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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. When is a lumbar puncture contraindicated?
Menorrhagia
>150mg per 24hrs
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.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

2. Name the skin lesion: honey colored crusts
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Impetigo
Dehydration - anemia - cardiac causes

3. At was quantity does urine dipstick test detect elevated protein?
Less than 3 stools per week
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
24 hour halter
100mg; means patient can be trace protein positive and not be detected

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
Subarachnoid hemorrhage
Cluster headache
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.
>150mg per 24hrs

5. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Dehydration - anemia - cardiac causes
Infectious esophagitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
ACEi - ARBS - thiazide diuretics

6. What is the preload?
>3.5g of protein per 24hrs
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

7. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
CBC
Furucnle
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

8. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Irregular bleeding between cycles
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
Rotator Cuff tendonitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

9. What are the primary glomerular diseases?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
ACEi - ARBS - thiazide diuretics

10. What is the standard tool used for diagnosis of GERD?
Pts with palpitations and dizziness - near syncope - or syncope
EGD
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

11. What is the caUse of benign positional vertigo?
HIV and syphilis
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.
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
MSK - pulmonary - GI - or psychological

12. Metrorrhagia
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
True
Irregular bleeding between cycles

13. What are the consequences of diastolic dysfunction?
Associated with hypotension
MSK - pulmonary - GI - or psychological
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Presence of proteinuria on at least two separate ocassion

14. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Polymenorrhea
Nonulcer dyspepsia
CBC
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.

15. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
A 24hr urine protein collection and urine creatinine clearance determination
MSK - pulmonary - GI - or psychological
Viral infection of the semicircular apparatus

16. Diarrhea from custard filled pastries
Kids: Rotavirus Adults: Norwalk Virus
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
S. Aureus
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

17. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
Intermenstrual bleeding
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

18. How are fungal infections diagnosed?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
With a KOH wet mount preparation
Increase; 200 g/day
Repeat Pap after infection treated

19. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Squamocolumnar junction=most common site of cervical cancer
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

20. What lab tests are recommended for newly diagnosed hypertensive patients?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Irregular bleeding between cycles
Temporal arteritis-biopsy of the temporal artery
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

21. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pts with palpitations and dizziness - near syncope - or syncope
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

22. patients with herpes zoster may experience what symptom before the rash appear?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pain
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Wolff-Parkinson-White syndrome

23. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral gastroenteritis
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

24. Complete the sentence: pericarditis can cause frictional rub and......
Impetigo
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Slow progression of cervical cancer changes -Availability of effective early treatment

25. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Squamocolumnar junction=most common site of cervical cancer
Peptic ulcer disease or gastritis
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
Acute headache - ataxia - profuse nausea - and vomiting

26. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Coronary artery disease/ angina
Scleroderma/polymyositis with secondary gastroesophageal reflux
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

27. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Streptococci
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

28. What are the signs of acute sinusitis?
Giardia
Fever with frontal or maxillary tenderness
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

29. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Increasing fluid (8 - 8oz glasses of water/day) -fiber
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Candida albicans

30. What does treatment for migrans include?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

31. 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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

32. Diagnostic Evaluation of Abnoraml vaginal bleeding
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Possibility of Ischemic colitis
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

33. What are the 2 psych disorders most commonly associated with palpitations?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Generalized Anxiety disorder and panic disorder
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Colposcopy - Endocervical curettage - and directed cervical biopsy

34. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

35. What is benign transient proteinuria?
Chest pain during pneumonia or PE
Common problem that resolves spontaneously and is most often seen in children and young adults
Cervical radiculopathy
Higher filling presure - pulmonary congestion - and decreasd cardiac return

36. History for Acute bronchitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
LH surge triggers ovulation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

37. After treatment of dysplasia - women need Pap smears every...
DM - HTN - DVT - seizures - depression - or anxiety
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Analgesic headache
Loop diuretics (Check serum K+ levels before drug admin)

38. What are the secondly causes of glomerular disease?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Cervical radiculopathy
S. aureus- beta hemolytic streptococcus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

39. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
MSK - pulmonary - GI - or psychological

40. Name the diagnosis of heartburn: regurgitation - dysphagia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
GERD
Impetigo

41. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

42. How is constipation clinically defined?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
EGD
Less than 3 stools per week

43. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Paroxysmal atrial fibrillation or supraventricular tachycardia
GERD
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

44. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Infectious esophagitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Peptic ulcer disease or gastritis

45. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Colposcopy - Endocervical curettage - and directed cervical biopsy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Rotator Cuff tendonitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil

46. What is the difference between a Holter monitor or an event monitor?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
100mg; means patient can be trace protein positive and not be detected
Increasing fluid (8 - 8oz glasses of water/day) -fiber

47. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Increase; 200 g/day

48. Oligomenorrhea
Kids: Rotavirus Adults: Norwalk Virus
Regular bleeding at intervals of more than 35 days
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

49. 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.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Tension headache
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

50. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
These patients are associated with low renin states=less likely to respond to medication
LH surge triggers ovulation
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule