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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. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Rotator cuff tendonitis
ACEi

2. PE for a patient getting an abnormal vaginal bleeding work up
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Albumin; low molecular weight proteins
Diuretics -BB -CCB -ACEi
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

3. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Medication or chemical esophagitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Paroxysmal atrial fibrillation or supraventricular tachycardia

4. What are the 2 psych disorders most commonly associated with palpitations?
Chest pain during pneumonia or PE
Generalized Anxiety disorder and panic disorder
>150mg per 24hrs
Pain

5. Initial treatment for Rhinosinusitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Analgesic headache
Impetigo
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

6. Treatment for supraventricular tachycardias
Viral gastroenteritis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
BB or CCB - catheter ablation of identified bypass tract
Analgesic headache

7. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

8. What is benign transient proteinuria?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Candida albicans

9. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cholelithiasis
Non-cardiac causes of palpitations

10. What are the three major risk factors for heart failure?
Diuretics -BB -CCB -ACEi
Hypertension - CAD - valvular heart disease
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Cholelithiasis

11. What the consequences of decreased cardiac output?
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
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
Associated with hypotension
Candida albicans

12. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Non-cardiac causes of palpitations
Medication or chemical esophagitis
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

13. What is the caUse of Meniere disease? What are the cardinal symptoms?
ACEi - ARBS - thiazide diuretics
Pleurisy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

14. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
ACEi - ARBS - thiazide diuretics
Regular bleeding at intervals of more than 35 days

15. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
A 24hr urine protein collection and urine creatinine clearance determination
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
CT

16. Carcinoma in situ is generally referred to a gynecologist and requires ______
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Varicella virus
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

17. Name the skin lesion: pustule in association with a hair follice
>150mg per 24hrs
Furucnle
Folliculitis
A central clear area

18. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Pleurisy
EGD
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

19. MI - pericardial tamponade - PE - GI bleed - are...
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Associated with hypotension

20. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
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.
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
100mg; means patient can be trace protein positive and not be detected

21. Difference between Pneumonia and Bronchitis
Chest pain during pneumonia or PE
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
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

22. How to NSAIDs contribute to gastritis and ulcer formation?
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.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Cluster headache
35 (exception for postmenopausal women who have recently been started on HRT)

23. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Rotator Cuff problem
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

24. Vaccines that should be updated before planned pregnancy
Folliculitis
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

25. Define the patient population typically affected by orthostatic or postural proteinuria
Polymenorrhea
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

26. 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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
HPV
Molluscum contagiosum- pox virus
Cluster headache

27. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
PE - MI - aortic dissection - pneumothorax
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

28. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
24 hour halter
Loop diuretics (Check serum K+ levels before drug admin)
Acute headache - ataxia - profuse nausea - and vomiting
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

29. What should preconception counseling include?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Cholelithiasis
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

30. What are the three types of lice?
HIV and syphilis
Staphylococcal scalded skin syndrome
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

31. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Tension headache
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
Loop diuretics (Check serum K+ levels before drug admin)
HPV

32. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
ACEi
Molluscum contagiosum- pox virus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

33. Uterine bleeding between regular cycles
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
BB or CCB - catheter ablation of identified bypass tract
Intermenstrual bleeding

34. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Cellulitis
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
Presence of proteinuria on at least two separate ocassion

35. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Pts with palpitations and dizziness - near syncope - or syncope

36. Name some medications that can cause proteinuria
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Loop diuretics (Check serum K+ levels before drug admin)
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

37. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Cellulitis
Temporal arteritis-biopsy of the temporal artery
Cluster headache

38. Where does the development of abnormal cervical cells begin?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Irregular bleeding between cycles
Squamocolumnar junction=most common site of cervical cancer
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

39. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Streptococci
Presence of proteinuria on at least two separate ocassion
Giardia
Diuretics -BB -CCB -ACEi

40. Four muscles of rotator cuff
Molluscum contagiosum- pox virus
Rotator cuff tendonitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

41. 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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

42. What are the consequences of diastolic dysfunction?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A 24hr urine protein collection and urine creatinine clearance determination
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

43. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Coag disorders
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

44. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age 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
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
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.

45. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Medication or chemical esophagitis
100mg; means patient can be trace protein positive and not be detected
Candida albicans
Peptic ulcer disease or gastritis

46. Clinical Manifestations of HTN
Upper sternal area burning pain - associated with a productive cough
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
True

47. When does troponin rise following myocardial injury or infarction?
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
BB or CCB - catheter ablation of identified bypass tract

48. What is the Barany maneuver?
Repeat Pap after infection treated
High blood pressure - focal neurologic defecit - or papilledema
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

49. What is the role of FSH in one's menstrual cycle
When the patient has symptoms in association with exercise or who describe chest pain or pressure
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
S. Aureus
Adhesive capsulitis (frozen shoulder): most common in middle age women

50. How is constipation clinically defined?
A central clear area
Less than 3 stools per week
Temporal arteritis-biopsy of the temporal artery
Cholelithiasis