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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 diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Temporal arteritis-biopsy of the temporal artery
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
Slow progression of cervical cancer changes -Availability of effective early treatment

2. 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.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Polymenorrhea
Cervical radiculopathy

3. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Hgb - Electrolytes - and TSH
Paroxysmal atrial fibrillation or supraventricular tachycardia
ACEi
Temporal arteritis-biopsy of the temporal artery

4. Regular bleeding at intervals of less than 21 days
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
Polymenorrhea
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
E. Coli O157:H7

5. Describe the history and PE of patient presenting with common cold
Supraspinatus and bicipital tendons
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
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

6. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Hypertension - CAD - valvular heart disease
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
PE - MI - aortic dissection - pneumothorax
HPV testing -Pos=colposcopy -Neg=repeat pap smear

7. Name the diagnosis of heartburn: regurgitation - dysphagia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Nonulcer dyspepsia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
GERD

8. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Supraspinatus and bicipital tendons
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
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
Candida albicans

9. What is the standard tool used for diagnosis of GERD?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
EGD
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Supraspinatus and bicipital tendons

10. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Chest pain during pneumonia or PE

11. How do you define persistent protein uria?
Coag disorders
Pleurisy
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Presence of proteinuria on at least two separate ocassion

12. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Subarachnoid hemorrhage
Scleroderma/polymyositis with secondary gastroesophageal reflux
Presence of proteinuria on at least two separate ocassion
HPV testing -Pos=colposcopy -Neg=repeat pap smear

13. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Scabies
Increase; 200 g/day
Less than 80 ml of blood

14. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Variability in the time for follicle development during the proliferative phase
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

15. What are the common causes for laryngitis?
Cluster headache
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Wolff-Parkinson-White syndrome
Influenza - Rhinovirus - Adenovirus - Parainfluenza

16. Irregular cycles with excessive flow - duration - or both
Folliculitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Menorrhagia

17. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
EGD
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

18. Name the skin lesion: pustule in association with a hair follice
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.
Folliculitis
Medication or chemical esophagitis
Tension headache

19. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Less than 80 ml of blood
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Rotator Cuff problem
100mg; means patient can be trace protein positive and not be detected

20. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Serotypes 16 - 18 - 31 -52 -58
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cluster headache

21. 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
Bence-Jones
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

22. patients with herpes zoster may experience what symptom before the rash appear?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

23. What test done in PE measures instability of shoulder?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Kids: Rotavirus Adults: Norwalk Virus

24. Describe the presentation of angina?
Furucnle
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
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

25. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Rotator Cuff problem
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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)

26. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Coag disorders
Cholelithiasis

27. 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
CT
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
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.

28. History for Sinusitis

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29. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Temporal arteritis-biopsy of the temporal artery

30. What are the three major risk factors for heart failure?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Diuretics -BB -CCB -ACEi
Hypertension - CAD - valvular heart disease

31. Difference between Pneumonia and Bronchitis
LH surge triggers ovulation
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
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

32. Lab testing for heart palpitation
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
Hgb - Electrolytes - and TSH
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Increasing fluid (8 - 8oz glasses of water/day) -fiber

33. What are the two common clinical presentations of acute diarrhea?
Nonulcer dyspepsia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

34. What are the symptoms of palpitations?
Kids: Rotavirus Adults: Norwalk Virus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Lightheadedness - dizziness - syncope
Repeat Pap after infection treated

35. What is the Barany maneuver?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Temporal arteritis-biopsy of the temporal artery
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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

36. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Cluster headache
Serotypes 16 - 18 - 31 -52 -58
Warts
>150mg per 24hrs

37. Describe the presentation of pericardial pain
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
>3.5g of protein per 24hrs
Common problem that resolves spontaneously and is most often seen in children and young adults
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

38. When should a patient get a stress test?
Wolff-Parkinson-White syndrome
35 (exception for postmenopausal women who have recently been started on HRT)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Generalized Anxiety disorder and panic disorder

39. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
100mg; means patient can be trace protein positive and not be detected
CBC
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

40. What are the signs of acute sinusitis?
Pleurisy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Fever with frontal or maxillary tenderness

41. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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
Less than 3 stools per week
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

42. What are the signs of malignant hypertension?
Subarachnoid hemorrhage
High blood pressure - focal neurologic defecit - or papilledema
Medication or chemical esophagitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

43. What is the preload?
>150mg per 24hrs
Kids: Rotavirus Adults: Norwalk Virus
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Hypertension - CAD - valvular heart disease

44. Who should have Xray testing for shoulder pain?
Albumin; low molecular weight proteins
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

45. Constipation: What are indications for lab testing?
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
Subarachnoid hemorrhage
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Coag disorders

46. How do you know if heart palpitations are due to stimulant or medication use?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
ACEi
Less abrupt onset and cessation of palpitations

47. What are the most common causes for the common cold?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

48. When should invasive eletrophysiologic study should be considered?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Upper sternal area burning pain - associated with a productive cough
Albumin; low molecular weight proteins

49. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Less than 80 ml of blood
Common problem that resolves spontaneously and is most often seen in children and young adults
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

50. What is the peripheral caUse of vertigo?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Tension headache
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve