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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Menometrorrhagia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Excessive bleeding in amount - duration - or both at irregular intervals
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

2. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Dehydration - anemia - cardiac causes

3. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
GERD
Loop diuretics (Check serum K+ levels before drug admin)
Medication or chemical esophagitis

4. 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
Echocardiogram
Warts
HPV testing -Pos=colposcopy -Neg=repeat pap smear
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

5. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
RBC casts and old to moderate HTN
>3.5g of protein per 24hrs
Analgesic headache

6. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Associated with hypotension
Tension headache
Albumin; low molecular weight proteins

7. How is constipation clinically defined?
Less than 3 stools per week
PE - MI - aortic dissection - pneumothorax
Bence-Jones
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

8. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Albumin; low molecular weight proteins
Associated with hypotension
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

9. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
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
Kids: Rotavirus Adults: Norwalk Virus
Irregular bleeding between cycles

10. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Slow progression of cervical cancer changes -Availability of effective early treatment
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.
24 hour halter

11. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
35 (exception for postmenopausal women who have recently been started on HRT)
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
Intermenstrual bleeding

12. Carcinoma in situ is generally referred to a gynecologist and requires ______
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Tension 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

13. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Chest pain during pneumonia or PE
Upper sternal area burning pain - associated with a productive cough

14. Name the diagnosis of heartburn: regurgitation - dysphagia
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
GERD
Non-cardiac causes of palpitations

15. Name types of laxatives
Hypertension - CAD - valvular heart disease
Dehydration - anemia - cardiac causes
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fever with frontal or maxillary tenderness

16. Uterine bleeding between regular cycles
Intermenstrual bleeding
Generalized Anxiety disorder and panic disorder
Warts
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

17. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Varicella virus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Repeat Pap after infection treated

18. What are the signs of acute sinusitis?
Variability in the time for follicle development during the proliferative phase
Fever with frontal or maxillary tenderness
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

19. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Rotator cuff tendonitis
A 24hr urine protein collection and urine creatinine clearance determination
Chest pain during pneumonia or PE
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.

20. Clinical Manifestations of HTN
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Less abrupt onset and cessation of palpitations
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Temporal arteritis-biopsy of the temporal artery

21. What is the Barany maneuver?
Associated with hypotension
LH surge triggers ovulation
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

22. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Rotator Cuff tendonitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

23. 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
PVC or Premature atrial contraction (PAC)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
PE - MI - aortic dissection - pneumothorax

24. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Lightheadedness - dizziness - syncope
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

25. 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.
Medication or chemical esophagitis
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Tension headache

26. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Paroxysmal atrial fibrillation or supraventricular tachycardia
35 (exception for postmenopausal women who have recently been started on HRT)
Peptic ulcer disease or gastritis
Subarachnoid hemorrhage

27. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Loop diuretics (Check serum K+ levels before drug admin)
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
MSK - pulmonary - GI - or psychological
Bulk forming: Psyllium - Methycellulose - Polycarbophil

28. Describes what occurs during squamous metaplasia of the cervix.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

29. What are the secondly causes of glomerular disease?
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HIV and syphilis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

30. What drugs do you use to treat H.pylori + PUD?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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)
Pain

31. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
True
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

32. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
A central clear area
Streptococci
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Molluscum contagiosum- pox virus

33. Pain in shoulder when throwing - swimming - or serving a tennis ball
MSK - pulmonary - GI - or psychological
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
Rotator cuff tendonitis
Wolff-Parkinson-White syndrome

34. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Irregular bleeding between cycles
Rotator Cuff problem
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
35 (exception for postmenopausal women who have recently been started on HRT)

35. Shoulder pain with pain radiating to elbow
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Menorrhagia
Slow progression of cervical cancer changes -Availability of effective early treatment
Cervical radiculopathy

36. What medications can cause heart palpitations?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Menorrhagia
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

37. What is the goal of CHF treatment? What drugs should be used?
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
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
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
Cellulitis

38. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

39. What is considered normal blood loss during a menstrual cycle?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Coag disorders
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Less than 80 ml of blood

40. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
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
Squamocolumnar junction=most common site of cervical cancer

41. Diagnostic Evaluation of Abnoraml vaginal bleeding
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Paroxysmal atrial fibrillation or supraventricular tachycardia

42. What places women at higher risk of getting cervical cancer?
Nonulcer dyspepsia
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
S. aureus- beta hemolytic streptococcus

43. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Irregular bleeding between cycles
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
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

44. Name the skin lesion: honey colored crusts
Infectious esophagitis
Impetigo
A 24hr urine protein collection and urine creatinine clearance determination
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

45. What the consequences of decreased cardiac output?
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
PVC or Premature atrial contraction (PAC)

46. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pancreatitis
Menorrhagia
Albumin; low molecular weight proteins

47. Treatment for supraventricular tachycardias
Higher filling presure - pulmonary congestion - and decreasd cardiac return
BB or CCB - catheter ablation of identified bypass tract
E. Coli O157:H7
MSK - pulmonary - GI - or psychological

48. What are the most common viral causes of diarrhea in kids and adults?
Molluscum contagiosum- pox virus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Kids: Rotavirus Adults: Norwalk Virus
Cluster headache

49. Pneumothorax - sudden sharp chest pain - preceded by viral illness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
HPV
Pleurisy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

50. What is benign transient proteinuria?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
>150mg per 24hrs
Common problem that resolves spontaneously and is most often seen in children and young adults

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