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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. name the 4 emergent causes of chest pain
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
PE - MI - aortic dissection - pneumothorax
DM - HTN - DVT - seizures - depression - or anxiety

2. Name the diagnosis of heartburn: regurgitation - dysphagia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Echocardiogram
GERD
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

3. Predictors of cardiac etiology
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
>3.5g of protein per 24hrs
Less than 3 stools per week
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

4. Difference between Pneumonia and Bronchitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Loop diuretics (Check serum K+ levels before drug admin)
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
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. Define proteinuria
Other brainstem or cranial nerve findings
Cholelithiasis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
>150mg per 24hrs

6. How can GERD (or esophageal motility disorders) lead to chest pain?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Intermenstrual bleeding
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

7. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

8. What treatments are the cornerstone for treating cases of functional constipation?
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Increasing fluid (8 - 8oz glasses of water/day) -fiber

9. What are the symptoms of palpitations?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Lightheadedness - dizziness - syncope

10. 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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
E. Coli O157:H7
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.
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

11. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Dehydration - anemia - cardiac causes
100mg; means patient can be trace protein positive and not be detected
Viral infection of the semicircular apparatus
Paroxysmal atrial fibrillation or supraventricular tachycardia

12. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
E. Coli O157:H7
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
S. Aureus

13. What are the most common causes for the common cold?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Rotator cuff tendonitis
Bence-Jones

14. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cholelithiasis

15. What is the preload?
Acute headache - ataxia - profuse nausea - and vomiting
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Scleroderma/polymyositis with secondary gastroesophageal reflux
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

16. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Less than 80 ml of blood
MSK - pulmonary - GI - or psychological
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

17. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Irregular bleeding between cycles
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Diuretics -BB -CCB -ACEi
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

18. Shoulder pain with pain radiating to elbow
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cervical radiculopathy

19. What occurs after ovulation
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Scleroderma/polymyositis with secondary gastroesophageal reflux
Higher filling presure - pulmonary congestion - and decreasd cardiac return

20. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
HIV and syphilis
Temporal arteritis-biopsy of the temporal artery
Analgesic headache

21. Name the skin lesion: honey colored crusts
Cholelithiasis
Subarachnoid hemorrhage
Impetigo
Anticoag with warfarin to prevent thromboembolism

22. What is the Epley maneuver?
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.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
CT
PVC or Premature atrial contraction (PAC)

23. What are the common causes for laryngitis?
E. Coli O157:H7
Supraspinatus and bicipital tendons
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

24. Clinical Manifestations of HTN
Presence of proteinuria on at least two separate ocassion
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cluster headache

25. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pleurisy

26. What are the consequences of diastolic dysfunction?
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
24 hour halter
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

27. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Molluscum contagiosum- pox virus
Repeat Pap after infection treated
35 (exception for postmenopausal women who have recently been started on HRT)
>3.5g of protein per 24hrs

28. How are fungal infections diagnosed?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
With a KOH wet mount preparation
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
HIV and syphilis

29. What are the most common viral causes of diarrhea in kids and adults?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Kids: Rotavirus Adults: Norwalk Virus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Less than 80 ml of blood

30. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Kids: Rotavirus Adults: Norwalk Virus
24 hour halter
Rotator Cuff tendonitis

31. 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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Molluscum contagiosum- pox virus

32. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming: Psyllium - Methycellulose - Polycarbophil

33. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Presence of proteinuria on at least two separate ocassion
A 24hr urine protein collection and urine creatinine clearance determination
Loop diuretics (Check serum K+ levels before drug admin)
Analgesic headache

34. Define the patient population typically affected by orthostatic or postural proteinuria
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. aureus- beta hemolytic streptococcus
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

35. Tx of chronic or intermittent afibs
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Anticoag with warfarin to prevent thromboembolism
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

36. What are signs of pulmonary congestion?
Variability in the time for follicle development during the proliferative phase
Albumin; low molecular weight proteins
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

37. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Tension headache
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

38. When should a patient get a stress test?
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
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
When the patient has symptoms in association with exercise or who describe chest pain or pressure

39. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Viral infection of the semicircular apparatus
Nonulcer dyspepsia

40. Describe the presentation of myocardial pain?
Varicella virus
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. Aureus

41. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Higher filling presure - pulmonary congestion - and decreasd cardiac return
PE - MI - aortic dissection - pneumothorax
Increase; 200 g/day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

42. Metrorrhagia
Cellulitis
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.
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Irregular bleeding between cycles

43. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Repeat Pap after infection treated
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

44. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Analgesic headache
Pancreatitis
Pleurisy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

45. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Associated with hypotension
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
Pleurisy

46. What drugs do you use to treat H.pylori + PUD?
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
Hgb - Electrolytes - and TSH
Pain
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

47. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

48. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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.
PVC or Premature atrial contraction (PAC)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

49. Describe the presentation of pneumonia
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Regular bleeding at intervals of more than 35 days

50. Diagnosis of HTN
Subarachnoid hemorrhage
Associated with hypotension
Candida albicans
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart