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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 the consequences of decreased cardiac output?
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
A central clear area
Infectious esophagitis
Loop diuretics (Check serum K+ levels before drug admin)

2. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
These patients are associated with low renin states=less likely to respond to medication
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Adhesive capsulitis (frozen shoulder): most common in middle age women

3. What lab tests are recommended for newly diagnosed hypertensive patients?
Lightheadedness - dizziness - syncope
S. aureus- beta hemolytic streptococcus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

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
CT
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
E. Coli O157:H7
Cluster headache

5. What occurs after ovulation
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Coronary artery disease/ angina
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
HPV testing -Pos=colposcopy -Neg=repeat pap smear

6. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
HPV

7. What is the role of FSH in one's menstrual cycle
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
High blood pressure - focal neurologic defecit - or papilledema
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

8. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
CT
Paroxysmal atrial fibrillation or supraventricular tachycardia
>150mg per 24hrs

9. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
LH surge triggers ovulation
HIV and syphilis
EGD

10. What should preconception counseling include?
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
CBC
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Squamocolumnar junction=most common site of cervical cancer

11. What are the two common clinical presentations of acute diarrhea?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Warts
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

12. What type of imaging is need for chronic sinusitis?
Coronary artery disease/ angina
Excessive bleeding in amount - duration - or both at irregular intervals
ACEi - ARBS - thiazide diuretics
CT

13. What is the goal of CHF treatment? What drugs should be used?
35 (exception for postmenopausal women who have recently been started on HRT)
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
A 24hr urine protein collection and urine creatinine clearance determination
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

14. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
DM - HTN - DVT - seizures - depression - or anxiety
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

15. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Presence of proteinuria on at least two separate ocassion
Infectious esophagitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

16. Define proteinuria
>150mg per 24hrs
Impetigo
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
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

17. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Pleurisy
Rotator Cuff tendonitis
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

18. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Possibility of Ischemic colitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

19. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Nonulcer dyspepsia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral infection of the semicircular apparatus

20. 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
Less than 80 ml of blood
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
100mg; means patient can be trace protein positive and not be detected
Scabies

21. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
24 hour halter
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
ACEi

22. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
S. aureus- beta hemolytic streptococcus
Medication or chemical esophagitis

23. Four muscles of rotator cuff
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Molluscum contagiosum- pox virus

24. What treatments are the cornerstone for treating cases of functional constipation?
Increase; 200 g/day
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

25. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Non-cardiac causes of palpitations

26. What are the features of nephrotic syndrome?
Bence-Jones
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

27. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Warts
E. Coli O157:H7
Infectious esophagitis
HIV and syphilis

28. Describe the presentation of pericardial pain
Nonulcer dyspepsia
Staphylococcal scalded skin syndrome
Medication or chemical esophagitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

29. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
MSK - pulmonary - GI - or psychological

30. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Squamocolumnar junction=most common site of cervical cancer
CBC
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Associated with hypotension

31. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HPV
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Non-cardiac causes of palpitations

32. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
When the patient has symptoms in association with exercise or who describe chest pain or pressure
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Infectious esophagitis

33. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Rotator cuff tendonitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

34. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

35. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Possibility of Ischemic colitis
Molluscum contagiosum- pox virus
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

36. What is afterload?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Impetigo
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Associated with hypotension

37. What diagnosis does the 'worse headache of my life' suggest?
Impetigo
Echocardiogram
Subarachnoid hemorrhage
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

38. SE Of Beta blockers?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Non-cardiac causes of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

39. Define the patient population typically affected by orthostatic or postural proteinuria
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
Generalized Anxiety disorder and panic disorder
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

40. 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
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.
Colposcopy - Endocervical curettage - and directed cervical biopsy
Tension headache

41. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Pancreatitis
Common problem that resolves spontaneously and is most often seen in children and young adults
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

42. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
PVC or Premature atrial contraction (PAC)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
High blood pressure - focal neurologic defecit - or papilledema

43. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Albumin; low molecular weight proteins
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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

44. Vaccines that should be updated before planned pregnancy
Pleurisy
Polymenorrhea
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

45. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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.
Increasing fluid (8 - 8oz glasses of water/day) -fiber

46. What is the role of LH in the menstrual cycle
S. aureus- beta hemolytic streptococcus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
LH surge triggers ovulation
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

47. Name the diagnosis of heartburn: regurgitation - dysphagia
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
GERD
HIV and syphilis

48. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
S. aureus- beta hemolytic streptococcus
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
Pleurisy

49. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
ACEi - ARBS - thiazide diuretics
Rotator cuff tendonitis
Menorrhagia

50. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Bence-Jones
Chest pain during pneumonia or PE
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
Peptic ulcer disease or gastritis