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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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1. What should be considered in younger patients with menorrhagia
Subarachnoid hemorrhage
Coag disorders
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Menorrhagia

2. What is the preload?
HIV and syphilis
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
DM - HTN - DVT - seizures - depression - or anxiety
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

3. What are signs of pulmonary congestion?
Candida albicans
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
Hypertension - CAD - valvular heart disease
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

4. Shoulder pain with pain radiating to elbow
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
Cervical radiculopathy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

5. What is the goal of CHF treatment? What drugs should be used?
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
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bulk forming: Psyllium - Methycellulose - Polycarbophil

6. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Subarachnoid hemorrhage
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Intermenstrual bleeding

7. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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

8. What HPV serotypes are most commonly associated with cervical cancer?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Kids: Rotavirus Adults: Norwalk Virus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Serotypes 16 - 18 - 31 -52 -58

9. What are symptoms are CHF?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Presence of proteinuria on at least two separate ocassion
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

10. Constipation: What are indications for lab testing?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Impetigo
Irregular bleeding between cycles

11. What does treatment for migrans include?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
24 hour halter
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

12. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Temporal arteritis-biopsy of the temporal artery
MSK - pulmonary - GI - or psychological

13. Define proteinuria
BB or CCB - catheter ablation of identified bypass tract
>150mg per 24hrs
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

14. Name the skin lesion: erythema - warmth - edema - pain - fever
Candida albicans
Rotator Cuff problem
Cellulitis
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

15. How is constipation clinically defined?
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Less than 3 stools per week

16. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pleurisy
Wolff-Parkinson-White syndrome

17. Why is the pap smear one of the most effective cancer screening tools?
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.
Slow progression of cervical cancer changes -Availability of effective early treatment
Hypertension - CAD - valvular heart disease
Regular bleeding at intervals of more than 35 days

18. What is the next best step if a patient has two or more positive dipstick tests?
Subarachnoid hemorrhage
A 24hr urine protein collection and urine creatinine clearance determination
Rotator Cuff problem
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

19. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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.
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

20. 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
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
Peptic ulcer disease or gastritis
Associated with hypotension
Scabies

21. Define the patient population typically affected by orthostatic or postural proteinuria
Nonulcer dyspepsia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

22. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Varicella virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
PE - MI - aortic dissection - pneumothorax

23. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Tension headache
Variability in the time for follicle development during the proliferative phase
Diuretics -BB -CCB -ACEi
Viral infection of the semicircular apparatus

24. 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)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Analgesic headache
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

25. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pain
Candida albicans
Increase; 200 g/day

26. What are the indiciations for neuroimaging?
MSK - pulmonary - GI - or psychological
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
Hgb - Electrolytes - and TSH
Echocardiogram

27. Describe the presentation tracheobronchitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
35 (exception for postmenopausal women who have recently been started on HRT)
Upper sternal area burning pain - associated with a productive cough

28. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Supraspinatus and bicipital tendons
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

29. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Scabies
DM - HTN - DVT - seizures - depression - or anxiety
Excessive bleeding in amount - duration - or both at irregular intervals

30. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Slow progression of cervical cancer changes -Availability of effective early treatment
Warts
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

31. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
BB or CCB - catheter ablation of identified bypass tract
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
>150mg per 24hrs

32. What are the consequences of diastolic dysfunction?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Higher filling presure - pulmonary congestion - and decreasd cardiac return

33. What is the standard tool used for diagnosis of GERD?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
PVC or Premature atrial contraction (PAC)
EGD
Albumin; low molecular weight proteins

34. Name the skin lesion: honey colored crusts
Lightheadedness - dizziness - syncope
Echocardiogram
Impetigo
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

35. 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
Increase; 200 g/day
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Molluscum contagiosum- pox virus

36. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Presence of proteinuria on at least two separate ocassion
Peptic ulcer disease or gastritis
Upper sternal area burning pain - associated with a productive cough
Colposcopy - Endocervical curettage - and directed cervical biopsy

37. What type of imaging is need for chronic sinusitis?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
CT
Variability in the time for follicle development during the proliferative phase

38. How are fungal infections diagnosed?
E. Coli O157:H7
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Acute headache - ataxia - profuse nausea - and vomiting
With a KOH wet mount preparation

39. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Echocardiogram
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

40. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Staphylococcal scalded skin syndrome
Pain
Hgb - Electrolytes - and TSH

41. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. 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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

43. What the consequences of decreased cardiac output?
Chest pain during pneumonia or PE
Rotator Cuff tendonitis
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

44. Mainstay treatment for soft tissue inflammation (Shoulder)
Varicella virus
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Candida albicans
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

45. Pneumonia tx: suitable for healthy adults older than 60
Streptococci
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
Varicella virus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

46. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Subarachnoid hemorrhage
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

47. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Non-cardiac causes of palpitations
GERD
ACEi - ARBS - thiazide diuretics
Pts with palpitations and dizziness - near syncope - or syncope

48. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

49. What are the two common clinical presentations of acute diarrhea?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Hgb - Electrolytes - and TSH

50. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
ACEi - ARBS - thiazide diuretics
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
Temporal arteritis-biopsy of the temporal artery