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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 diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Scleroderma/polymyositis with secondary gastroesophageal reflux
When the patient has symptoms in association with exercise or who describe chest pain or pressure

2. History and PE for Pneumonia
Less abrupt onset and cessation of palpitations
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

3. What are the two common clinical presentations of acute diarrhea?
BB or CCB - catheter ablation of identified bypass tract
Rotator Cuff problem
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

4. What should be considered in younger patients with menorrhagia
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Nonulcer dyspepsia
Coag disorders
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

5. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
CBC
Rotator Cuff tendonitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

6. What places women at higher risk of getting cervical cancer?
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Paroxysmal atrial fibrillation or supraventricular tachycardia

7. patients with herpes zoster may experience what symptom before the rash appear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pain

8. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Generalized Anxiety disorder and panic disorder
Dehydration - anemia - cardiac causes

9. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Giardia
Bence-Jones
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

10. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Other brainstem or cranial nerve findings
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

11. Diarrhea is defined as an ____ in stool weight to more than ____g per day
>3.5g of protein per 24hrs
Increase; 200 g/day
Analgesic headache
PVC or Premature atrial contraction (PAC)

12. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Anticoag with warfarin to prevent thromboembolism
Pleurisy
Temporal arteritis-biopsy of the temporal artery
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

13. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
ACEi - ARBS - thiazide diuretics
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 problem

14. What is the role of FSH in one's menstrual cycle
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PE - MI - aortic dissection - pneumothorax

15. Clinical Manifestations of HTN
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 3 stools per week
Supraspinatus and bicipital tendons

16. Name types of laxatives
Higher filling presure - pulmonary congestion - and decreasd cardiac return
PE - MI - aortic dissection - pneumothorax
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

17. 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.
Supraspinatus and bicipital tendons
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Non-cardiac causes of palpitations

18. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Infectious esophagitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

19. Difference between Pneumonia and Bronchitis
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Associated with hypotension
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

20. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
100mg; means patient can be trace protein positive and not be detected
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

21. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Streptococci
Candida albicans
S. aureus- beta hemolytic streptococcus
A 24hr urine protein collection and urine creatinine clearance determination

22. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Serotypes 16 - 18 - 31 -52 -58
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
MSK - pulmonary - GI - or psychological
Diuretics -BB -CCB -ACEi

23. How do you know if heart palpitations are due to stimulant or medication use?
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Less abrupt onset and cessation of palpitations
Furucnle

24. Name the diagnosis of heartburn: regurgitation - dysphagia
>150mg per 24hrs
>3.5g of protein per 24hrs
MSK - pulmonary - GI - or psychological
GERD

25. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Less abrupt onset and cessation of palpitations
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi - ARBS - thiazide diuretics

26. What are symptoms are CHF?
Giardia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fever with frontal or maxillary tenderness
Furucnle

27. 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
RBC casts and old to moderate HTN
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Echocardiogram
E. Coli O157:H7

28. What is the difference between a Holter monitor or an event monitor?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
CT
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

29. Name the diagnosis of heartburn: severe constant mid abdominal pain
Fever with frontal or maxillary tenderness
Less than 3 stools per week
Cellulitis
Pancreatitis

30. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Fever with frontal or maxillary tenderness

31. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
24 hour halter
35 (exception for postmenopausal women who have recently been started on HRT)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Cholelithiasis

32. Tx of chronic or intermittent afibs
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Anticoag with warfarin to prevent thromboembolism

33. What does the classic ring worm lesion have?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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.
A central clear area
Medication or chemical esophagitis

34. What are the indiciations for neuroimaging?
Increase; 200 g/day
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
Medication or chemical esophagitis
E. Coli O157:H7

35. What is the Epley maneuver?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Kids: Rotavirus Adults: Norwalk Virus
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.
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

36. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
MSK - pulmonary - GI - or psychological
Pancreatitis
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

37. What does orthostatic positional changes that bring on dizziness suggest?
>150mg per 24hrs
Dehydration - anemia - cardiac causes
Pts with palpitations and dizziness - near syncope - or syncope
Common problem that resolves spontaneously and is most often seen in children and young adults

38. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
S. aureus- beta hemolytic streptococcus
True
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
Cellulitis

39. What diagnosis does the 'worse headache of my life' suggest?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Subarachnoid hemorrhage
Bence-Jones

40. What is the preload?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Repeat Pap after infection treated
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

41. Diarrhea from custard filled pastries
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
S. Aureus
Common problem that resolves spontaneously and is most often seen in children and young adults
Non-cardiac causes of palpitations

42. What are the 2 psych disorders most commonly associated with palpitations?
PE - MI - aortic dissection - pneumothorax
Generalized Anxiety disorder and panic disorder
Temporal arteritis-biopsy of the temporal artery
Dehydration - anemia - cardiac causes

43. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Cellulitis

44. Uterine bleeding between regular cycles
MSK - pulmonary - GI - or psychological
Intermenstrual bleeding
Presence of proteinuria on at least two separate ocassion
Impetigo

45. Define proteinuria
>150mg per 24hrs
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

46. What are signs of pulmonary congestion?
Pts with palpitations and dizziness - near syncope - or syncope
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

47. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
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.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

48. Cycle length variabilty is primarily due to what?
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
Variability in the time for follicle development during the proliferative phase
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Kids: Rotavirus Adults: Norwalk Virus

49. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Scleroderma/polymyositis with secondary gastroesophageal reflux
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

50. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Infectious esophagitis
Loop diuretics (Check serum K+ levels before drug admin)
ACEi