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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 4 factors that predispose an individual to develop pneumonia.
HIV and syphilis
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.
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.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

2. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
With a KOH wet mount preparation
Serotypes 16 - 18 - 31 -52 -58
>150mg per 24hrs

3. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Peptic ulcer disease or gastritis
Temporal arteritis-biopsy of the temporal artery
Regular bleeding at intervals of more than 35 days

4. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HIV and syphilis
Cervical radiculopathy

5. Uterine bleeding between regular cycles
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
Intermenstrual bleeding
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

6. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
RBC casts and old to moderate HTN
Molluscum contagiosum- pox virus
Cervical radiculopathy
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

7. 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
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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.

8. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
High blood pressure - focal neurologic defecit - or papilledema
Scabies
Streptococci

9. 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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

10. What is the mechanism of action for stimulant agents in treating constipation?
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
Warts
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

11. What are the two common clinical presentations of acute diarrhea?
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.
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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

12. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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.
HPV
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

13. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
With a KOH wet mount preparation
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

14. What should preconception counseling include?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

15. What is the standard tool used for diagnosis of GERD?
EGD
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi
Irregular bleeding between cycles

16. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Infectious esophagitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

17. What should blood work include for suspected heart failure?
Echocardiogram
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pain
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

18. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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.
Medication or chemical esophagitis

19. 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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Varicella virus
Serotypes 16 - 18 - 31 -52 -58

20. Describe the presentation of angina?
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
Less abrupt onset and cessation of 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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

21. Metrorrhagia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Irregular bleeding between cycles
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

22. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Chest pain during pneumonia or PE
Kids: Rotavirus Adults: Norwalk Virus
PVC or Premature atrial contraction (PAC)

23. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Adhesive capsulitis (frozen shoulder): most common in middle age women
High blood pressure - focal neurologic defecit - or papilledema
Folliculitis

24. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Warts
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Increase; 200 g/day

25. Natural history of cervical cancer
Rotator cuff tendonitis
Tension headache
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

26. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
CBC
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Paroxysmal atrial fibrillation or supraventricular tachycardia
Dehydration - anemia - cardiac causes

27. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Warts
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

28. Diarrhea from custard filled pastries
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
S. Aureus
Temporal arteritis-biopsy of the temporal artery

29. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Acute headache - ataxia - profuse nausea - and vomiting
Giardia

30. 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.
A central clear area
Repeat Pap after infection treated
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

31. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Staphylococcal scalded skin syndrome
Associated with hypotension

32. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Dehydration - anemia - cardiac causes
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
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
Infectious esophagitis

33. What is the role of FSH in one's menstrual cycle
ACEi - ARBS - thiazide diuretics
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

34. What does the classic ring worm lesion have?
Kids: Rotavirus Adults: Norwalk Virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
A central clear area
Anticoag with warfarin to prevent thromboembolism

35. What HPV serotypes are most commonly associated with cervical cancer?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Serotypes 16 - 18 - 31 -52 -58
Wolff-Parkinson-White syndrome
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

36. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
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.
Bence-Jones
HPV testing -Pos=colposcopy -Neg=repeat pap smear

37. History for Sinusitis

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38. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
These patients are associated with low renin states=less likely to respond to medication
Wolff-Parkinson-White syndrome
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Furucnle

39. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
E. Coli O157:H7
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pts with palpitations and dizziness - near syncope - or syncope
Medication or chemical esophagitis

40. Complete the sentence: pericarditis can cause frictional rub and......
Staphylococcal scalded skin syndrome
Fever with frontal or maxillary tenderness
Scabies
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

41. Difference between Pneumonia and Bronchitis
Scleroderma/polymyositis with secondary gastroesophageal reflux
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
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

42. Prenatal visit schedule for low-risk pregnancies
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
Less than 3 stools per week
Less than 80 ml of blood
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

43. Tx of chronic or intermittent afibs
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
Other brainstem or cranial nerve findings
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
Anticoag with warfarin to prevent thromboembolism

44. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Coronary artery disease/ angina
Serotypes 16 - 18 - 31 -52 -58
PVC or Premature atrial contraction (PAC)

45. What are the consequences of diastolic dysfunction?
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.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

46. Describe the presentation tracheobronchitis
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pts with palpitations and dizziness - near syncope - or syncope
Upper sternal area burning pain - associated with a productive cough

47. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Furucnle

48. MI - pericardial tamponade - PE - GI bleed - are...
Upper sternal area burning pain - associated with a productive cough
24 hour halter
Associated with hypotension
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

49. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A central clear area
Candida albicans

50. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Dehydration - anemia - cardiac causes
Kids: Rotavirus Adults: Norwalk Virus