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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 the diagnosis of heartburn: severe constant mid abdominal pain
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pancreatitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV testing -Pos=colposcopy -Neg=repeat pap smear

2. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Chest pain during pneumonia or PE
Subarachnoid hemorrhage
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

3. What is the mechanism of action for stimulant agents in treating constipation?
Staphylococcal scalded skin syndrome
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

4. What type of imaging is need for chronic sinusitis?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
CT
Hypertension - CAD - valvular heart disease

5. Vaccines that should be updated before planned pregnancy
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
Squamocolumnar junction=most common site of cervical cancer
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

6. 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
Chest pain during pneumonia or PE
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Scabies

7. Oligomenorrhea
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Regular bleeding at intervals of more than 35 days
Associated with hypotension
A 24hr urine protein collection and urine creatinine clearance determination

8. Describe the history and PE of patient presenting with common cold
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
Non-cardiac causes of palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Cholelithiasis

9. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
24 hour halter
>150mg per 24hrs
Medication or chemical esophagitis
A central clear area

10. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Kids: Rotavirus Adults: Norwalk Virus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

11. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Possibility of Ischemic colitis
Rotator Cuff problem
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

12. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Bence-Jones
Diuretics -BB -CCB -ACEi

13. 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.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Cellulitis
HPV
Supraspinatus and bicipital tendons

14. What are the consequences of diastolic dysfunction?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Albumin; low molecular weight proteins
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

15. Describes what occurs during squamous metaplasia of the cervix.
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Nonulcer dyspepsia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

16. History for Acute bronchitis
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Coag disorders
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.

17. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Excessive bleeding in amount - duration - or both at irregular intervals
Repeat Pap after infection treated
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
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

18. What are the 2 psych disorders most commonly associated with palpitations?
Cellulitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Generalized Anxiety disorder and panic disorder
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

19. At was quantity does urine dipstick test detect elevated protein?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Hypertension - CAD - valvular heart disease
Supraspinatus and bicipital tendons
100mg; means patient can be trace protein positive and not be detected

20. History and PE for Pneumonia
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

21. Describe the presentation of pericardial pain
Impetigo
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hgb - Electrolytes - and TSH
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

22. 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
Supraspinatus and bicipital tendons
Pancreatitis
Molluscum contagiosum- pox virus
Serotypes 16 - 18 - 31 -52 -58

23. Regular bleeding at intervals of less than 21 days
Furucnle
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Polymenorrhea
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

24. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
S. Aureus
Staphylococcal scalded skin syndrome
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

25. What is the Barany maneuver?
True
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

26. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Tension headache
Bence-Jones
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

27. What is afterload?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Molluscum contagiosum- pox virus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

28. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Wolff-Parkinson-White syndrome
BB or CCB - catheter ablation of identified bypass tract

29. Shoulder pain with pain radiating to elbow
Loop diuretics (Check serum K+ levels before drug admin)
Cervical radiculopathy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Infectious esophagitis

30. Name the skin lesion: honey colored crusts
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
Impetigo
These patients are associated with low renin states=less likely to respond to medication
Candida albicans

31. Define nephrotic range proteinuria
True
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
>3.5g of protein per 24hrs
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

32. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Presence of proteinuria on at least two separate ocassion

33. What diagnosis does the 'worse headache of my life' suggest?
With a KOH wet mount preparation
Subarachnoid hemorrhage
Excessive bleeding in amount - duration - or both at irregular intervals
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

34. Lab testing for heart palpitation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Pancreatitis
Hgb - Electrolytes - and TSH
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

35. Things that need to be included in history of shoulder pain
Rotator Cuff problem
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
A 24hr urine protein collection and urine creatinine clearance determination
Influenza - Rhinovirus - Adenovirus - Parainfluenza

36. Four muscles of rotator cuff
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Less than 3 stools per week
Viral infection of the semicircular apparatus
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

37. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Paroxysmal atrial fibrillation or supraventricular tachycardia
Streptococci
Generalized Anxiety disorder and panic disorder
MSK - pulmonary - GI - or psychological

38. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
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
Folliculitis
Slow progression of cervical cancer changes -Availability of effective early treatment

39. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Staphylococcal scalded skin syndrome
Infectious esophagitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

40. 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
Cluster headache
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

41. Who should have Xray testing for shoulder pain?
Associated with hypotension
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Analgesic headache

42. Complete the sentence: pericarditis can cause frictional rub and......
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Candida albicans

43. When does troponin rise following myocardial injury or infarction?
Viral gastroenteritis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

44. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Anticoag with warfarin to prevent thromboembolism
These patients are associated with low renin states=less likely to respond to medication
>150mg per 24hrs

45. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Repeat Pap after infection treated
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Albumin; low molecular weight proteins
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Medication or chemical esophagitis

47. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Polymenorrhea
Serotypes 16 - 18 - 31 -52 -58
Staphylococcal scalded skin syndrome

48. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Coag disorders
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Influenza - Rhinovirus - Adenovirus - Parainfluenza

49. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Giardia
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Echocardiogram
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

50. Pneumonia tx: suitable for healthy adults less than 60
Menorrhagia
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.
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline