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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. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Tension headache
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Other brainstem or cranial nerve findings
Possibility of Ischemic colitis

2. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
High blood pressure - focal neurologic defecit - or papilledema
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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.
ACEi

3. What type of imaging is need for chronic sinusitis?
CT
Analgesic headache
Varicella virus
These patients are associated with low renin states=less likely to respond to medication

4. Tx of chronic or intermittent afibs
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
Pain
Rotator Cuff problem
Anticoag with warfarin to prevent thromboembolism

5. Describe the presentation of myocardial pain?
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
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

6. What are the most common causes for the common cold?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

7. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

8. What are the indiciations for neuroimaging?
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
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.
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

9. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Albumin; low molecular weight proteins
Pts with palpitations and dizziness - near syncope - or syncope
Repeat Pap after infection treated

10. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Peptic ulcer disease or gastritis
These patients are associated with low renin states=less likely to respond to medication
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

11. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
GERD
Anticoag with warfarin to prevent thromboembolism
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.
MSK - pulmonary - GI - or psychological

12. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Excessive bleeding in amount - duration - or both at irregular intervals
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

13. 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.
Generalized Anxiety disorder and panic disorder
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
LH surge triggers ovulation

14. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Rotator Cuff problem
Staphylococcal scalded skin syndrome

15. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
A central clear area
Chest pain during pneumonia or PE

16. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

17. Metrorrhagia
Pain
Irregular bleeding between cycles
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

18. How are fungal infections diagnosed?
Pleurisy
S. Aureus
Bence-Jones
With a KOH wet mount preparation

19. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Cholelithiasis

20. What are the signs of acute sinusitis?
Non-cardiac causes of palpitations
Fever with frontal or maxillary tenderness
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
>150mg per 24hrs

21. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Variability in the time for follicle development during the proliferative phase
CT

22. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Giardia
Colposcopy - Endocervical curettage - and directed cervical biopsy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

23. SE Of Beta blockers?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Generalized Anxiety disorder and panic disorder
Impetigo
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

24. What are the consequences of diastolic dysfunction?
PE - MI - aortic dissection - pneumothorax
Higher filling presure - pulmonary congestion - and decreasd cardiac return
ACEi
Coronary artery disease/ angina

25. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Chest pain during pneumonia or PE

26. Describe the presentation of pneumonia
Common problem that resolves spontaneously and is most often seen in children and young adults
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

27. Pain in shoulder when throwing - swimming - or serving a tennis ball
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
HIV and syphilis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Rotator cuff tendonitis

28. What should preconception counseling include?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Slow progression of cervical cancer changes -Availability of effective early treatment
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
>3.5g of protein per 24hrs

29. Shoulder pain with pain radiating to elbow
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Cervical radiculopathy
Hypertension - CAD - valvular heart disease

30. What occurs after ovulation
A 24hr urine protein collection and urine creatinine clearance determination
HPV testing -Pos=colposcopy -Neg=repeat pap smear
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

31. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
CBC
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

32. Diarrhea from custard filled pastries
Hgb - Electrolytes - and TSH
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
S. Aureus
HIV and syphilis

33. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

34. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
Less than 80 ml of blood
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

35. Define nephrotic range proteinuria
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Supraspinatus and bicipital tendons
PE - MI - aortic dissection - pneumothorax
>3.5g of protein per 24hrs

36. Uterine bleeding between regular cycles
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Intermenstrual bleeding
Generalized Anxiety disorder and panic disorder
Medication or chemical esophagitis

37. Difference between Pneumonia and Bronchitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

38. Name the skin lesion: pustule in association with a hair follice
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
Molluscum contagiosum- pox virus
35 (exception for postmenopausal women who have recently been started on HRT)
Folliculitis

39. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Rotator cuff tendonitis
Temporal arteritis-biopsy of the temporal artery
Giardia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

40. Describe the presentation of angina?
Infectious esophagitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Less than 80 ml of blood

41. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
CBC
Nonulcer dyspepsia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

43. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
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
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
Repeat Pap after infection treated
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

44. What does the classic ring worm lesion have?
Common problem that resolves spontaneously and is most often seen in children and young adults
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
A central clear area
>3.5g of protein per 24hrs

45. What treatments are the cornerstone for treating cases of functional constipation?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Impetigo
>150mg per 24hrs

46. What is the difference between a Holter monitor or an event monitor?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Upper sternal area burning pain - associated with a productive cough
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

47. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Rotator Cuff problem
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Giardia
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

48. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Candida albicans
Variability in the time for follicle development during the proliferative phase
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

49. How does systolic vs. diastolic heart failure present on the echocardiogram?
Molluscum contagiosum- pox virus
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
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

50. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
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
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
Candida albicans