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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. Mainstay treatment for soft tissue inflammation (Shoulder)
With a KOH wet mount preparation
Coag disorders
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

2. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Loop diuretics (Check serum K+ levels before drug admin)
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
Kids: Rotavirus Adults: Norwalk Virus

3. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Other brainstem or cranial nerve findings
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

4. Cycle length variabilty is primarily due to what?
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
Irregular bleeding between cycles
Variability in the time for follicle development during the proliferative phase
Colposcopy - Endocervical curettage - and directed cervical biopsy

5. Shoulder pain with pain radiating to elbow
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Cervical radiculopathy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

6. What are the most common viral causes of diarrhea in kids and adults?
Adhesive capsulitis (frozen shoulder): most common in middle age women
ACEi - ARBS - thiazide diuretics
Kids: Rotavirus Adults: Norwalk Virus
Dehydration - anemia - cardiac causes

7. Pneumonia tx: suitable for healthy adults less than 60
Higher filling presure - pulmonary congestion - and decreasd cardiac return
A central clear area
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Viral infection of the semicircular apparatus

8. How to NSAIDs contribute to gastritis and ulcer formation?
Rotator Cuff problem
A central clear area
EGD
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.

9. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Staphylococcal scalded skin syndrome
Possibility of Ischemic colitis

10. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Albumin; low molecular weight proteins
Medication or chemical esophagitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Paroxysmal atrial fibrillation or supraventricular tachycardia

11. Uterine bleeding between regular cycles
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
Intermenstrual bleeding
Giardia
Staphylococcal scalded skin syndrome

12. Name the skin lesion: erythema - warmth - edema - pain - fever
Viral infection of the semicircular apparatus
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
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
Cellulitis

13. What are the consequences of diastolic dysfunction?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pts with palpitations and dizziness - near syncope - or syncope
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Higher filling presure - pulmonary congestion - and decreasd cardiac return

14. 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
Hgb - Electrolytes - and TSH
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

15. name the 4 emergent causes of chest pain
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Lightheadedness - dizziness - syncope
PE - MI - aortic dissection - pneumothorax

16. What is the Epley maneuver?
ACEi - ARBS - thiazide diuretics
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.
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.
Menorrhagia

17. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Colposcopy - Endocervical curettage - and directed cervical biopsy

18. 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
PVC or Premature atrial contraction (PAC)
Varicella virus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
ACEi - ARBS - thiazide diuretics

19. Describe the presentation of angina?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Increasing fluid (8 - 8oz glasses of water/day) -fiber
PE - MI - aortic dissection - pneumothorax
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

20. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Intermenstrual bleeding
Anticoag with warfarin to prevent thromboembolism

21. What test done in PE measures instability of shoulder?
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
PE - MI - aortic dissection - pneumothorax
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

22. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Influenza - Rhinovirus - Adenovirus - Parainfluenza
PVC or Premature atrial contraction (PAC)
Cholelithiasis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

23. What treatments are the cornerstone for treating cases of functional constipation?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Supraspinatus and bicipital tendons

24. What are the signs of acute sinusitis?
RBC casts and old to moderate HTN
Acute headache - ataxia - profuse nausea - and vomiting
Fever with frontal or maxillary tenderness
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

25. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Staphylococcal scalded skin syndrome
S. aureus- beta hemolytic streptococcus
Pleurisy
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

26. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Menorrhagia
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

27. History for Sinusitis

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28. 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
A central clear area
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Warts
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi

29. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Upper sternal area burning pain - associated with a productive cough
S. aureus- beta hemolytic streptococcus
Pain
Supraspinatus and bicipital tendons

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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Molluscum contagiosum- pox virus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

31. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
ACEi - ARBS - thiazide diuretics
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi

32. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
ACEi
Varicella virus
CT

33. What is the goal of CHF treatment? What drugs should be used?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Presence of proteinuria on at least two separate ocassion
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
Scabies

34. Where does the development of abnormal cervical cells begin?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Squamocolumnar junction=most common site of cervical cancer
S. Aureus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

35. What is the caUse of benign positional vertigo?
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
ACEi - ARBS - thiazide diuretics
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.
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

36. What type of imaging is need for chronic sinusitis?
CT
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
Giardia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

37. Describe the presentation of pericardial pain
GERD
Hgb - Electrolytes - and TSH
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Repeat Pap after infection treated

38. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
E. Coli O157:H7
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

39. What are the physical exam signs of CHF?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

40. What is the role of LH in the menstrual cycle
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
RBC casts and old to moderate HTN
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
LH surge triggers ovulation

41. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
ACEi - ARBS - thiazide diuretics
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

42. How is constipation clinically defined?
Pain
Squamocolumnar junction=most common site of cervical cancer
Less than 3 stools per week
Wolff-Parkinson-White syndrome

43. Clinical Manifestations of HTN
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

44. When does troponin rise following myocardial injury or infarction?
Wolff-Parkinson-White syndrome
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
With a KOH wet mount preparation

45. PE for a patient getting an abnormal vaginal bleeding work up
Viral gastroenteritis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Repeat Pap after infection treated
These patients are associated with low renin states=less likely to respond to medication

46. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Diuretics -BB -CCB -ACEi
DM - HTN - DVT - seizures - depression - or anxiety

47. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Fever with frontal or maxillary tenderness
These patients are associated with low renin states=less likely to respond to medication
Subarachnoid hemorrhage
Rotator Cuff problem

48. What should blood work include for suspected heart failure?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

49. Why is the pap smear one of the most effective cancer screening tools?
Warts
Slow progression of cervical cancer changes -Availability of effective early treatment
>150mg per 24hrs
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

50. Define the patient population typically affected by orthostatic or postural proteinuria
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.
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
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
Coronary artery disease/ angina