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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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 types of laxatives
Dehydration - anemia - cardiac causes
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
100mg; means patient can be trace protein positive and not be detected

2. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Non-cardiac causes of palpitations
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

3. What are symptoms are CHF?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Possibility of Ischemic colitis

4. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
>150mg per 24hrs

5. 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.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Supraspinatus and bicipital tendons
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Higher filling presure - pulmonary congestion - and decreasd cardiac return

6. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Rotator Cuff problem
Associated with hypotension
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

7. 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
Medication or chemical esophagitis
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
Less than 3 stools per week
Varicella virus

8. What drugs do you use to treat H.pylori + PUD?
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
24 hour halter
Viral infection of the semicircular apparatus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

9. Regular bleeding at intervals of less than 21 days
Squamocolumnar junction=most common site of cervical cancer
PE - MI - aortic dissection - pneumothorax
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
Polymenorrhea

10. Define nephrotic range proteinuria
Hgb - Electrolytes - and TSH
>3.5g of protein per 24hrs
EGD
Upper sternal area burning pain - associated with a productive cough

11. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Scabies
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

12. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Acute headache - ataxia - profuse nausea - and vomiting
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
Nonulcer dyspepsia

13. Diagnosis of HTN
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Peptic ulcer disease or gastritis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

14. What is the caUse of Meniere disease? What are the cardinal symptoms?
Loop diuretics (Check serum K+ levels before drug admin)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
PVC or Premature atrial contraction (PAC)

15. What are the physical exam signs of CHF?
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
Regular bleeding at intervals of more than 35 days
Cellulitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

16. History for Sinusitis

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17. What are the signs of acute sinusitis?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Less abrupt onset and cessation of palpitations
Nonulcer dyspepsia
Fever with frontal or maxillary tenderness

18. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
DM - HTN - DVT - seizures - depression - or anxiety
Common problem that resolves spontaneously and is most often seen in children and young adults
Non-cardiac causes of palpitations

19. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
RBC casts and old to moderate HTN
Pleurisy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

20. What is the role of LH in the menstrual cycle
100mg; means patient can be trace protein positive and not be detected
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
LH surge triggers ovulation
Loop diuretics (Check serum K+ levels before drug admin)

21. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Pleurisy
Peptic ulcer disease or gastritis
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
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

22. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
CBC
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

23. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Viral gastroenteritis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Associated with hypotension

24. Describes what occurs during squamous metaplasia of the cervix.
Echocardiogram
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Coag disorders
Higher filling presure - pulmonary congestion - and decreasd cardiac return

25. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Non-cardiac causes of palpitations
ACEi
Associated with hypotension

26. What is the difference between a Holter monitor or an event monitor?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
ACEi - ARBS - thiazide diuretics
Furucnle

27. 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
Generalized Anxiety disorder and panic disorder
Cluster headache
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. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
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
Increase; 200 g/day

29. What test done in PE measures instability of shoulder?
Scleroderma/polymyositis with secondary gastroesophageal reflux
CT
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

30. What are the signs of malignant hypertension?
CT
High blood pressure - focal neurologic defecit - or papilledema
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

31. Diarrhea from custard filled pastries
Serotypes 16 - 18 - 31 -52 -58
Dehydration - anemia - cardiac causes
Pancreatitis
S. Aureus

32. What is considered normal blood loss during a menstrual cycle?
Cholelithiasis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Regular bleeding at intervals of more than 35 days
Less than 80 ml of blood

33. Things that need to be included in history of shoulder pain
Dehydration - anemia - cardiac causes
Supraspinatus and bicipital tendons
Pleurisy
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

34. What is benign transient proteinuria?
Polymenorrhea
Common problem that resolves spontaneously and is most often seen in children and young adults
DM - HTN - DVT - seizures - depression - or anxiety
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.

35. SE Of Beta blockers?
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

36. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Analgesic headache
>150mg per 24hrs
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Hypertension - CAD - valvular heart disease

37. What is the standard tool used for diagnosis of GERD?
Hypertension - CAD - valvular heart disease
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

38. Four muscles of rotator cuff
Excessive bleeding in amount - duration - or both at irregular intervals
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
E. Coli O157:H7

39. When should a patient get a stress test?
Hgb - Electrolytes - and TSH
Viral infection of the semicircular apparatus
PE - MI - aortic dissection - pneumothorax
When the patient has symptoms in association with exercise or who describe chest pain or pressure

40. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Generalized Anxiety disorder and panic disorder
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

41. 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
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
A 24hr urine protein collection and urine creatinine clearance determination

42. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Analgesic headache
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
DM - HTN - DVT - seizures - depression - or anxiety

43. 1+ protein level on urine dipstick usually represents how much protein in the urine?
With a KOH wet mount preparation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Serotypes 16 - 18 - 31 -52 -58

44. What is the peripheral caUse of vertigo?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Albumin; low molecular weight proteins
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

45. 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
Scabies
Hypertension - CAD - valvular heart disease
Molluscum contagiosum- pox virus
Influenza - Rhinovirus - Adenovirus - Parainfluenza

46. Irregular cycles with excessive flow - duration - or both
Menorrhagia
Less abrupt onset and cessation of palpitations
Diuretics -BB -CCB -ACEi
Anticoag with warfarin to prevent thromboembolism

47. Name the diagnosis of heartburn: severe constant mid abdominal pain
PE - MI - aortic dissection - pneumothorax
Molluscum contagiosum- pox virus
Pancreatitis
LH surge triggers ovulation

48. What is a markers of CNS vertigo?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Irregular bleeding between cycles
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
Other brainstem or cranial nerve findings

49. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
GERD
MSK - pulmonary - GI - or psychological
Nonulcer dyspepsia
Other brainstem or cranial nerve findings

50. 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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

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