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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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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 diuretic is the most widely used for HTN? What are some SE of this drug?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

2. Describe the presentation of myocardial pain?
Analgesic headache
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Less than 3 stools per week

3. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HIV and syphilis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

4. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Squamocolumnar junction=most common site of cervical cancer
Infectious esophagitis

5. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
35 (exception for postmenopausal women who have recently been started on HRT)
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
True

6. 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
PVC or Premature atrial contraction (PAC)
Viral gastroenteritis
Varicella virus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

7. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

8. What is the next best step if a patient has two or more positive dipstick tests?
>150mg per 24hrs
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Less than 80 ml of blood

9. Carcinoma in situ is generally referred to a gynecologist and requires ______
RBC casts and old to moderate HTN
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

10. What does the classic ring worm lesion have?
A central clear area
Diuretics -BB -CCB -ACEi
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Staphylococcal scalded skin syndrome

11. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Supraspinatus and bicipital tendons
Medication or chemical esophagitis
Non-cardiac causes of palpitations
Intermenstrual bleeding

12. 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
Less than 3 stools per week
E. Coli O157:H7
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pancreatitis

13. 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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Warts
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.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

14. When should invasive eletrophysiologic study should be considered?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Medication or chemical esophagitis

15. What are the three major risk factors for heart failure?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cluster headache
Hypertension - CAD - valvular heart disease
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

16. History and PE for Pneumonia
HPV
Paroxysmal atrial fibrillation or supraventricular tachycardia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

17. Metrorrhagia
Varicella virus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Irregular bleeding between cycles
Scleroderma/polymyositis with secondary gastroesophageal reflux

18. Predictors of cardiac etiology
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Regular bleeding at intervals of more than 35 days

19. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
PE - MI - aortic dissection - pneumothorax
Lightheadedness - dizziness - syncope
Slow progression of cervical cancer changes -Availability of effective early treatment

20. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
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
Rotator cuff tendonitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

21. What should preconception counseling include?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

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

23. How are fungal infections diagnosed?
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
With a KOH wet mount preparation
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
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

24. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Increase; 200 g/day
CT
>150mg per 24hrs
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

25. What are the indiciations for neuroimaging?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Intermenstrual bleeding
Non-cardiac causes of 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

26. 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.
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
Variability in the time for follicle development during the proliferative phase
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Supraspinatus and bicipital tendons

27. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
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
Diuretics -BB -CCB -ACEi
True

28. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Higher filling presure - pulmonary congestion - and decreasd cardiac return
MSK - pulmonary - GI - or psychological

29. Why is the pap smear one of the most effective cancer screening tools?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
24 hour halter
Slow progression of cervical cancer changes -Availability of effective early treatment
Acute headache - ataxia - profuse nausea - and vomiting

30. After treatment of dysplasia - women need Pap smears every...
Furucnle
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
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

31. Cycle length variabilty is primarily due to what?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HPV
Pleurisy
Variability in the time for follicle development during the proliferative phase

32. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Candida albicans
35 (exception for postmenopausal women who have recently been started on HRT)
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

33. What is the caUse of benign positional vertigo?
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.
Impetigo
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Loop diuretics (Check serum K+ levels before drug admin)

34. How does CHF present on X-ray?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

35. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Squamocolumnar junction=most common site of cervical cancer
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
PVC or Premature atrial contraction (PAC)

36. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Streptococci
Increase; 200 g/day
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

37. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Less than 80 ml of blood
ACEi
Cluster headache
Cellulitis

38. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
With a KOH wet mount preparation
Serotypes 16 - 18 - 31 -52 -58
HIV and syphilis

39. Name 4 factors that predispose an individual to develop pneumonia.
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
With a KOH wet mount preparation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

40. What is the role of FSH in one's menstrual cycle
Streptococci
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Varicella virus

41. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Increase; 200 g/day
Non-cardiac causes of palpitations
Higher filling presure - pulmonary congestion - and decreasd cardiac return

42. Discomfort with abducting the arm past 90 degress
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Rotator Cuff tendonitis

43. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
S. Aureus
E. Coli O157:H7
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff problem

44. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cluster headache
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

45. Diagnostic Evaluation of Abnoraml vaginal bleeding
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

46. What are the consequences of diastolic dysfunction?
Peptic ulcer disease or gastritis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
With a KOH wet mount preparation

47. 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.
Tension headache
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
CT

48. What lab tests are recommended for newly diagnosed hypertensive patients?
Repeat Pap after infection treated
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A central clear area
Candida albicans

49. When does troponin rise following myocardial injury or infarction?
>3.5g of protein per 24hrs
Cluster headache
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Polymenorrhea

50. What are the signs of acute sinusitis?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Coag disorders
Fever with frontal or maxillary tenderness

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