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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. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Generalized Anxiety disorder and panic disorder
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
Coag disorders

2. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Squamocolumnar junction=most common site of cervical cancer
Albumin; low molecular weight proteins
A 24hr urine protein collection and urine creatinine clearance determination
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

3. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
DM - HTN - DVT - seizures - depression - or anxiety
100mg; means patient can be trace protein positive and not be detected

4. What treatments are the cornerstone for treating cases of functional constipation?
GERD
S. aureus- beta hemolytic streptococcus
Tension headache
Increasing fluid (8 - 8oz glasses of water/day) -fiber

5. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
EGD
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
Irregular bleeding between cycles
Furucnle

6. What is the difference between a Holter monitor or an event monitor?
Regular bleeding at intervals of more than 35 days
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

7. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
High blood pressure - focal neurologic defecit - or papilledema
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
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

8. What is the role of FSH in one's menstrual cycle
Wolff-Parkinson-White syndrome
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

9. 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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Generalized Anxiety disorder and panic disorder
Warts
Varicella virus

10. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Tension headache
ACEi
Cellulitis
Colposcopy - Endocervical curettage - and directed cervical biopsy

11. Tx of chronic or intermittent afibs
Nonulcer dyspepsia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Anticoag with warfarin to prevent thromboembolism

12. Natural history of cervical cancer
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pain
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

13. What HPV serotypes are most commonly associated with cervical cancer?
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
With a KOH wet mount preparation
Serotypes 16 - 18 - 31 -52 -58
Presence of proteinuria on at least two separate ocassion

14. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
E. Coli O157:H7
Possibility of Ischemic colitis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

15. What are the features of glomerular nephritis
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
RBC casts and old to moderate HTN
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

16. What is the Barany maneuver?
24 hour halter
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Albumin; low molecular weight proteins

17. What are the signs of malignant hypertension?
Subarachnoid hemorrhage
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
High blood pressure - focal neurologic defecit - or papilledema
Diuretics -BB -CCB -ACEi

18. Prenatal visit schedule for low-risk pregnancies
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HIV and syphilis
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

19. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Menorrhagia
Increasing fluid (8 - 8oz glasses of water/day) -fiber

20. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Subarachnoid hemorrhage
24 hour halter
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Scabies

21. What medications can cause heart palpitations?
ACEi
DM - HTN - DVT - seizures - depression - or anxiety
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

22. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Hypertension - CAD - valvular heart disease
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

23. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
>150mg per 24hrs
Cluster headache

24. What are the secondly causes of glomerular disease?
Varicella virus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

25. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Molluscum contagiosum- pox virus
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
ACEi - ARBS - thiazide diuretics
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

26. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Slow progression of cervical cancer changes -Availability of effective early treatment
PVC or Premature atrial contraction (PAC)

27. What should preconception counseling include?
Varicella 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
ACEi - ARBS - thiazide diuretics
Higher filling presure - pulmonary congestion - and decreasd cardiac return

28. How can GERD (or esophageal motility disorders) lead to chest pain?
>3.5g of protein per 24hrs
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Acute headache - ataxia - profuse nausea - and vomiting

29. What diagnosis does the 'worse headache of my life' suggest?
S. aureus- beta hemolytic streptococcus
Colposcopy - Endocervical curettage - and directed cervical biopsy
24 hour halter
Subarachnoid hemorrhage

30. What are signs of pulmonary congestion?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Temporal arteritis-biopsy of the temporal artery
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

31. What are the physical exam signs of CHF?
Repeat Pap after infection treated
Pleurisy
Albumin; low molecular weight proteins
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

32. HIgh risk pregnant patients should be evaluated for ____ and ____
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
HIV and syphilis
Loop diuretics (Check serum K+ levels before drug admin)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

33. How are fungal infections diagnosed?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Temporal arteritis-biopsy of the temporal artery
With a KOH wet mount preparation

34. What are the three types of lice?
Rotator Cuff problem
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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.

35. What is the caUse of Meniere disease? What are the cardinal symptoms?
>150mg per 24hrs
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
S. Aureus

36. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

37. What should be considered in younger patients with menorrhagia
>3.5g of protein per 24hrs
Coag disorders
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Kids: Rotavirus Adults: Norwalk Virus

38. History for Sinusitis

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39. What are the primary glomerular diseases?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lightheadedness - dizziness - syncope
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

40. Clinical Manifestations of HTN
A central clear area
S. Aureus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Candida albicans

41. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Viral infection of the semicircular apparatus

42. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Presence of proteinuria on at least two separate ocassion
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
Wolff-Parkinson-White syndrome
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

43. Name 4 factors that predispose an individual to develop pneumonia.
CBC
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

44. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Nonulcer dyspepsia
Paroxysmal atrial fibrillation or supraventricular tachycardia
Candida albicans
Medication or chemical esophagitis

45. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
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
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

46. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Rotator Cuff problem
Kids: Rotavirus Adults: Norwalk Virus
Varicella virus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

47. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Rotator cuff tendonitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

48. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Rotator cuff tendonitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

49. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Upper sternal area burning pain - associated with a productive cough
Possibility of Ischemic colitis
Intermenstrual bleeding

50. What places women at higher risk of getting cervical cancer?
Tension headache
HIV and syphilis
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
Viral gastroenteritis