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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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. aureus- beta hemolytic streptococcus

2. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
MSK - pulmonary - GI - or psychological
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Albumin; low molecular weight proteins
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

3. Define the patient population typically affected by orthostatic or postural proteinuria
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cholelithiasis
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
Albumin; low molecular weight proteins

4. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Pain
Squamocolumnar junction=most common site of cervical cancer
Albumin; low molecular weight proteins
Echocardiogram

5. How can GERD (or esophageal motility disorders) lead to chest pain?
Medication or chemical esophagitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less than 3 stools per week
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

6. How are fungal infections diagnosed?
EGD
S. aureus- beta hemolytic streptococcus
With a KOH wet mount preparation
Bulk forming: Psyllium - Methycellulose - Polycarbophil

7. Name the skin lesion: pustule in association with a hair follice
Nonulcer dyspepsia
Folliculitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Temporal arteritis-biopsy of the temporal artery

8. What are the two common clinical presentations of acute diarrhea?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
100mg; means patient can be trace protein positive and not be detected
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

9. Discomfort with abducting the arm past 90 degress
Staphylococcal scalded skin syndrome
Rotator Cuff tendonitis
Polymenorrhea
Pain

10. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Giardia
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Lightheadedness - dizziness - syncope
Coronary artery disease/ angina

11. What is the mechanism of action for stimulant agents in treating constipation?
Polymenorrhea
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Supraspinatus and bicipital tendons
24 hour halter

12. Isolated - extra pounding beats
Streptococci
PVC or Premature atrial contraction (PAC)
LH surge triggers ovulation
>3.5g of protein per 24hrs

13. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

14. Natural history of cervical cancer
Polymenorrhea
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

15. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
ACEi - ARBS - thiazide diuretics
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

16. Diagnosis of HTN
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Varicella virus

17. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Less than 3 stools per week
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Temporal arteritis-biopsy of the temporal artery
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

19. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
Generalized Anxiety disorder and panic disorder
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
S. Aureus

20. Where does the development of abnormal cervical cells begin?
Generalized Anxiety disorder and panic disorder
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Squamocolumnar junction=most common site of cervical cancer
Less abrupt onset and cessation of palpitations

21. What are the physical exam signs of CHF?
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
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
Coronary artery disease/ angina
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

22. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Less than 80 ml of blood
High blood pressure - focal neurologic defecit - or papilledema
S. aureus- beta hemolytic streptococcus
Analgesic headache

23. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Less abrupt onset and cessation of palpitations
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
Menorrhagia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

24. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Influenza - Rhinovirus - Adenovirus - Parainfluenza
HPV
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

25. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
These patients are associated with low renin states=less likely to respond to medication
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
CBC

26. 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.
Supraspinatus and bicipital tendons
A central clear area
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Slow progression of cervical cancer changes -Availability of effective early treatment

27. 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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Lightheadedness - dizziness - syncope
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

28. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
E. Coli O157:H7

29. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Medication or chemical esophagitis
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

30. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
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
Coag disorders
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

31. 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
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
S. aureus- beta hemolytic streptococcus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

32. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

33. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
HPV
With a KOH wet mount preparation
Pts with palpitations and dizziness - near syncope - or syncope
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

34. name the 4 emergent causes of chest pain
>150mg per 24hrs
PE - MI - aortic dissection - pneumothorax
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Pain

35. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Diuretics -BB -CCB -ACEi
Wolff-Parkinson-White syndrome
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

36. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
LH surge triggers ovulation
Acute headache - ataxia - profuse nausea - and vomiting

37. Irregular cycles with excessive flow - duration - or both
CT
Hypertension - CAD - valvular heart disease
Menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

38. What is a markers of CNS vertigo?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Other brainstem or cranial nerve findings
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

39. Describe the presentation of myocardial pain?
100mg; means patient can be trace protein positive and not be detected
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

40. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Anticoag with warfarin to prevent thromboembolism
Molluscum contagiosum- pox virus
Subarachnoid hemorrhage

41. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
ACEi - ARBS - thiazide diuretics
True

42. What the consequences of decreased cardiac output?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Viral gastroenteritis
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
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

43. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Echocardiogram
DM - HTN - DVT - seizures - depression - or anxiety
With a KOH wet mount preparation
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

44. What are the features of nephrotic syndrome?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Cervical radiculopathy
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.

45. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Temporal arteritis-biopsy of the temporal artery
Giardia
Irregular bleeding between cycles

46. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Other brainstem or cranial nerve findings
DM - HTN - DVT - seizures - depression - or anxiety
Viral gastroenteritis

47. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
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.
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Infectious esophagitis
Supraspinatus and bicipital tendons

48. Shoulder pain with pain radiating to elbow
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cervical radiculopathy
Possibility of Ischemic colitis
24 hour halter

49. What are the indiciations for neuroimaging?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
A central clear area
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

50. History for Sinusitis

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