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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Coronary artery disease/ angina

2. What lab tests are recommended for newly diagnosed hypertensive patients?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

3. What are signs of pulmonary congestion?
ACEi - ARBS - thiazide diuretics
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Analgesic headache

4. Describes what occurs during squamous metaplasia of the cervix.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Variability in the time for follicle development during the proliferative phase
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

5. History for Sinusitis

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6. What test done in PE measures instability of shoulder?
HIV and syphilis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Possibility of Ischemic colitis

7. What is afterload?
True
Coag disorders
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

8. Isolated - extra pounding beats
Cluster headache
Polymenorrhea
PVC or Premature atrial contraction (PAC)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

9. Difference between Pneumonia and Bronchitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Tension headache
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
Albumin; low molecular weight proteins

10. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
MSK - pulmonary - GI - or psychological
Diuretics -BB -CCB -ACEi

11. Define the patient population typically affected by orthostatic or postural proteinuria
Furucnle
Loop diuretics (Check serum K+ levels before drug admin)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

12. What is the preload?
ACEi - ARBS - thiazide diuretics
Dehydration - anemia - cardiac causes
Rotator Cuff tendonitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

13. What should be considered in younger patients with menorrhagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Slow progression of cervical cancer changes -Availability of effective early treatment
Infectious esophagitis
Coag disorders

14. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Acute headache - ataxia - profuse nausea - and vomiting
Other brainstem or cranial nerve findings
Molluscum contagiosum- pox virus
ACEi - ARBS - thiazide diuretics

15. How are fungal infections diagnosed?
Repeat Pap after infection treated
With a KOH wet mount preparation
Associated with hypotension
High blood pressure - focal neurologic defecit - or papilledema

16. 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
Varicella virus
Cellulitis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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

17. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Dehydration - anemia - cardiac causes
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

18. What are the physical exam signs of CHF?
Slow progression of cervical cancer changes -Availability of effective early treatment
Diuretics -BB -CCB -ACEi
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
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

19. HIgh risk pregnant patients should be evaluated for ____ and ____
Common problem that resolves spontaneously and is most often seen in children and young adults
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
HIV and syphilis
Peptic ulcer disease or gastritis

20. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
100mg; means patient can be trace protein positive and not be detected
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
Non-cardiac causes of palpitations
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

21. Name the skin lesion: honey colored crusts
PE - MI - aortic dissection - pneumothorax
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Impetigo

22. What drugs do you use to treat H.pylori + PUD?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Less than 3 stools per week
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

23. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Acute headache - ataxia - profuse nausea - and vomiting
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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
Chest pain during pneumonia or PE

24. What medications can cause heart palpitations?
Pts with palpitations and dizziness - near syncope - or syncope
LH surge triggers ovulation
Less than 3 stools per week
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

25. Four muscles of rotator cuff
Regular bleeding at intervals of more than 35 days
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
Viral gastroenteritis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

26. 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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
These patients are associated with low renin states=less likely to respond to medication
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

27. When should invasive eletrophysiologic study should be considered?
E. Coli O157:H7
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Warts
Slow progression of cervical cancer changes -Availability of effective early treatment

28. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Hgb - Electrolytes - and TSH
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Increase; 200 g/day

29. What are the three types of lice?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Pancreatitis
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

30. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Nonulcer dyspepsia
Anticoag with warfarin to prevent thromboembolism
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

31. Name the skin lesion: erythema - warmth - edema - pain - fever
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Candida albicans
Hgb - Electrolytes - and TSH
Cellulitis

32. 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
Medication or chemical esophagitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

33. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Bulk forming: Psyllium - Methycellulose - Polycarbophil
HPV

34. What is the goal of CHF treatment? What drugs should be used?
Variability in the time for follicle development during the proliferative phase
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff problem
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

35. What are the features of nephrotic syndrome?
Paroxysmal atrial fibrillation or supraventricular tachycardia
>3.5g of protein per 24hrs
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

36. What does the classic ring worm lesion have?
Fever with frontal or maxillary tenderness
100mg; means patient can be trace protein positive and not be detected
Loop diuretics (Check serum K+ levels before drug admin)
A central clear area

37. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
MSK - pulmonary - GI - or psychological
Rotator Cuff tendonitis
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.
Giardia

38. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Cervical radiculopathy
Pleurisy
True
Higher filling presure - pulmonary congestion - and decreasd cardiac return

39. What are the most common causes for the common cold?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Infectious esophagitis
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

40. Pain in shoulder when throwing - swimming - or serving a tennis ball
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Rotator cuff tendonitis
Varicella virus
Scabies

41. Treatment for supraventricular tachycardias
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
BB or CCB - catheter ablation of identified bypass tract
Bulk forming: Psyllium - Methycellulose - Polycarbophil
CBC

42. What is the Epley maneuver?
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
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
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.
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

43. 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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Cholelithiasis
Repeat Pap after infection treated

44. How do you define persistent protein uria?
A central clear area
Molluscum contagiosum- pox virus
Generalized Anxiety disorder and panic disorder
Presence of proteinuria on at least two separate ocassion

45. Uterine bleeding between regular cycles
Molluscum contagiosum- pox virus
Intermenstrual bleeding
Nonulcer dyspepsia
Rotator Cuff problem

46. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PE - MI - aortic dissection - pneumothorax

47. Carcinoma in situ is generally referred to a gynecologist and requires ______
Slow progression of cervical cancer changes -Availability of effective early treatment
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
BB or CCB - catheter ablation of identified bypass tract
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

48. How is constipation clinically defined?
Less than 3 stools per week
Anticoag with warfarin to prevent thromboembolism
Tension headache
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

49. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Folliculitis
Viral infection of the semicircular apparatus
24 hour halter
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

50. 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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

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