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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. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Chest pain during pneumonia or PE
Coag disorders
100mg; means patient can be trace protein positive and not be detected

2. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
A central clear area

3. What are the two common clinical presentations of acute diarrhea?
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
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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

4. 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.
Lightheadedness - dizziness - syncope
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
Repeat Pap after infection treated

5. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Staphylococcal scalded skin syndrome
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

6. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Coag disorders
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
Upper sternal area burning pain - associated with a productive cough

7. Describe the history and PE of patient presenting with common cold
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
Polymenorrhea
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
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

8. What are the consequences of diastolic dysfunction?
Echocardiogram
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

9. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Dehydration - anemia - cardiac causes
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

10. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Staphylococcal scalded skin syndrome
Cellulitis
A central clear area

11. 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
>3.5g of protein per 24hrs
Kids: Rotavirus Adults: Norwalk Virus
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

12. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Pain
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

13. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
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
Infectious esophagitis
Viral infection of the semicircular apparatus

14. Where does the development of abnormal cervical cells begin?
Pancreatitis
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
Squamocolumnar junction=most common site of cervical cancer
A 24hr urine protein collection and urine creatinine clearance determination

15. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Paroxysmal atrial fibrillation or supraventricular tachycardia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

16. What does the classic ring worm lesion have?
A central clear area
Analgesic headache
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Generalized Anxiety disorder and panic disorder

17. When does troponin rise following myocardial injury or infarction?
Analgesic headache
Loop diuretics (Check serum K+ levels before drug admin)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
High blood pressure - focal neurologic defecit - or papilledema

18. What are signs of pulmonary congestion?
HIV and syphilis
S. Aureus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

19. Pneumothorax - sudden sharp chest pain - preceded by viral illness
A central clear area
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
Pleurisy
Warts

20. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Non-cardiac causes of palpitations
Varicella virus
CBC
Peptic ulcer disease or gastritis

21. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Molluscum contagiosum- pox virus
Viral infection of the semicircular apparatus

22. What is the mechanism of action for stimulant agents in treating constipation?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Less abrupt onset and cessation of palpitations

23. What are the signs of cerebral hemorrhage?
Tension headache
ACEi
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Acute headache - ataxia - profuse nausea - and vomiting

24. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
RBC casts and old to moderate HTN
MSK - pulmonary - GI - or psychological
DM - HTN - DVT - seizures - depression - or anxiety
Less than 80 ml of blood

25. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Squamocolumnar junction=most common site of cervical cancer
24 hour halter

26. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
EGD
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Coag disorders

27. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
BB or CCB - catheter ablation of identified bypass tract
Less abrupt onset and cessation of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals

28. 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
Giardia
Loop diuretics (Check serum K+ levels before drug admin)
RBC casts and old to moderate HTN
Varicella virus

29. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
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
Viral gastroenteritis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

30. Difference between Pneumonia and Bronchitis
MSK - pulmonary - GI - or psychological
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
RBC casts and old to moderate HTN
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

31. At was quantity does urine dipstick test detect elevated protein?
Presence of proteinuria on at least two separate ocassion
Impetigo
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
100mg; means patient can be trace protein positive and not be detected

32. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Acute headache - ataxia - profuse nausea - and vomiting
BB or CCB - catheter ablation of identified bypass tract

33. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Regular bleeding at intervals of more than 35 days
DM - HTN - DVT - seizures - depression - or anxiety
ACEi
Pain

34. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Coronary artery disease/ angina
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Analgesic headache

35. Treatment for supraventricular tachycardias
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
BB or CCB - catheter ablation of identified bypass tract
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Folliculitis

36. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
A central clear area
Echocardiogram
S. aureus- beta hemolytic streptococcus

37. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
These patients are associated with low renin states=less likely to respond to medication
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

38. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Nonulcer dyspepsia
Presence of proteinuria on at least two separate ocassion
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

39. History for Sinusitis

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40. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Less than 80 ml of blood
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Acute headache - ataxia - profuse nausea - and vomiting

41. Define the patient population typically affected by orthostatic or postural proteinuria
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
S. Aureus
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

42. When is a lumbar puncture contraindicated?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Slow progression of cervical cancer changes -Availability of effective early treatment
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

43. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Pleurisy
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Coronary artery disease/ angina
Medication or chemical esophagitis

44. Why is the pap smear one of the most effective cancer screening tools?
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
Bence-Jones
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Slow progression of cervical cancer changes -Availability of effective early treatment

45. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Coronary artery disease/ angina
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

46. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Folliculitis
Warts

47. Prenatal visit schedule for low-risk pregnancies
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.
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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

48. Describe the presentation of pneumonia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

49. Oligomenorrhea
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
Regular bleeding at intervals of more than 35 days
Upper sternal area burning pain - associated with a productive cough
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

50. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Streptococci
E. Coli O157:H7
Variability in the time for follicle development during the proliferative phase