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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. Vaccines that should be updated before planned pregnancy
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Intermenstrual bleeding

2. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Cellulitis
Giardia
Molluscum contagiosum- pox virus

3. Initial treatment for Rhinosinusitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Associated with hypotension
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.
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

4. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Varicella virus
A central clear area

5. History and PE for Pneumonia
HIV and syphilis
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

6. Pain in shoulder when throwing - swimming - or serving a tennis ball
A 24hr urine protein collection and urine creatinine clearance determination
ACEi
Rotator cuff tendonitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

7. What is the caUse of benign positional vertigo?
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.
Intermenstrual bleeding
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.
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

8. 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
Impetigo
Intermenstrual bleeding
GERD
Varicella virus

9. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
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
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
S. aureus- beta hemolytic streptococcus

10. Diagnosis of HTN
Fever with frontal or maxillary tenderness
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

11. What are the common causes for laryngitis?
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.
Rotator Cuff tendonitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Influenza - Rhinovirus - Adenovirus - Parainfluenza

12. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Increasing fluid (8 - 8oz glasses of water/day) -fiber
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
100mg; means patient can be trace protein positive and not be detected

13. What are the symptoms of palpitations?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Lightheadedness - dizziness - syncope
Colposcopy - Endocervical curettage - and directed cervical biopsy
24 hour halter

14. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Wolff-Parkinson-White syndrome
Pain

15. Diarrhea from custard filled pastries
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
S. Aureus
Coronary artery disease/ angina
Warts

16. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Variability in the time for follicle development during the proliferative phase
Rotator cuff tendonitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Candida albicans

17. Name the diagnosis of heartburn: severe constant mid abdominal pain
Increasing fluid (8 - 8oz glasses of water/day) -fiber
With a KOH wet mount preparation
Pancreatitis
Giardia

18. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
24 hour halter
RBC casts and old to moderate HTN
Polymenorrhea

19. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pleurisy
Temporal arteritis-biopsy of the temporal artery
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

20. What does orthostatic positional changes that bring on dizziness suggest?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Dehydration - anemia - cardiac causes
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
Excessive bleeding in amount - duration - or both at irregular intervals

21. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Variability in the time for follicle development during the proliferative phase
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cluster headache

22. History for Acute bronchitis
Wolff-Parkinson-White syndrome
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Diuretics -BB -CCB -ACEi

23. Name the skin lesion: pustule in association with a hair follice
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Folliculitis
Presence of proteinuria on at least two separate ocassion
Intermenstrual bleeding

24. Describe the presentation of myocardial pain?
Polymenorrhea
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Loop diuretics (Check serum K+ levels before drug admin)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

25. When does troponin rise following myocardial injury or infarction?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Repeat Pap after infection treated
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

26. How are fungal infections diagnosed?
With a KOH wet mount preparation
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

27. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Upper sternal area burning pain - associated with a productive cough
35 (exception for postmenopausal women who have recently been started on HRT)
Fever with frontal or maxillary tenderness

28. What is the Epley maneuver?
Associated with hypotension
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.
Adhesive capsulitis (frozen shoulder): most common in middle age women
Medication or chemical esophagitis

29. Name the skin lesion: erythema - warmth - edema - pain - fever
Generalized Anxiety disorder and panic disorder
Loop diuretics (Check serum K+ levels before drug admin)
Cellulitis
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.

30. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Furucnle
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

31. Pneumothorax - sudden sharp chest pain - preceded by viral illness
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Other brainstem or cranial nerve findings
Pleurisy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

32. SE Of Beta blockers?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Increasing fluid (8 - 8oz glasses of water/day) -fiber
S. Aureus
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

33. What are the signs of malignant hypertension?
HPV
Cellulitis
High blood pressure - focal neurologic defecit - or papilledema
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

34. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Kids: Rotavirus Adults: Norwalk Virus

35. Menometrorrhagia
Loop diuretics (Check serum K+ levels before drug admin)
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
Infectious esophagitis
Excessive bleeding in amount - duration - or both at irregular intervals

36. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral infection of the semicircular apparatus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

37. What drugs do you use to treat H.pylori + PUD?
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
Wolff-Parkinson-White syndrome
Squamocolumnar junction=most common site of cervical cancer
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

38. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Rotator cuff tendonitis
Loop diuretics (Check serum K+ levels before drug admin)
Non-cardiac causes of palpitations
Intermenstrual bleeding

39. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Non-cardiac causes of palpitations
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
LH surge triggers ovulation
Paroxysmal atrial fibrillation or supraventricular tachycardia

40. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CT
Kids: Rotavirus Adults: Norwalk Virus

41. What is the mechanism of action for stimulant agents in treating constipation?
Temporal arteritis-biopsy of the temporal artery
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

42. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
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
Nonulcer dyspepsia
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.
Fever with frontal or maxillary tenderness

43. Name the skin lesion: honey colored crusts
Acute headache - ataxia - profuse nausea - and vomiting
Albumin; low molecular weight proteins
Impetigo
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

44. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
These patients are associated with low renin states=less likely to respond to medication
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

45. Constipation: What are indications for lab testing?
Impetigo
Possibility of Ischemic colitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

46. What does treatment for migrans include?
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
Pancreatitis
Upper sternal area burning pain - associated with a productive cough
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

47. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Echocardiogram
Infectious esophagitis
Pain
Adhesive capsulitis (frozen shoulder): most common in middle age women

48. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Tension headache
Analgesic headache
DM - HTN - DVT - seizures - depression - or anxiety

49. Uterine bleeding between regular cycles
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
Echocardiogram
Rotator Cuff tendonitis
Intermenstrual bleeding

50. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Variability in the time for follicle development during the proliferative phase
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