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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: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pts with palpitations and dizziness - near syncope - or syncope
Wolff-Parkinson-White syndrome

2. What is considered normal blood loss during a menstrual cycle?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
GERD
Less than 80 ml of blood
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

3. 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
Irregular bleeding between cycles
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
E. Coli O157:H7
Hypertension - CAD - valvular heart disease

4. Regular bleeding at intervals of less than 21 days
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.
Varicella virus
Anticoag with warfarin to prevent thromboembolism
Polymenorrhea

5. Describe the history and PE of patient presenting with common cold
Pancreatitis
Giardia
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

6. Isolated - extra pounding beats
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Subarachnoid hemorrhage
PVC or Premature atrial contraction (PAC)

7. HIgh risk pregnant patients should be evaluated for ____ and ____
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
HIV and syphilis
Associated with hypotension
Adhesive capsulitis (frozen shoulder): most common in middle age women

8. Pneumonia tx: suitable for healthy adults older than 60
Other brainstem or cranial nerve findings
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Variability in the time for follicle development during the proliferative phase
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

9. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
100mg; means patient can be trace protein positive and not be detected
Folliculitis
ACEi - ARBS - thiazide diuretics

10. Where does the development of abnormal cervical cells begin?
Coag disorders
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
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
Squamocolumnar junction=most common site of cervical cancer

11. What are the features of nephrotic syndrome?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
A 24hr urine protein collection and urine creatinine clearance determination
Staphylococcal scalded skin syndrome
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

12. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
CT
BB or CCB - catheter ablation of identified bypass tract
Temporal arteritis-biopsy of the temporal artery

13. Describe the presentation of angina?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Temporal arteritis-biopsy of the temporal artery
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
Presence of proteinuria on at least two separate ocassion

14. History and PE for Pneumonia
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
Bence-Jones
PE - MI - aortic dissection - pneumothorax
Temporal arteritis-biopsy of the temporal artery

15. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

16. What places women at higher risk of getting cervical cancer?
Infectious esophagitis
Rotator Cuff problem
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
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

17. What drugs do you use to treat H.pylori + PUD?
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

18. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Peptic ulcer disease or gastritis
Temporal arteritis-biopsy of the temporal artery
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

19. 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
RBC casts and old to moderate HTN
S. aureus- beta hemolytic streptococcus
Infectious esophagitis

20. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Cellulitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Regular bleeding at intervals of more than 35 days

21. 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.
Viral gastroenteritis
Rotator cuff tendonitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Supraspinatus and bicipital tendons

22. Shoulder pain with pain radiating to elbow
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
Impetigo
Cervical radiculopathy

23. What should blood work include for suspected heart failure?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Hypertension - CAD - valvular heart disease

24. What is the standard tool used for diagnosis of GERD?
With a KOH wet mount preparation
Fever with frontal or maxillary tenderness
A central clear area
EGD

25. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Viral infection of the semicircular apparatus
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Generalized Anxiety disorder and panic disorder
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

26. What is the peripheral caUse of vertigo?
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
Hgb - Electrolytes - and TSH
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

27. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
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
Non-cardiac causes of palpitations
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
S. aureus- beta hemolytic streptococcus

28. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Regular bleeding at intervals of more than 35 days
Peptic ulcer disease or gastritis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

29. 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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Cluster headache
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
PE - MI - aortic dissection - pneumothorax

30. How to NSAIDs contribute to gastritis and ulcer formation?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Non-cardiac causes of palpitations
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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

31. How does systolic vs. diastolic heart failure present on the echocardiogram?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
S. Aureus
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
Dehydration - anemia - cardiac causes

32. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

33. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
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
Varicella virus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

34. Define nephrotic range proteinuria
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
>3.5g of protein per 24hrs
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Diuretics -BB -CCB -ACEi

35. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
S. aureus- beta hemolytic streptococcus
Echocardiogram

36. How can GERD (or esophageal motility disorders) lead to chest pain?
Bence-Jones
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

37. Things that need to be included in history of shoulder pain
Pain
Hgb - Electrolytes - and TSH
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Possibility of Ischemic colitis

38. Tx of chronic or intermittent afibs
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
HIV and syphilis
Anticoag with warfarin to prevent thromboembolism
Echocardiogram

39. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Less than 3 stools per week
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
MSK - pulmonary - GI - or psychological
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

40. Name some medications that can cause proteinuria
Varicella virus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Folliculitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

41. Oligomenorrhea
Loop diuretics (Check serum K+ levels before drug admin)
CT
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Regular bleeding at intervals of more than 35 days

42. What are the signs of malignant hypertension?
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
Infectious esophagitis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
High blood pressure - focal neurologic defecit - or papilledema

43. patients with herpes zoster may experience what symptom before the rash appear?
Intermenstrual bleeding
Streptococci
Pain
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

44. Natural history of cervical cancer
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Generalized Anxiety disorder and panic disorder

45. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Diuretics -BB -CCB -ACEi
>3.5g of protein per 24hrs
Echocardiogram

46. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Staphylococcal scalded skin syndrome
Polymenorrhea
Streptococci
Non-cardiac causes of palpitations

47. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Kids: Rotavirus Adults: Norwalk Virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Scabies
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

48. 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
Scabies
Cervical radiculopathy
Staphylococcal scalded skin syndrome

49. What are the secondly causes of glomerular disease?
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
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

50. What is the next best step if a patient has two or more positive dipstick tests?
E. Coli O157:H7
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Impetigo
A 24hr urine protein collection and urine creatinine clearance determination