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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 are the features of glomerular nephritis
RBC casts and old to moderate HTN
Loop diuretics (Check serum K+ levels before drug admin)
Presence of proteinuria on at least two separate ocassion
Pts with palpitations and dizziness - near syncope - or syncope

2. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Regular bleeding at intervals of more than 35 days
Non-cardiac causes of palpitations
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

3. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Generalized Anxiety disorder and panic disorder
Other brainstem or cranial nerve findings
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

4. 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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

5. What are the most common causes for the common cold?
Wolff-Parkinson-White syndrome
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HPV

6. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Less abrupt onset and cessation of palpitations
Non-cardiac causes of palpitations
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

7. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Menorrhagia
Colposcopy - Endocervical curettage - and directed cervical biopsy

8. How does CHF present on X-ray?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

9. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Medication or chemical esophagitis
ACEi

10. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Varicella virus
Supraspinatus and bicipital tendons
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

11. Difference between Pneumonia and Bronchitis
Menorrhagia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
True

12. Name the skin lesion: pustule in association with a hair follice
HIV and syphilis
Nonulcer dyspepsia
Folliculitis
Excessive bleeding in amount - duration - or both at irregular intervals

13. What is afterload?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
>3.5g of protein per 24hrs
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

14. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
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
Analgesic headache

15. How is constipation clinically defined?
Coag disorders
Less than 3 stools per week
Variability in the time for follicle development during the proliferative phase
These patients are associated with low renin states=less likely to respond to medication

16. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Coag disorders
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Cholelithiasis

17. After treatment of dysplasia - women need Pap smears every...
RBC casts and old to moderate HTN
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Subarachnoid hemorrhage
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

18. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
True

19. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Coronary artery disease/ angina
EGD

20. What are the signs of malignant hypertension?
Kids: Rotavirus Adults: Norwalk Virus
High blood pressure - focal neurologic defecit - or papilledema
Temporal arteritis-biopsy of the temporal artery
Less than 80 ml of blood

21. Isolated - extra pounding beats
Anticoag with warfarin to prevent thromboembolism
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.
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
PVC or Premature atrial contraction (PAC)

22. What is the role of FSH in one's menstrual cycle
>3.5g of protein per 24hrs
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Non-cardiac causes of palpitations
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

23. What medications can cause heart palpitations?
Repeat Pap after infection treated
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
Albumin; low molecular weight proteins
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

24. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Folliculitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Common problem that resolves spontaneously and is most often seen in children and young adults

25. Where does the development of abnormal cervical cells begin?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Squamocolumnar junction=most common site of cervical cancer
Peptic ulcer disease or gastritis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

26. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

27. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
MSK - pulmonary - GI - or psychological
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

28. What are the secondly causes of glomerular disease?
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

29. What are the features of nephrotic syndrome?
S. aureus- beta hemolytic streptococcus
Paroxysmal atrial fibrillation or supraventricular tachycardia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Fever with frontal or maxillary tenderness

30. What is the Epley maneuver?
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.
BB or CCB - catheter ablation of identified bypass tract
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Temporal arteritis-biopsy of the temporal artery

31. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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.
Presence of proteinuria on at least two separate ocassion
Nonulcer dyspepsia

32. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Cholelithiasis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Giardia
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

33. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
Hgb - Electrolytes - and TSH
HPV testing -Pos=colposcopy -Neg=repeat pap smear
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

34. Why is the pap smear one of the most effective cancer screening tools?
Intermenstrual bleeding
Squamocolumnar junction=most common site of cervical cancer
Folliculitis
Slow progression of cervical cancer changes -Availability of effective early treatment

35. What is the standard tool used for diagnosis of GERD?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Non-cardiac causes of palpitations
EGD

36. 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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Scabies
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
True

37. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi
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
Infectious esophagitis

38. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Cervical radiculopathy
MSK - pulmonary - GI - or psychological
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

39. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pleurisy

40. What is the difference between a Holter monitor or an event monitor?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Repeat Pap after infection treated
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

41. What is the peripheral caUse of vertigo?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Cervical radiculopathy
Rotator cuff tendonitis

42. What are the signs of cerebral hemorrhage?
Serotypes 16 - 18 - 31 -52 -58
Acute headache - ataxia - profuse nausea - and vomiting
Scabies
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

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
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

44. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Upper sternal area burning pain - associated with a productive cough
Increase; 200 g/day

45. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
A 24hr urine protein collection and urine creatinine clearance determination

46. name the 4 emergent causes of chest pain
100mg; means patient can be trace protein positive and not be detected
>3.5g of protein per 24hrs
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
PE - MI - aortic dissection - pneumothorax

47. What does treatment for migrans include?
Subarachnoid hemorrhage
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Lightheadedness - dizziness - syncope

48. Tx of chronic or intermittent afibs
100mg; means patient can be trace protein positive and not be detected
GERD
Anticoag with warfarin to prevent thromboembolism
Generalized Anxiety disorder and panic disorder

49. Clinical Manifestations of HTN
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
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

50. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Colposcopy - Endocervical curettage - and directed cervical biopsy
Peptic ulcer disease or gastritis
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.