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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. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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.
HIV and syphilis
EGD
Streptococci

2. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
ACEi
A central clear area
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

3. Tx of chronic or intermittent afibs
Presence of proteinuria on at least two separate ocassion
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Anticoag with warfarin to prevent thromboembolism
Candida albicans

4. History for Acute bronchitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

5. 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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Rotator Cuff tendonitis
Streptococci

6. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

7. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Menorrhagia
Viral infection of the semicircular apparatus
A central clear area
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

8. PE for a patient getting an abnormal vaginal bleeding work up
Intermenstrual bleeding
RBC casts and old to moderate HTN
With a KOH wet mount preparation
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

9. Name types of laxatives
S. Aureus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

10. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

11. What is the mechanism of action for stimulant agents in treating constipation?
35 (exception for postmenopausal women who have recently been started on HRT)
Peptic ulcer disease or gastritis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

12. What are the symptoms of palpitations?
Increase; 200 g/day
Lightheadedness - dizziness - syncope
Scabies
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

13. What treatments are the cornerstone for treating cases of functional constipation?
35 (exception for postmenopausal women who have recently been started on HRT)
Possibility of Ischemic colitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Increasing fluid (8 - 8oz glasses of water/day) -fiber

14. Define nephrotic range proteinuria
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
>3.5g of protein per 24hrs
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Polymenorrhea

15. Prenatal visit schedule for low-risk pregnancies
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
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
Menorrhagia
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

16. 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.
Repeat Pap after infection treated
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Loop diuretics (Check serum K+ levels before drug admin)
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

17. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
A central clear area
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
True
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

18. Describe the presentation tracheobronchitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Upper sternal area burning pain - associated with a productive cough
ACEi - ARBS - thiazide diuretics
Kids: Rotavirus Adults: Norwalk Virus

19. How is constipation clinically defined?
Loop diuretics (Check serum K+ levels before drug admin)
Less than 3 stools per week
Impetigo
LH surge triggers ovulation

20. What should preconception counseling include?
Scabies
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

21. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Staphylococcal scalded skin syndrome
Variability in the time for follicle development during the proliferative phase
Possibility of Ischemic colitis

22. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Rotator cuff tendonitis

23. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
BB or CCB - catheter ablation of identified bypass tract
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV testing -Pos=colposcopy -Neg=repeat pap smear

24. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Less abrupt onset and cessation of palpitations
Loop diuretics (Check serum K+ levels before drug admin)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

25. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
A central clear area
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

26. What HPV serotypes are most commonly associated with cervical cancer?
Scabies
Serotypes 16 - 18 - 31 -52 -58
Pleurisy
Infectious esophagitis

27. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Other brainstem or cranial nerve findings
Viral gastroenteritis

28. Describe the presentation of angina?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Bence-Jones
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

29. Carcinoma in situ is generally referred to a gynecologist and requires ______
PVC or Premature atrial contraction (PAC)
A central clear area
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
Staphylococcal scalded skin syndrome

30. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Intermenstrual bleeding
Viral infection of the semicircular apparatus

31. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Fever with frontal or maxillary tenderness
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.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

32. What lab tests are recommended for newly diagnosed hypertensive patients?
Warts
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Fever with frontal or maxillary tenderness
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

33. Pneumothorax - sudden sharp chest pain - preceded by viral illness
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
Impetigo

34. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
A central clear area
Generalized Anxiety disorder and panic disorder
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Loop diuretics (Check serum K+ levels before drug admin)

35. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Rotator cuff tendonitis
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
Less abrupt onset and cessation of palpitations

36. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
HPV
ACEi

37. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Rotator Cuff problem
Giardia
Common problem that resolves spontaneously and is most often seen in children and young adults
Coronary artery disease/ angina

38. What is the Epley maneuver?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Furucnle
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.
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

39. Name the diagnosis of heartburn: severe constant mid abdominal pain
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pancreatitis
MSK - pulmonary - GI - or psychological
ACEi

40. How do you know if heart palpitations are due to stimulant or medication use?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
GERD
ACEi - ARBS - thiazide diuretics
Less abrupt onset and cessation of palpitations

41. What is the caUse of Meniere disease? What are the cardinal symptoms?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
A 24hr urine protein collection and urine creatinine clearance determination
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

42. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Pain
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Non-cardiac causes of palpitations

43. What are the 2 psych disorders most commonly associated with palpitations?
Subarachnoid hemorrhage
GERD
Generalized Anxiety disorder and panic disorder
Repeat Pap after infection treated

44. 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
Nonulcer dyspepsia
Coag disorders
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

45. 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
Acute headache - ataxia - profuse nausea - and vomiting
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

46. name the 4 emergent causes of chest pain
Temporal arteritis-biopsy of the temporal artery
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
Coronary artery disease/ angina

47. Constipation: What are indications for lab testing?
Viral infection of the semicircular apparatus
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
These patients are associated with low renin states=less likely to respond to medication
Rotator Cuff tendonitis

48. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Less than 80 ml of blood
Common problem that resolves spontaneously and is most often seen in children and young adults
Increasing fluid (8 - 8oz glasses of water/day) -fiber

49. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
High blood pressure - focal neurologic defecit - or papilledema
Furucnle

50. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Scabies
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC
Less abrupt onset and cessation of palpitations