>3.5g of protein per 24hrs
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

22. History and PE for Pneumonia
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

23. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
S. aureus- beta hemolytic streptococcus
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

24. Lab testing for heart palpitation
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
Furucnle
Hgb - Electrolytes - and TSH
CBC

25. 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
Viral infection of the semicircular apparatus
DM - HTN - DVT - seizures - depression - or anxiety
Pancreatitis

26. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Molluscum contagiosum- pox virus
Viral gastroenteritis
Serotypes 16 - 18 - 31 -52 -58

27. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Acute headache - ataxia - profuse nausea - and vomiting

28. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Lightheadedness - dizziness - syncope
DM - HTN - DVT - seizures - depression - or anxiety
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

29. What are the 2 psych disorders most commonly associated with palpitations?
Cellulitis
Generalized Anxiety disorder and panic disorder
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

30. What is the caUse of benign positional vertigo?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
DM - HTN - DVT - seizures - depression - or anxiety
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.

31. Tx of chronic or intermittent afibs
Impetigo
Anticoag with warfarin to prevent thromboembolism
Scabies
S. aureus- beta hemolytic streptococcus

32. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Streptococci
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Serotypes 16 - 18 - 31 -52 -58

33. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

34. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cholelithiasis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

35. SE Of Beta blockers?
With a KOH wet mount preparation
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
A central clear area

36. What treatments are the cornerstone for treating cases of functional constipation?
Viral infection of the semicircular apparatus
Peptic ulcer disease or gastritis
Less than 80 ml of blood
Increasing fluid (8 - 8oz glasses of water/day) -fiber

37. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
These patients are associated with low renin states=less likely to respond to medication
Higher filling presure - pulmonary congestion - and decreasd cardiac return
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

38. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Molluscum contagiosum- pox virus
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

39. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
HIV and syphilis
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
Candida albicans
Cellulitis

40. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Streptococci
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Colposcopy - Endocervical curettage - and directed cervical biopsy

41. 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.
Bence-Jones
Supraspinatus and bicipital tendons
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

42. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Other brainstem or cranial nerve findings
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
>150mg per 24hrs

43. Define the patient population typically affected by orthostatic or postural proteinuria
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

44. Cycle length variabilty is primarily due to what?
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
Variability in the time for follicle development during the proliferative phase
S. aureus- beta hemolytic streptococcus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

45. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
When the patient has symptoms in association with exercise or who describe chest pain or pressure
CBC
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

46. Name 4 factors that predispose an individual to develop pneumonia.
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

47. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
E. Coli O157:H7
Paroxysmal atrial fibrillation or supraventricular tachycardia
Staphylococcal scalded skin syndrome

48. What are symptoms are CHF?
Possibility of Ischemic colitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

49. 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
Less than 80 ml of blood
Cluster headache
Less abrupt onset and cessation of palpitations
Slow progression of cervical cancer changes -Availability of effective early treatment

50. HIgh risk pregnant patients should be evaluated for ____ and ____
Supraspinatus and bicipital tendons
Variability in the time for follicle development during the proliferative phase
HIV and syphilis
Varicella virus