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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. Clinical Manifestations of HTN
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
Other brainstem or cranial nerve findings
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cervical radiculopathy

2. 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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Cellulitis

3. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Infectious esophagitis

4. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
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)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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

5. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HIV and syphilis
Molluscum contagiosum- pox virus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
HPV testing -Pos=colposcopy -Neg=repeat pap smear

6. When should invasive eletrophysiologic study should be considered?
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
Albumin; low molecular weight proteins
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

7. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
LH surge triggers ovulation

8. What is the mechanism of action for stimulant agents in treating constipation?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Subarachnoid hemorrhage
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Squamocolumnar junction=most common site of cervical cancer

9. 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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Impetigo

10. Describe the history and PE of patient presenting with common cold
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Albumin; low molecular weight proteins
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

11. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Furucnle
Giardia
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

12. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Other brainstem or cranial nerve findings

13. Name the skin lesion: honey colored crusts
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.
Impetigo
Rotator Cuff tendonitis
Higher filling presure - pulmonary congestion - and decreasd cardiac return

14. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Pancreatitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

15. What are the physical exam signs of CHF?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
These patients are associated with low renin states=less likely to respond to medication
Regular bleeding at intervals of more than 35 days

16. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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
Echocardiogram
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

17. Difference between Pneumonia and Bronchitis
Folliculitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Pain

18. Define the patient population typically affected by orthostatic or postural proteinuria
Supraspinatus and bicipital tendons
Possibility of Ischemic colitis
Variability in the time for follicle development during the proliferative phase
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

19. 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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Scabies
Folliculitis

20. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Infectious esophagitis
Supraspinatus and bicipital tendons

21. Constipation: What are indications for lab testing?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Associated with hypotension
Coronary artery disease/ angina
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

22. Define proteinuria
>150mg per 24hrs
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

23. What lab tests are recommended for newly diagnosed hypertensive patients?
35 (exception for postmenopausal women who have recently been started on HRT)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
LH surge triggers ovulation

24. What are the most common causes for the common cold?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

25. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Albumin; low molecular weight proteins
PE - MI - aortic dissection - pneumothorax
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

26. What is afterload?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Acute headache - ataxia - profuse nausea - and vomiting

27. What is the Barany maneuver?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Rotator Cuff tendonitis
Varicella virus

28. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Irregular bleeding between cycles
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Albumin; low molecular weight proteins
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

29. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Viral gastroenteritis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

30. After treatment of dysplasia - women need Pap smears every...
GERD
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

31. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Viral gastroenteritis
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

32. Shoulder pain with pain radiating to elbow
Hgb - Electrolytes - and TSH
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Cervical radiculopathy
Hypertension - CAD - valvular heart disease

33. Diarrhea from custard filled pastries
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
S. Aureus

34. Carcinoma in situ is generally referred to a gynecologist and requires ______
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Loop diuretics (Check serum K+ levels before drug admin)

35. What is benign transient proteinuria?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Common problem that resolves spontaneously and is most often seen in children and young adults
CT
ACEi

36. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Albumin; low molecular weight proteins
Repeat Pap after infection treated
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Dehydration - anemia - cardiac causes

37. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Kids: Rotavirus Adults: Norwalk Virus
Streptococci

38. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Non-cardiac causes of palpitations
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

39. Pain in shoulder when throwing - swimming - or serving a tennis ball
Scleroderma/polymyositis with secondary gastroesophageal reflux
Rotator cuff tendonitis
Upper sternal area burning pain - associated with a productive cough
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

40. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Tension headache
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

41. What are the signs of malignant hypertension?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
High blood pressure - focal neurologic defecit - or papilledema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Slow progression of cervical cancer changes -Availability of effective early treatment

42. When should a patient get a stress test?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Medication or chemical esophagitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

43. 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.
Peptic ulcer disease or gastritis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

44. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Irregular bleeding between cycles

45. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Coronary artery disease/ angina
Paroxysmal atrial fibrillation or supraventricular tachycardia
RBC casts and old to moderate HTN

46. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
These patients are associated with low renin states=less likely to respond to medication
PE - MI - aortic dissection - pneumothorax

47. What is the role of LH in the menstrual cycle
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
LH surge triggers ovulation
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

48. What is the peripheral caUse of vertigo?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Coronary artery disease/ angina
HIV and syphilis

49. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
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
Pancreatitis
24 hour halter

50. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Candida albicans
Slow progression of cervical cancer changes -Availability of effective early treatment
Tension headache