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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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1. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Colposcopy - Endocervical curettage - and directed cervical biopsy
Generalized Anxiety disorder and panic disorder
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Albumin; low molecular weight proteins

2. What medications can cause heart palpitations?
Bence-Jones
BB or CCB - catheter ablation of identified bypass tract
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Polymenorrhea

3. What are the two common clinical presentations of acute diarrhea?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
With a KOH wet mount preparation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

4. Menometrorrhagia
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
Excessive bleeding in amount - duration - or both at irregular intervals
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

5. What are the common causes for laryngitis?
Increase; 200 g/day
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
True

6. Describe the presentation of pericardial pain
S. Aureus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

7. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Acute headache - ataxia - profuse nausea - and vomiting
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Lightheadedness - dizziness - syncope

8. Vaccines that should be updated before planned pregnancy
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
S. Aureus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pleurisy

9. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Pancreatitis
HPV
With a KOH wet mount preparation

10. Who should have Xray testing for shoulder pain?
Squamocolumnar junction=most common site of cervical cancer
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Other brainstem or cranial nerve findings
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

11. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
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
E. Coli O157:H7
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

12. What is considered normal blood loss during a menstrual cycle?
Giardia
Pts with palpitations and dizziness - near syncope - or syncope
Less than 80 ml of blood
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

13. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Cholelithiasis
LH surge triggers ovulation
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

14. What are the symptoms of palpitations?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Lightheadedness - dizziness - syncope
Scleroderma/polymyositis with secondary gastroesophageal reflux

15. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Rotator cuff tendonitis
High blood pressure - focal neurologic defecit - or papilledema

17. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Tension headache
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
>150mg per 24hrs
Temporal arteritis-biopsy of the temporal artery

18. Initial treatment for Rhinosinusitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

19. Oligomenorrhea
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Regular bleeding at intervals of more than 35 days
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.

20. Tx of chronic or intermittent afibs
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Molluscum contagiosum- pox virus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Anticoag with warfarin to prevent thromboembolism

21. Name some medications that can cause proteinuria
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Less than 80 ml of blood
Cluster headache

22. What are the three major risk factors for heart failure?
>3.5g of protein per 24hrs
Non-cardiac causes of palpitations
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hypertension - CAD - valvular heart disease

23. Define proteinuria
>150mg per 24hrs
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
Lightheadedness - dizziness - syncope
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

24. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Variability in the time for follicle development during the proliferative phase
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
Cluster headache
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

25. What should be considered in younger patients with menorrhagia
Less abrupt onset and cessation of palpitations
Coag disorders
Echocardiogram
Molluscum contagiosum- pox virus

26. 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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
HIV and syphilis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

27. When should a patient get a stress test?
Pts with palpitations and dizziness - near syncope - or syncope
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Hgb - Electrolytes - and TSH
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

28. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Molluscum contagiosum- pox virus
Less abrupt onset and cessation of palpitations
Echocardiogram
Bulk forming: Psyllium - Methycellulose - Polycarbophil

29. How are fungal infections diagnosed?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
With a KOH wet mount preparation
Hgb - Electrolytes - and TSH
Menorrhagia

30. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Cellulitis
Other brainstem or cranial nerve findings
High blood pressure - focal neurologic defecit - or papilledema

31. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
Diuretics -BB -CCB -ACEi
S. Aureus
These patients are associated with low renin states=less likely to respond to medication

32. What is an acoustic neuroma?
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
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

33. Clinical Manifestations of HTN
Variability in the time for follicle development during the proliferative phase
BB or CCB - catheter ablation of identified bypass tract
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hypertension - CAD - valvular heart disease

34. What is afterload?
MSK - pulmonary - GI - or psychological
Menorrhagia
Adhesive capsulitis (frozen shoulder): most common in middle age women
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

35. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
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
MSK - pulmonary - GI - or psychological
Candida albicans
Nonulcer dyspepsia

36. What should preconception counseling include?
Irregular bleeding between cycles
Viral gastroenteritis
Regular bleeding at intervals of more than 35 days
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

37. Describe the presentation of myocardial pain?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cholelithiasis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

38. 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.
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Chest pain during pneumonia or PE
Nonulcer dyspepsia

39. What are signs of pulmonary congestion?
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.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Less than 80 ml of blood

40. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Warts
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

41. Uterine bleeding between regular cycles
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Intermenstrual bleeding
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

42. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Bence-Jones
Pts with palpitations and dizziness - near syncope - or syncope

43. What is the mechanism of action for stimulant agents in treating constipation?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Analgesic headache

44. How does systolic vs. diastolic heart failure present on the echocardiogram?
GERD
PE - MI - aortic dissection - pneumothorax
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
Possibility of Ischemic colitis

45. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
HIV and syphilis
Less than 3 stools per week
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

46. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Possibility of Ischemic colitis
Non-cardiac causes of palpitations
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

47. When should invasive eletrophysiologic study should be considered?
Staphylococcal scalded skin syndrome
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

48. 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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Menorrhagia
PE - MI - aortic dissection - pneumothorax

49. What are the 2 psych disorders most commonly associated with palpitations?
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Candida albicans
Generalized Anxiety disorder and panic disorder

50. 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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Cluster headache
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Irregular bleeding between cycles