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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 some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
S. aureus- beta hemolytic streptococcus

2. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Dehydration - anemia - cardiac causes
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Coronary artery disease/ angina
MSK - pulmonary - GI - or psychological

3. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination

4. What are the three types of lice?
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.
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Staphylococcal scalded skin syndrome
CT

5. What type of imaging is need for chronic sinusitis?
S. aureus- beta hemolytic streptococcus
Less than 3 stools per week
CT
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

6. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Chest pain during pneumonia or PE
Dehydration - anemia - cardiac causes
Possibility of Ischemic colitis
E. Coli O157:H7

7. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
PE - MI - aortic dissection - pneumothorax
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

8. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Viral infection of the semicircular apparatus
24 hour halter
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

9. SE Of Beta blockers?
BB or CCB - catheter ablation of identified bypass tract
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV
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

10. What drugs do you use to treat H.pylori + PUD?
Chest pain during pneumonia or PE
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Infectious esophagitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

11. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
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.
Warts
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

12. What is the Barany maneuver?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
>3.5g of protein per 24hrs
True
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

13. History for Sinusitis

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14. Discomfort with abducting the arm past 90 degress
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
Rotator Cuff tendonitis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Staphylococcal scalded skin syndrome

15. Regular bleeding at intervals of less than 21 days
Polymenorrhea
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Pancreatitis

16. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Rotator Cuff tendonitis

17. What is the goal of CHF treatment? What drugs should be used?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

18. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Scleroderma/polymyositis with secondary gastroesophageal reflux
Giardia

19. HIgh risk pregnant patients should be evaluated for ____ and ____
24 hour halter
>150mg per 24hrs
HIV and syphilis
Folliculitis

20. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
E. Coli O157:H7
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Echocardiogram
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

21. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Fever with frontal or maxillary tenderness
Less abrupt onset and cessation of palpitations
Irregular bleeding between cycles

22. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Echocardiogram
Subarachnoid hemorrhage
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Bence-Jones

23. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Non-cardiac causes of palpitations
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

24. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

25. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Rotator Cuff tendonitis

26. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Streptococci
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Colposcopy - Endocervical curettage - and directed cervical biopsy
Chest pain during pneumonia or PE

27. patients with herpes zoster may experience what symptom before the rash appear?
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.
Pain
High blood pressure - focal neurologic defecit - or papilledema
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

28. Who should have Xray testing for shoulder pain?
Supraspinatus and bicipital tendons
LH surge triggers ovulation
Kids: Rotavirus Adults: Norwalk Virus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

29. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Folliculitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Less than 80 ml of blood

30. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
CBC
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

31. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
ACEi
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Cluster headache

32. What is benign transient proteinuria?
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
Giardia
Echocardiogram
Common problem that resolves spontaneously and is most often seen in children and young adults

33. Difference between Pneumonia and Bronchitis
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
CT
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

34. How does systolic vs. diastolic heart failure present on the echocardiogram?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
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
Furucnle

35. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Hgb - Electrolytes - and TSH
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dehydration - anemia - cardiac causes

36. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Albumin; low molecular weight proteins
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pts with palpitations and dizziness - near syncope - or syncope

37. How does CHF present on X-ray?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

38. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Molluscum contagiosum- pox virus
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Viral infection of the semicircular apparatus

39. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Non-cardiac causes of palpitations
Candida albicans
Regular bleeding at intervals of more than 35 days

40. MI - pericardial tamponade - PE - GI bleed - are...
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Associated with hypotension
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Supraspinatus and bicipital tendons

41. What are the most common viral causes of diarrhea in kids and adults?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Kids: Rotavirus Adults: Norwalk Virus
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.
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

42. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Other brainstem or cranial nerve findings
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
Rotator Cuff problem

43. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Warts
MSK - pulmonary - GI - or psychological
Diuretics -BB -CCB -ACEi

44. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
Pancreatitis
Furucnle
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

45. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
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
Cholelithiasis
RBC casts and old to moderate HTN
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

46. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Presence of proteinuria on at least two separate ocassion
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
GERD

47. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
A 24hr urine protein collection and urine creatinine clearance determination
ACEi
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

48. What is the standard tool used for diagnosis of GERD?
Possibility of Ischemic colitis
Impetigo
Cluster headache
EGD

49. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Common problem that resolves spontaneously and is most often seen in children and young adults
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

50. What is the mechanism of action for stimulant agents in treating constipation?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Coronary artery disease/ angina
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Colposcopy - Endocervical curettage - and directed cervical biopsy