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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

2. SE Of Beta blockers?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

3. Define the patient population typically affected by orthostatic or postural proteinuria
Infectious esophagitis
Associated with hypotension
Rotator Cuff problem
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

4. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
ACEi
Associated with hypotension
Loop diuretics (Check serum K+ levels before drug admin)

5. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Polymenorrhea
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

6. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Diuretics -BB -CCB -ACEi
Bence-Jones
>150mg per 24hrs
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

7. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
EGD
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

8. Why is the pap smear one of the most effective cancer screening tools?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Slow progression of cervical cancer changes -Availability of effective early treatment
Paroxysmal atrial fibrillation or supraventricular tachycardia

9. What places women at higher risk of getting cervical cancer?
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
Other brainstem or cranial nerve findings
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Regular bleeding at intervals of more than 35 days

10. What are the 2 psych disorders most commonly associated with palpitations?
>3.5g of protein per 24hrs
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Generalized Anxiety disorder and panic disorder
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

11. What are the common causes for laryngitis?
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
With a KOH wet mount preparation
Generalized Anxiety disorder and panic disorder
Influenza - Rhinovirus - Adenovirus - Parainfluenza

12. What is the next best step if a patient has two or more positive dipstick tests?
Squamocolumnar junction=most common site of cervical cancer
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Associated with hypotension
A 24hr urine protein collection and urine creatinine clearance determination

13. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
24 hour halter
E. Coli O157:H7
Influenza - Rhinovirus - Adenovirus - Parainfluenza

14. What is the goal of CHF treatment? What drugs should be used?
BB or CCB - catheter ablation of identified bypass tract
Regular bleeding at intervals of more than 35 days
Upper sternal area burning pain - associated with a productive cough
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

15. Constipation: What are indications for lab testing?
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
Non-cardiac causes of palpitations
Squamocolumnar junction=most common site of cervical cancer
Furucnle

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Diuretics -BB -CCB -ACEi
Rotator cuff tendonitis
>150mg per 24hrs

17. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Slow progression of cervical cancer changes -Availability of effective early treatment
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
EGD
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

18. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.
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

19. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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.
These patients are associated with low renin states=less likely to respond to medication
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

20. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Molluscum contagiosum- pox virus
Chest pain during pneumonia or PE
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
Non-cardiac causes of palpitations

21. Pneumonia tx: suitable for healthy adults less than 60
A central clear area
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
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

22. Describe the presentation of pericardial pain
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

23. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Rotator Cuff problem
Less than 3 stools per week
Serotypes 16 - 18 - 31 -52 -58

24. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Hypertension - CAD - valvular heart disease
A 24hr urine protein collection and urine creatinine clearance determination
Less than 80 ml of blood

25. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Diuretics -BB -CCB -ACEi

26. What are the secondly causes of glomerular disease?
Less than 80 ml of blood
RBC casts and old to moderate HTN
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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

27. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

28. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
Albumin; low molecular weight proteins
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
HPV

29. 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
Infectious esophagitis
Lightheadedness - dizziness - syncope
Cholelithiasis

30. 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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Impetigo
Associated with hypotension
Molluscum contagiosum- pox virus

31. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
Upper sternal area burning pain - associated with a productive cough
Candida albicans

32. What are the three types of lice?
PVC or Premature atrial contraction (PAC)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

33. Pneumonia tx: suitable for healthy adults older than 60
Viral gastroenteritis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
HPV testing -Pos=colposcopy -Neg=repeat pap smear

34. What are symptoms are CHF?
Molluscum contagiosum- pox virus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

35. Irregular cycles with excessive flow - duration - or both
Possibility of Ischemic colitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Menorrhagia
A central clear area

36. What are the primary glomerular diseases?
S. Aureus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Common problem that resolves spontaneously and is most often seen in children and young adults
Coronary artery disease/ angina

37. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
Menorrhagia
HPV
Staphylococcal scalded skin syndrome

38. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Less than 80 ml of blood
Acute headache - ataxia - profuse nausea - and vomiting
Paroxysmal atrial fibrillation or supraventricular tachycardia
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

39. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Cellulitis

40. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

41. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
E. Coli O157:H7
LH surge triggers ovulation
Pancreatitis

42. What are the physical exam signs of CHF?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
S. aureus- beta hemolytic streptococcus

43. Pneumothorax - sudden sharp chest pain - preceded by viral illness
With a KOH wet mount preparation
Pleurisy
High blood pressure - focal neurologic defecit - or papilledema
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. When should a patient get a stress test?
E. Coli O157:H7
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Fever with frontal or maxillary tenderness

45. Things that need to be included in history of shoulder pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fever with frontal or maxillary tenderness
Cervical radiculopathy

46. What is the role of FSH in one's menstrual cycle
HPV
S. Aureus
Infectious esophagitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

47. What is the Barany maneuver?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
ACEi - ARBS - thiazide diuretics

48. What are the signs of cerebral hemorrhage?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Nonulcer dyspepsia
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
Acute headache - ataxia - profuse nausea - and vomiting

49. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
PVC or Premature atrial contraction (PAC)
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
Giardia
Wolff-Parkinson-White syndrome

50. What are signs of pulmonary congestion?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Medication or chemical esophagitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema