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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. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Pain
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Non-cardiac causes of palpitations

2. Describe the presentation of angina?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Tension headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

3. History for Sinusitis

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4. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
True
Hgb - Electrolytes - and TSH
Giardia
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

5. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
24 hour halter
Varicella virus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

6. What are the indiciations for neuroimaging?
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
Pancreatitis
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

7. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Squamocolumnar junction=most common site of cervical cancer
Slow progression of cervical cancer changes -Availability of effective early treatment
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

8. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

9. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Analgesic headache
24 hour halter

10. Tx of chronic or intermittent afibs
S. Aureus
Anticoag with warfarin to prevent thromboembolism
Folliculitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

11. 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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
GERD

12. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

13. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Rotator Cuff problem
Variability in the time for follicle development during the proliferative phase
Excessive bleeding in amount - duration - or both at irregular intervals

14. When is a lumbar puncture contraindicated?
Cluster headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
A central clear area

15. Treatment for supraventricular tachycardias
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.
Intermenstrual bleeding
Less than 3 stools per week
BB or CCB - catheter ablation of identified bypass tract

16. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Warts
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

17. Diarrhea is defined as an ____ in stool weight to more than ____g per day
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
High blood pressure - focal neurologic defecit - or papilledema
Increase; 200 g/day

18. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Generalized Anxiety disorder and panic disorder

19. Pneumonia tx: suitable for healthy adults older than 60
Menorrhagia
Folliculitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

20. What is the standard tool used for diagnosis of GERD?
GERD
EGD
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
Wolff-Parkinson-White syndrome

21. 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
Candida albicans
Rotator Cuff problem
Cholelithiasis

22. 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
HIV and syphilis
Pain
Bence-Jones

23. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Cluster headache
PE - MI - aortic dissection - pneumothorax
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

24. Metrorrhagia
True
Adhesive capsulitis (frozen shoulder): most common in middle age women
Less abrupt onset and cessation of palpitations
Irregular bleeding between cycles

25. When does troponin rise following myocardial injury or infarction?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

26. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
CBC
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

27. Difference between Pneumonia and Bronchitis
Serotypes 16 - 18 - 31 -52 -58
Molluscum contagiosum- pox virus
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
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

28. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Peptic ulcer disease or gastritis
Nonulcer dyspepsia
Squamocolumnar junction=most common site of cervical cancer
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

29. Describe the history and PE of patient presenting with common cold
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
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
Giardia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

30. What are the common causes for laryngitis?
Other brainstem or cranial nerve findings
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

31. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cellulitis
Furucnle
Subarachnoid hemorrhage

32. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
HPV
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Coronary artery disease/ angina

33. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Rotator cuff tendonitis
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
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

34. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A 24hr urine protein collection and urine creatinine clearance determination
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

35. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cervical radiculopathy
Chest pain during pneumonia or PE
True

36. 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
Serotypes 16 - 18 - 31 -52 -58
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Subarachnoid hemorrhage

37. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Tension headache
Temporal arteritis-biopsy of the temporal artery

38. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
A 24hr urine protein collection and urine creatinine clearance determination
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

39. What drugs do you use to treat H.pylori + PUD?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Squamocolumnar junction=most common site of cervical cancer
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Impetigo

40. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Tension headache
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Cholelithiasis
Scabies

41. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Chest pain during pneumonia or PE
S. Aureus
Subarachnoid hemorrhage

42. What does orthostatic positional changes that bring on dizziness suggest?
ACEi - ARBS - thiazide diuretics
Dehydration - anemia - cardiac causes
Serotypes 16 - 18 - 31 -52 -58
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

43. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Cervical radiculopathy
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
LH surge triggers ovulation
Bence-Jones

44. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Hgb - Electrolytes - and TSH
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HIV and syphilis

45. What are the physical exam signs of CHF?
Loop diuretics (Check serum K+ levels before drug admin)
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
Hypertension - CAD - valvular heart disease
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

46. What is the role of LH in the menstrual cycle
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
Cervical radiculopathy
LH surge triggers ovulation
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

47. What should be considered in younger patients with menorrhagia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Chest pain during pneumonia or PE
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
Coag disorders

48. What medications can cause heart palpitations?
Hypertension - CAD - valvular heart disease
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

49. patients with herpes zoster may experience what symptom before the rash appear?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Possibility of Ischemic colitis
Pain
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

50. Cycle length variabilty is primarily due to what?
Hypertension - CAD - valvular heart disease
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
Variability in the time for follicle development during the proliferative phase
Less abrupt onset and cessation of palpitations