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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. Mainstay treatment for soft tissue inflammation (Shoulder)
Regular bleeding at intervals of more than 35 days
Rotator cuff tendonitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Increasing fluid (8 - 8oz glasses of water/day) -fiber

2. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

3. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Molluscum contagiosum- pox virus
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Serotypes 16 - 18 - 31 -52 -58
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

4. 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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Slow progression of cervical cancer changes -Availability of effective early treatment
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

5. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
S. Aureus
MSK - pulmonary - GI - or psychological
Albumin; low molecular weight proteins

6. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Infectious esophagitis

7. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Wolff-Parkinson-White syndrome
Anticoag with warfarin to prevent thromboembolism
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Loop diuretics (Check serum K+ levels before drug admin)

8. Oligomenorrhea
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Regular bleeding at intervals of more than 35 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

9. What is the role of LH in the menstrual cycle
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
LH surge triggers ovulation
Rotator Cuff tendonitis
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.

10. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Pleurisy

11. Describes what occurs during squamous metaplasia of the cervix.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

12. Describe the presentation tracheobronchitis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Upper sternal area burning pain - associated with a productive cough

13. What test done in PE measures instability of shoulder?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Viral gastroenteritis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

14. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Analgesic headache
Higher filling presure - pulmonary congestion - and decreasd cardiac return
LH surge triggers ovulation
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

15. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Infectious esophagitis
These patients are associated with low renin states=less likely to respond to medication
Viral infection of the semicircular apparatus

16. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Bence-Jones
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Nonulcer dyspepsia
Adhesive capsulitis (frozen shoulder): most common in middle age women

17. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
These patients are associated with low renin states=less likely to respond to medication
Repeat Pap after infection treated
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

18. 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
Varicella virus
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Squamocolumnar junction=most common site of cervical cancer

19. What are the three major risk factors for heart failure?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Hypertension - CAD - valvular heart disease
Regular bleeding at intervals of more than 35 days
ACEi

20. What the consequences of decreased cardiac output?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
With a KOH wet mount preparation
HPV
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

21. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Squamocolumnar junction=most common site of cervical cancer
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Anticoag with warfarin to prevent thromboembolism

22. Cycle length variabilty is primarily due to what?
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
Folliculitis
Variability in the time for follicle development during the proliferative phase
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

23. Describe the history and PE of patient presenting with common cold
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Fever with frontal or maxillary tenderness

24. 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
Dehydration - anemia - cardiac causes
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
Scabies
CT

25. Treatment for supraventricular tachycardias
BB or CCB - catheter ablation of identified bypass tract
Hgb - Electrolytes - and TSH
CBC
Scabies

26. When should a patient get a stress test?
Candida albicans
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Anticoag with warfarin to prevent thromboembolism

27. What does treatment for migrans include?
Kids: Rotavirus Adults: Norwalk Virus
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Adhesive capsulitis (frozen shoulder): most common in middle age women

28. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Presence of proteinuria on at least two separate ocassion
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Wolff-Parkinson-White syndrome

29. 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
With a KOH wet mount preparation
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
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

30. 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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

31. Describe the presentation of myocardial pain?
Excessive bleeding in amount - duration - or both at irregular intervals
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Variability in the time for follicle development during the proliferative phase
Pancreatitis

32. Regular bleeding at intervals of less than 21 days
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Polymenorrhea
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Kids: Rotavirus Adults: Norwalk Virus

33. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
PVC or Premature atrial contraction (PAC)
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

34. Four muscles of rotator cuff
Non-cardiac causes of palpitations
Hgb - Electrolytes - and TSH
ACEi - ARBS - thiazide diuretics
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

35. What is a markers of CNS vertigo?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Medication or chemical esophagitis
Other brainstem or cranial nerve findings
Squamocolumnar junction=most common site of cervical cancer

36. What are the consequences of diastolic dysfunction?
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Squamocolumnar junction=most common site of cervical cancer
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

37. What places women at higher risk of getting cervical cancer?
Lightheadedness - dizziness - syncope
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
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

38. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Temporal arteritis-biopsy of the temporal artery
Pts with palpitations and dizziness - near syncope - or syncope
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Intermenstrual bleeding

39. What does orthostatic positional changes that bring on dizziness suggest?
Varicella virus
Pts with palpitations and dizziness - near syncope - or syncope
Dehydration - anemia - cardiac causes
HIV and syphilis

40. What are the three types of lice?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
CT
Chest pain during pneumonia or PE

41. 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
Viral gastroenteritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

42. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Squamocolumnar junction=most common site of cervical cancer
EGD
ACEi
Bulk forming: Psyllium - Methycellulose - Polycarbophil

43. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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.

44. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
>3.5g of protein per 24hrs
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

45. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Staphylococcal scalded skin syndrome

46. What diagnosis does the 'worse headache of my life' suggest?
Loop diuretics (Check serum K+ levels before drug admin)
Subarachnoid hemorrhage
Diuretics -BB -CCB -ACEi
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

47. What drugs do you use to treat H.pylori + PUD?
Loop diuretics (Check serum K+ levels before drug admin)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
These patients are associated with low renin states=less likely to respond to medication
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

48. Prenatal visit schedule for low-risk pregnancies
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
Pleurisy
Less abrupt onset and cessation of palpitations
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

49. name the 4 emergent causes of chest pain
100mg; means patient can be trace protein positive and not be detected
PE - MI - aortic dissection - pneumothorax
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Scleroderma/polymyositis with secondary gastroesophageal reflux

50. Irregular cycles with excessive flow - duration - or both
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
Menorrhagia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
100mg; means patient can be trace protein positive and not be detected