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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. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
100mg; means patient can be trace protein positive and not be detected
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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.
Pleurisy

2. Name types of laxatives
Scabies
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Serotypes 16 - 18 - 31 -52 -58

3. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
MSK - pulmonary - GI - or psychological
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

4. What is the standard tool used for diagnosis of GERD?
LH surge triggers ovulation
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
EGD
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

5. 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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Associated with hypotension
Nonulcer dyspepsia

6. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Generalized Anxiety disorder and panic disorder
Supraspinatus and bicipital tendons
Menorrhagia
Giardia

7. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Slow progression of cervical cancer changes -Availability of effective early treatment
True
HPV testing -Pos=colposcopy -Neg=repeat pap smear
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

8. Pneumonia tx: suitable for healthy adults less than 60
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.
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
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

9. Name the diagnosis of heartburn: severe constant mid abdominal pain
HIV and syphilis
Giardia
Pancreatitis
Staphylococcal scalded skin syndrome

10. Constipation: What are indications for lab testing?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Dehydration - anemia - cardiac causes
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

11. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Pleurisy
Variability in the time for follicle development during the proliferative phase
35 (exception for postmenopausal women who have recently been started on HRT)
PE - MI - aortic dissection - pneumothorax

12. Difference between Pneumonia and Bronchitis
Varicella virus
HPV
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

13. Menometrorrhagia
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Excessive bleeding in amount - duration - or both at irregular intervals
Furucnle
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

14. What is a markers of CNS vertigo?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
E. Coli O157:H7
Other brainstem or cranial nerve findings
Less than 3 stools per week

15. What drugs do you use to treat H.pylori + PUD?
Streptococci
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Rotator cuff tendonitis
Associated with hypotension

16. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Increase; 200 g/day
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

17. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Regular bleeding at intervals of more than 35 days
DM - HTN - DVT - seizures - depression - or anxiety
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

18. How does CHF present on X-ray?
Acute headache - ataxia - profuse nausea - and vomiting
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Folliculitis

19. 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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Warts
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

20. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Viral infection of the semicircular apparatus

21. What are the signs of cerebral hemorrhage?
>3.5g of protein per 24hrs
Tension headache
Acute headache - ataxia - profuse nausea - and vomiting
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

22. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Cellulitis
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
Streptococci
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

23. 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
RBC casts and old to moderate HTN
Irregular bleeding between cycles
True
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

24. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Wolff-Parkinson-White syndrome
Temporal arteritis-biopsy of the temporal artery
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Peptic ulcer disease or gastritis

25. Carcinoma in situ is generally referred to a gynecologist and requires ______
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

26. Oligomenorrhea
Cervical radiculopathy
Regular bleeding at intervals of more than 35 days
Scleroderma/polymyositis with secondary gastroesophageal reflux
Increase; 200 g/day

27. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Tension headache
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

28. Name the diagnosis of heartburn: regurgitation - dysphagia
HPV
GERD
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
MSK - pulmonary - GI - or psychological

29. Name the skin lesion: pustule in association with a hair follice
Fever with frontal or maxillary tenderness
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
Folliculitis
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

30. HIgh risk pregnant patients should be evaluated for ____ and ____
Possibility of Ischemic colitis
Kids: Rotavirus Adults: Norwalk Virus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
HIV and syphilis

31. After treatment of dysplasia - women need Pap smears every...
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
Associated with hypotension
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

32. Why don't ACEi work well for the elderly and African Americans when treating HTN?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
These patients are associated with low renin states=less likely to respond to medication
Bence-Jones
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

33. Tx of chronic or intermittent afibs
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
Anticoag with warfarin to prevent thromboembolism
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

34. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Polymenorrhea
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Anticoag with warfarin to prevent thromboembolism
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

35. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Serotypes 16 - 18 - 31 -52 -58

36. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Other brainstem or cranial nerve findings
Scleroderma/polymyositis with secondary gastroesophageal reflux
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Candida albicans

37. What are the two common clinical presentations of acute diarrhea?
GERD
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

38. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
GERD
Supraspinatus and bicipital tendons
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

39. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

40. How does systolic vs. diastolic heart failure present on the echocardiogram?
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
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

41. What are the signs of acute sinusitis?
Tension headache
CT
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fever with frontal or maxillary tenderness

42. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
>150mg per 24hrs

43. Describe the presentation tracheobronchitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Upper sternal area burning pain - associated with a productive cough
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

44. What does orthostatic positional changes that bring on dizziness suggest?
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
Dehydration - anemia - cardiac causes
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

45. Lab testing for heart palpitation
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Non-cardiac causes of palpitations
Hgb - Electrolytes - and TSH
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

46. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Cholelithiasis
Scabies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

47. PE for a patient getting an abnormal vaginal bleeding work up
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Subarachnoid hemorrhage
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

48. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
High blood pressure - focal neurologic defecit - or papilledema
ACEi - ARBS - thiazide diuretics
Bence-Jones
Echocardiogram

49. Where does the development of abnormal cervical cells begin?
Cellulitis
Squamocolumnar junction=most common site of cervical cancer
Nonulcer dyspepsia
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

50. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Pancreatitis
Viral gastroenteritis
Dehydration - anemia - cardiac causes