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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?
S. Aureus
Excessive bleeding in amount - duration - or both at irregular intervals
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
ACEi

2. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Intermenstrual bleeding
Warts
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

3. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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
Staphylococcal scalded skin syndrome
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Viral gastroenteritis

4. At was quantity does urine dipstick test detect elevated protein?
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
ACEi
100mg; means patient can be trace protein positive and not be detected
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

5. What are the features of nephrotic syndrome?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

6. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Presence of proteinuria on at least two separate ocassion
Echocardiogram
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Pancreatitis

7. 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)
Chest pain during pneumonia or PE
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

8. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Infectious esophagitis
>3.5g of protein per 24hrs
Pts with palpitations and dizziness - near syncope - or syncope
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

9. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
ACEi - ARBS - thiazide diuretics
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

10. What is the difference between a Holter monitor or an event monitor?
Possibility of Ischemic colitis
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Anticoag with warfarin to prevent thromboembolism

11. Constipation: What are indications for lab testing?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Scabies

12. What are the features of glomerular nephritis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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.
Menorrhagia

13. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Menorrhagia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
CBC

14. What are the signs of malignant hypertension?
Echocardiogram
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Streptococci
High blood pressure - focal neurologic defecit - or papilledema

15. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Varicella virus
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
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

16. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator cuff tendonitis

17. History for Sinusitis

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18. Describe the history and PE of patient presenting with common cold
BB or CCB - catheter ablation of identified bypass tract
Menorrhagia
Wolff-Parkinson-White syndrome
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

19. What is the next best step if a patient has two or more positive dipstick tests?
Rotator cuff tendonitis
Generalized Anxiety disorder and panic disorder
A 24hr urine protein collection and urine creatinine clearance determination
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

20. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Subarachnoid hemorrhage
Coronary artery disease/ angina
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

21. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Albumin; low molecular weight proteins
Anticoag with warfarin to prevent thromboembolism

22. Chronic pain and shoulder stiffness with limited motion
Warts
Adhesive capsulitis (frozen shoulder): most common in middle age women
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
E. Coli O157:H7

23. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Dehydration - anemia - cardiac causes
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bulk forming: Psyllium - Methycellulose - Polycarbophil

24. Name 4 factors that predispose an individual to develop pneumonia.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Upper sternal area burning pain - associated with a productive cough
Lightheadedness - dizziness - syncope
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

25. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

26. How to NSAIDs contribute to gastritis and ulcer formation?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Hypertension - CAD - valvular heart disease
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.
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

27. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Bence-Jones
Variability in the time for follicle development during the proliferative phase
Generalized Anxiety disorder and panic disorder

28. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Temporal arteritis-biopsy of the temporal artery
HIV and syphilis
Anticoag with warfarin to prevent thromboembolism

29. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Lightheadedness - dizziness - syncope
HPV

30. What places women at higher risk of getting cervical cancer?
Staphylococcal scalded skin syndrome
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
Squamocolumnar junction=most common site of cervical cancer
Irregular bleeding between cycles

31. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Dehydration - anemia - cardiac causes
GERD
Viral gastroenteritis

32. Lab testing for heart palpitation
Wolff-Parkinson-White syndrome
Hgb - Electrolytes - and TSH
Diuretics -BB -CCB -ACEi
Viral gastroenteritis

33. When is a lumbar puncture contraindicated?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Furucnle
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

34. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
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
CBC
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Analgesic headache

35. 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.
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Tension headache

36. History for Acute bronchitis
Non-cardiac causes of palpitations
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase; 200 g/day
Bence-Jones

37. Initial treatment for Rhinosinusitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

38. When should a patient get a stress test?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Cervical radiculopathy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

39. What is the standard tool used for diagnosis of GERD?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
True
HPV testing -Pos=colposcopy -Neg=repeat pap smear
EGD

40. 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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
True
Non-cardiac causes of palpitations
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

41. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
EGD

42. 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
E. Coli O157:H7
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

43. How does CHF present on X-ray?
Varicella virus
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Variability in the time for follicle development during the proliferative phase

44. What are the consequences of diastolic dysfunction?
Molluscum contagiosum- pox virus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
24 hour halter
Peptic ulcer disease or gastritis

45. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Varicella virus
ACEi

46. What is the caUse of benign positional vertigo?
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
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.
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

47. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
ACEi
Furucnle
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
S. aureus- beta hemolytic streptococcus

48. Who should have Xray testing for shoulder pain?
Lightheadedness - dizziness - syncope
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Rotator Cuff problem
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

49. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
ACEi
PE - MI - aortic dissection - pneumothorax
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

50. Treatment for supraventricular tachycardias
With a KOH wet mount preparation
PE - MI - aortic dissection - pneumothorax
BB or CCB - catheter ablation of identified bypass tract
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume