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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. Treatment for supraventricular tachycardias
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
BB or CCB - catheter ablation of identified bypass tract
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 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.

2. Natural history of cervical cancer
DM - HTN - DVT - seizures - depression - or anxiety
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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.

3. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
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
Kids: Rotavirus Adults: Norwalk Virus
MSK - pulmonary - GI - or psychological
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

4. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Anticoag with warfarin to prevent thromboembolism
Peptic ulcer disease or gastritis
Pleurisy
Diuretics -BB -CCB -ACEi

5. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Fever with frontal or maxillary tenderness
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cholelithiasis
Intermenstrual bleeding

6. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
E. Coli O157:H7
Scleroderma/polymyositis with secondary gastroesophageal reflux
When the patient has symptoms in association with exercise or who describe chest pain or pressure

7. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
24 hour halter
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

8. 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
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
Wolff-Parkinson-White syndrome

9. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
PVC or Premature atrial contraction (PAC)
Infectious esophagitis
Other brainstem or cranial nerve findings
Fever with frontal or maxillary tenderness

10. Name some medications that can cause proteinuria
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

11. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Hgb - Electrolytes - and TSH
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.

12. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

13. 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.
Tension headache
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
35 (exception for postmenopausal women who have recently been started on HRT)
Giardia

14. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
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
Dehydration - anemia - cardiac causes
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

15. 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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

16. Menometrorrhagia
Slow progression of cervical cancer changes -Availability of effective early treatment
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.
Excessive bleeding in amount - duration - or both at irregular intervals
Rotator cuff tendonitis

17. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Variability in the time for follicle development during the proliferative phase
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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

18. What test done in PE measures instability of shoulder?
Excessive bleeding in amount - duration - or both at irregular intervals
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

19. What is the next best step if a patient has two or more positive dipstick tests?
Folliculitis
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
Coronary artery disease/ angina
A 24hr urine protein collection and urine creatinine clearance determination

20. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
HPV
Less than 80 ml of blood

21. Predictors of cardiac etiology
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
Rotator cuff tendonitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

22. Diagnosis of HTN
Infectious esophagitis
Rotator Cuff problem
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

23. HIgh risk pregnant patients should be evaluated for ____ and ____
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
HIV and syphilis
Less than 80 ml of blood
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

24. Diarrhea from custard filled pastries
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
S. Aureus
MSK - pulmonary - GI - or psychological
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

25. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

26. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
E. Coli O157:H7
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
Varicella virus

27. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Bence-Jones
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.

28. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

29. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Hgb - Electrolytes - and TSH
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

30. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
100mg; means patient can be trace protein positive and not be detected
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pain

31. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
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
Cellulitis
Viral gastroenteritis
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.

32. Metrorrhagia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Irregular bleeding between cycles
Varicella virus

33. Define the patient population typically affected by orthostatic or postural proteinuria
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Slow progression of cervical cancer changes -Availability of effective early treatment
PE - MI - aortic dissection - pneumothorax

34. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
CBC
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

35. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Upper sternal area burning pain - associated with a productive cough
Pain
With a KOH wet mount preparation

36. What is the caUse of benign positional vertigo?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Furucnle
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.
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

37. What are the three types of lice?
Viral infection of the semicircular apparatus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Variability in the time for follicle development during the proliferative phase
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

38. What are the common causes for laryngitis?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Upper sternal area burning pain - associated with a productive cough
Influenza - Rhinovirus - Adenovirus - Parainfluenza

39. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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
Possibility of Ischemic colitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

40. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Albumin; low molecular weight proteins
Scabies
Loop diuretics (Check serum K+ levels before drug admin)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

41. What are symptoms are CHF?
Impetigo
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

42. 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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pain
Warts
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

43. Describe the presentation of angina?
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
A central clear area
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Kids: Rotavirus Adults: Norwalk Virus

44. What are the features of glomerular nephritis
Slow progression of cervical cancer changes -Availability of effective early treatment
RBC casts and old to moderate HTN
Subarachnoid hemorrhage
High blood pressure - focal neurologic defecit - or papilledema

45. 1+ protein level on urine dipstick usually represents how much protein in the urine?
MSK - pulmonary - GI - or psychological
Other brainstem or cranial nerve findings
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

46. What does the classic ring worm lesion have?
100mg; means patient can be trace protein positive and not be detected
A central clear area
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

47. What diagnosis does the 'worse headache of my life' suggest?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Less abrupt onset and cessation of palpitations
Subarachnoid hemorrhage
E. Coli O157:H7

48. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pleurisy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

49. What is the role of LH in the menstrual cycle
Other brainstem or cranial nerve findings
LH surge triggers ovulation
Scabies
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

50. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Temporal arteritis-biopsy of the temporal artery
Giardia
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse