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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. Treatment for supraventricular tachycardias
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
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.
EGD
BB or CCB - catheter ablation of identified bypass tract

2. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
Staphylococcal scalded skin syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

3. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Coronary artery disease/ angina
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
ACEi

4. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Polymenorrhea
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Staphylococcal scalded skin syndrome

5. What are the features of nephrotic syndrome?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
With a KOH wet mount preparation
Squamocolumnar junction=most common site of cervical cancer
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

6. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Analgesic headache
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

7. Pneumonia tx: suitable for healthy adults less than 60
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Cervical radiculopathy

8. Chronic pain and shoulder stiffness with limited motion
Coronary artery disease/ angina
Adhesive capsulitis (frozen shoulder): most common in middle age women
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
With a KOH wet mount preparation

9. How can GERD (or esophageal motility disorders) lead to chest pain?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Irregular bleeding between cycles
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator cuff tendonitis

10. Describe the presentation of myocardial pain?
Less abrupt onset and cessation of palpitations
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pancreatitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

11. History and PE for Pneumonia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
DM - HTN - DVT - seizures - depression - or anxiety
Wolff-Parkinson-White syndrome
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

12. What is the goal of CHF treatment? What drugs should be used?
Increase; 200 g/day
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

13. How does systolic vs. diastolic heart failure present on the echocardiogram?
Irregular bleeding between cycles
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Impetigo

14. Name the diagnosis of heartburn: regurgitation - dysphagia
Dehydration - anemia - cardiac causes
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Slow progression of cervical cancer changes -Availability of effective early treatment
GERD

15. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Pancreatitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Cholelithiasis

16. What is the caUse of benign positional vertigo?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Colposcopy - Endocervical curettage - and directed cervical biopsy
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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.

17. What is the Epley maneuver?
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.
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Pleurisy

18. What are the symptoms of palpitations?
Folliculitis
Lightheadedness - dizziness - syncope
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

19. What is afterload?
Albumin; low molecular weight proteins
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
A 24hr urine protein collection and urine creatinine clearance determination
Less than 3 stools per week

20. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Cluster headache
CBC
Squamocolumnar junction=most common site of cervical cancer

21. What the consequences of decreased cardiac output?
High blood pressure - focal neurologic defecit - or papilledema
Repeat Pap after infection treated
CBC
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

22. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Infectious esophagitis
Increase; 200 g/day
Temporal arteritis-biopsy of the temporal artery

23. What occurs after ovulation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

24. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
GERD
Furucnle
CBC

25. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Loop diuretics (Check serum K+ levels before drug admin)
Viral gastroenteritis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

26. Menometrorrhagia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Excessive bleeding in amount - duration - or both at irregular intervals
Cholelithiasis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

27. What is the role of LH in the menstrual cycle
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
LH surge triggers ovulation
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

28. 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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pancreatitis
Molluscum contagiosum- pox virus

29. patients with herpes zoster may experience what symptom before the rash appear?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Pain
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

30. History for Sinusitis

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31. How to NSAIDs contribute to gastritis and ulcer formation?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Paroxysmal atrial fibrillation or supraventricular tachycardia
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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

32. What are the most common causes for the common cold?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Viral gastroenteritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

33. 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
Warts
BB or CCB - catheter ablation of identified bypass tract
Rotator Cuff tendonitis
Upper sternal area burning pain - associated with a productive cough

34. What is the Barany maneuver?
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
Hgb - Electrolytes - and TSH
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Irregular bleeding between cycles

35. 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
Regular bleeding at intervals of more than 35 days
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Varicella virus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

36. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Warts
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Increasing fluid (8 - 8oz glasses of water/day) -fiber

37. Why is the pap smear one of the most effective cancer screening tools?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Acute headache - ataxia - profuse nausea - and vomiting
Dehydration - anemia - cardiac causes
Slow progression of cervical cancer changes -Availability of effective early treatment

38. What does the classic ring worm lesion have?
Rotator cuff tendonitis
Warts
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
A central clear area

39. Cycle length variabilty is primarily due to what?
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
Peptic ulcer disease or gastritis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Variability in the time for follicle development during the proliferative phase

40. At was quantity does urine dipstick test detect elevated protein?
Hypertension - CAD - valvular heart disease
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
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
100mg; means patient can be trace protein positive and not be detected

41. What are the primary glomerular diseases?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
EGD
Hypertension - CAD - valvular heart disease

42. Things that need to be included in history of shoulder pain
Nonulcer dyspepsia
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

43. 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.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Tension headache
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

44. Carcinoma in situ is generally referred to a gynecologist and requires ______
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

45. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Candida albicans
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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

46. What places women at higher risk of getting cervical cancer?
Varicella virus
CT
Pain
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

47. Constipation: What are indications for lab testing?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Giardia
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
Non-cardiac causes of palpitations

48. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
PVC or Premature atrial contraction (PAC)
Viral infection of the semicircular apparatus
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

49. What should preconception counseling include?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Upper sternal area burning pain - associated with a productive cough
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

50. Name the skin lesion: pustule in association with a hair follice
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Folliculitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis