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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 type of diuretic is the most widely used for HTN? What are some SE of this drug?
Supraspinatus and bicipital tendons
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
When the patient has symptoms in association with exercise or who describe chest pain or pressure

2. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
ACEi - ARBS - thiazide diuretics
Varicella virus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

3. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Excessive bleeding in amount - duration - or both at irregular intervals
Increasing fluid (8 - 8oz glasses of water/day) -fiber
MSK - pulmonary - GI - or psychological

4. After treatment of dysplasia - women need Pap smears every...
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

5. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Tension headache
Coronary artery disease/ angina
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

6. What is the preload?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

7. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
EGD
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Non-cardiac causes of palpitations

8. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Variability in the time for follicle development during the proliferative phase
Pleurisy
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

9. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Increase; 200 g/day
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

10. What is the Barany maneuver?
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
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
Nonulcer dyspepsia
EGD

11. Name the skin lesion: honey colored crusts
PE - MI - aortic dissection - pneumothorax
Impetigo
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Common problem that resolves spontaneously and is most often seen in children and young adults

12. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
ACEi - ARBS - thiazide diuretics
Rotator cuff tendonitis
Tension headache
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

13. Oligomenorrhea
Generalized Anxiety disorder and panic disorder
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Lightheadedness - dizziness - syncope
Regular bleeding at intervals of more than 35 days

14. History for Sinusitis

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15. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Candida albicans
PVC or Premature atrial contraction (PAC)
Pleurisy

16. What is the caUse of benign positional vertigo?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
ACEi
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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.

17. What should blood work include for suspected heart failure?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Echocardiogram
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

18. What are the secondly causes of glomerular disease?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Molluscum contagiosum- pox virus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

19. Define the patient population typically affected by orthostatic or postural proteinuria
Scleroderma/polymyositis with secondary gastroesophageal reflux
Regular bleeding at intervals of more than 35 days
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
Supraspinatus and bicipital tendons

20. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Echocardiogram
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

21. Define proteinuria
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Cholelithiasis
Possibility of Ischemic colitis
>150mg per 24hrs

22. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
CT
EGD

23. At was quantity does urine dipstick test detect elevated protein?
Dehydration - anemia - cardiac causes
Chest pain during pneumonia or PE
Giardia
100mg; means patient can be trace protein positive and not be detected

24. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Less abrupt onset and cessation of palpitations
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
Viral gastroenteritis
Paroxysmal atrial fibrillation or supraventricular tachycardia

25. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

26. When does troponin rise following myocardial injury or infarction?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Hypertension - CAD - valvular heart disease
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. Aureus

27. Difference between Pneumonia and Bronchitis
Echocardiogram
Presence of proteinuria on at least two separate ocassion
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
Peptic ulcer disease or gastritis

28. What is the goal of CHF treatment? What drugs should be used?
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
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
DM - HTN - DVT - seizures - depression - or anxiety
Generalized Anxiety disorder and panic disorder

29. Describe the presentation of pericardial pain
Less than 80 ml of blood
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

30. Constipation: What are indications for lab testing?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Analgesic headache
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

31. Describe the presentation of angina?
Cervical radiculopathy
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
Generalized Anxiety disorder and panic disorder
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

32. What should preconception counseling include?
Kids: Rotavirus Adults: Norwalk Virus
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hypertension - CAD - valvular heart disease
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

33. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff problem

34. Vaccines that should be updated before planned pregnancy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Slow progression of cervical cancer changes -Availability of effective early treatment
BB or CCB - catheter ablation of identified bypass tract

35. What does the classic ring worm lesion have?
Acute headache - ataxia - profuse nausea - and vomiting
Pain
Presence of proteinuria on at least two separate ocassion
A central clear area

36. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
CBC
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cholelithiasis
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

37. What diagnosis does the 'worse headache of my life' suggest?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Subarachnoid hemorrhage
Irregular bleeding between cycles

38. What is the role of FSH in one's menstrual cycle
Coag disorders
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

39. Describe the presentation of myocardial pain?
PE - MI - aortic dissection - pneumothorax
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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.

40. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Peptic ulcer disease or gastritis
24 hour halter

41. Clinical Manifestations of HTN
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Echocardiogram
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

42. What does orthostatic positional changes that bring on dizziness suggest?
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
Excessive bleeding in amount - duration - or both at irregular intervals
Dehydration - anemia - cardiac causes
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

43. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Less abrupt onset and cessation of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
ACEi - ARBS - thiazide diuretics

44. Prenatal visit schedule for low-risk pregnancies
>3.5g of protein per 24hrs
Cholelithiasis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

45. What does treatment for migrans include?
Acute headache - ataxia - profuse nausea - and vomiting
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
Loop diuretics (Check serum K+ levels before drug admin)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

46. What are signs of pulmonary congestion?
Rotator Cuff problem
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Infectious esophagitis
Regular bleeding at intervals of more than 35 days

47. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Warts
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

48. What are the signs of acute sinusitis?
Viral gastroenteritis
Fever with frontal or maxillary tenderness
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Scabies

49. What are symptoms are CHF?
Temporal arteritis-biopsy of the temporal artery
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
RBC casts and old to moderate HTN
Pancreatitis

50. 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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cluster headache
Cholelithiasis
Coronary artery disease/ angina