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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. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pts with palpitations and dizziness - near syncope - or syncope
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

2. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

3. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
These patients are associated with low renin states=less likely to respond to medication
Menorrhagia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

4. Define nephrotic range proteinuria
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
Polymenorrhea
>3.5g of protein per 24hrs
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

5. What does the classic ring worm lesion have?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Acute headache - ataxia - profuse nausea - and vomiting
BB or CCB - catheter ablation of identified bypass tract
A central clear area

6. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Bence-Jones
DM - HTN - DVT - seizures - depression - or anxiety
Excessive bleeding in amount - duration - or both at irregular intervals

7. Who should have Xray testing for shoulder pain?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
High blood pressure - focal neurologic defecit - or papilledema
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

8. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Varicella virus
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

9. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Pancreatitis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

10. What does treatment for migrans include?
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
CT
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

11. Uterine bleeding between regular cycles
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Intermenstrual bleeding
Viral infection of the semicircular apparatus
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

12. What should preconception counseling include?
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
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
Scabies
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

13. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Medication or chemical esophagitis
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
Lightheadedness - dizziness - syncope
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. Constipation: What are indications for lab testing?
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
True
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

15. 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
Slow progression of cervical cancer changes -Availability of effective early treatment
Scabies
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

16. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Irregular bleeding between cycles
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Increase; 200 g/day
Squamocolumnar junction=most common site of cervical cancer

17. Pneumonia tx: suitable for healthy adults less than 60
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Pts with palpitations and dizziness - near syncope - or syncope
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

18. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Pain
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

19. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
HPV testing -Pos=colposcopy -Neg=repeat pap smear
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
HPV

20. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Rotator Cuff tendonitis
PVC or Premature atrial contraction (PAC)

21. What are the signs of acute sinusitis?
Scabies
Fever with frontal or maxillary tenderness
CT
Impetigo

22. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
LH surge triggers ovulation

23. Shoulder pain with pain radiating to elbow
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.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
RBC casts and old to moderate HTN
Cervical radiculopathy

24. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Serotypes 16 - 18 - 31 -52 -58
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

25. Initial treatment for Rhinosinusitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Echocardiogram
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
LH surge triggers ovulation

26. What is the next best step if a patient has two or more positive dipstick tests?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
A 24hr urine protein collection and urine creatinine clearance determination
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

27. Natural history of cervical cancer
Medication or chemical esophagitis
Rotator cuff tendonitis
>3.5g of protein per 24hrs
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

28. Diagnostic Evaluation of Abnoraml vaginal bleeding
Tension headache
Squamocolumnar junction=most common site of cervical cancer
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
Staphylococcal scalded skin syndrome

29. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Candida albicans
Wolff-Parkinson-White syndrome
Presence of proteinuria on at least two separate ocassion
Peptic ulcer disease or gastritis

30. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Viral gastroenteritis
24 hour halter
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator Cuff tendonitis

31. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
S. aureus- beta hemolytic streptococcus
Possibility of Ischemic colitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Lightheadedness - dizziness - syncope

32. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Peptic ulcer disease or gastritis
Echocardiogram
100mg; means patient can be trace protein positive and not be detected

33. 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
HPV
CBC
Cellulitis

34. Why is the pap smear one of the most effective cancer screening tools?
Irregular bleeding between cycles
Slow progression of cervical cancer changes -Availability of effective early treatment
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

35. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Infectious esophagitis
Echocardiogram
With a KOH wet mount preparation
S. Aureus

36. What are the consequences of diastolic dysfunction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Adhesive capsulitis (frozen shoulder): most common in middle age women
These patients are associated with low renin states=less likely to respond to medication

37. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
PVC or Premature atrial contraction (PAC)
HPV
PE - MI - aortic dissection - pneumothorax
Temporal arteritis-biopsy of the temporal artery

38. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Molluscum contagiosum- pox virus
Colposcopy - Endocervical curettage - and directed cervical biopsy
CT
Fever with frontal or maxillary tenderness

39. History for Sinusitis

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40. 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
ACEi - ARBS - thiazide diuretics
Folliculitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

41. What is an acoustic neuroma?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

42. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Hypertension - CAD - valvular heart disease
Echocardiogram
With a KOH wet mount preparation
Cluster headache

43. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
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
PE - MI - aortic dissection - pneumothorax
S. Aureus

44. Pneumonia tx: suitable for healthy adults older than 60
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Pancreatitis

45. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Temporal arteritis-biopsy of the temporal artery
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Loop diuretics (Check serum K+ levels before drug admin)
Medication or chemical esophagitis

46. What is a markers of CNS vertigo?
Adhesive capsulitis (frozen shoulder): most common in middle age women
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Other brainstem or cranial nerve findings
S. aureus- beta hemolytic streptococcus

47. What is benign transient proteinuria?
Tension headache
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
Viral gastroenteritis
Common problem that resolves spontaneously and is most often seen in children and young adults

48. When is a lumbar puncture contraindicated?
Cellulitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Regular bleeding at intervals of more than 35 days

49. Predictors of cardiac etiology
Rotator Cuff tendonitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
With a KOH wet mount preparation

50. What are the symptoms of palpitations?
Lightheadedness - dizziness - syncope
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
Peptic ulcer disease or gastritis
Anticoag with warfarin to prevent thromboembolism