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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. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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.
Staphylococcal scalded skin syndrome
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
CBC

2. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
EGD
Echocardiogram
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

3. 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
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
Rotator cuff tendonitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

4. When should invasive eletrophysiologic study should be considered?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Hypertension - CAD - valvular heart disease
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

5. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
These patients are associated with low renin states=less likely to respond to medication
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
Candida albicans

6. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Supraspinatus and bicipital tendons
100mg; means patient can be trace protein positive and not be detected
Molluscum contagiosum- pox virus

7. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Supraspinatus and bicipital tendons
Albumin; low molecular weight proteins
Hgb - Electrolytes - and TSH

8. Things that need to be included in history of shoulder pain
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

9. Describe the presentation of pericardial pain
These patients are associated with low renin states=less likely to respond to medication
CT
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

10. Metrorrhagia
ACEi - ARBS - thiazide diuretics
Pts with palpitations and dizziness - near syncope - or syncope
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.
Irregular bleeding between cycles

11. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Lightheadedness - dizziness - syncope
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Pts with palpitations and dizziness - near syncope - or syncope

12. What are the features of nephrotic syndrome?
Regular bleeding at intervals of more than 35 days
Kids: Rotavirus Adults: Norwalk Virus
Coronary artery disease/ angina
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

13. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Chest pain during pneumonia or PE
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
E. Coli O157:H7

14. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
100mg; means patient can be trace protein positive and not be detected
>3.5g of protein per 24hrs
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

15. Name 4 factors that predispose an individual to develop pneumonia.
Medication or chemical esophagitis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

16. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

17. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Coronary artery disease/ angina
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

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Viral infection of the semicircular apparatus
Pts with palpitations and dizziness - near syncope - or syncope
ACEi - ARBS - thiazide diuretics
Colposcopy - Endocervical curettage - and directed cervical biopsy

19. What are the signs of malignant hypertension?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Paroxysmal atrial fibrillation or supraventricular tachycardia
When the patient has symptoms in association with exercise or who describe chest pain or pressure
High blood pressure - focal neurologic defecit - or papilledema

20. Describe the presentation of myocardial pain?
Folliculitis
Colposcopy - Endocervical curettage - and directed cervical biopsy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Albumin; low molecular weight proteins

21. Describe the history and PE of patient presenting with common cold
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.
Dehydration - anemia - cardiac causes
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

22. What should be considered in younger patients with menorrhagia
Coag disorders
Cluster headache
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

23. Uterine bleeding between regular cycles
Intermenstrual bleeding
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
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

24. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pancreatitis

25. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Supraspinatus and bicipital tendons
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Folliculitis

26. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

27. Who should have Xray testing for shoulder pain?
Infectious esophagitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
PE - MI - aortic dissection - pneumothorax
Rotator cuff tendonitis

28. 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
With a KOH wet mount preparation
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Kids: Rotavirus Adults: Norwalk Virus

29. History for Acute bronchitis
Upper sternal area burning pain - associated with a productive cough
Rotator Cuff problem
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

30. Irregular cycles with excessive flow - duration - or both
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Molluscum contagiosum- pox virus
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
Menorrhagia

31. What is the standard tool used for diagnosis of GERD?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
EGD
Impetigo
Rotator cuff tendonitis

32. What are the signs of cerebral hemorrhage?
Hgb - Electrolytes - and TSH
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
MSK - pulmonary - GI - or psychological
Acute headache - ataxia - profuse nausea - and vomiting

33. 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
HPV
Scabies
Pain
Folliculitis

34. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

35. How to NSAIDs contribute to gastritis and ulcer formation?
Viral infection of the semicircular apparatus
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
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.
Analgesic headache

36. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
MSK - pulmonary - GI - or psychological
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

37. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Scleroderma/polymyositis with secondary gastroesophageal reflux
Viral gastroenteritis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

38. Lab testing for heart palpitation
Fever with frontal or maxillary tenderness
Hypertension - CAD - valvular heart disease
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Hgb - Electrolytes - and TSH

39. Pneumonia tx: suitable for healthy adults older than 60
Less abrupt onset and cessation of palpitations
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
>3.5g of protein per 24hrs
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

40. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
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

41. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Peptic ulcer disease or gastritis
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

42. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pancreatitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

43. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
EGD
These patients are associated with low renin states=less likely to respond to medication
Scleroderma/polymyositis with secondary gastroesophageal reflux

44. 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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Irregular bleeding between cycles
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

45. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Cluster headache
Possibility of Ischemic colitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

46. What is a markers of CNS vertigo?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Other brainstem or cranial nerve findings
MSK - pulmonary - GI - or psychological

47. Tx of chronic or intermittent afibs
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
CBC
Anticoag with warfarin to prevent thromboembolism
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

48. What is considered normal blood loss during a menstrual cycle?
LH surge triggers ovulation
Less than 80 ml of blood
Excessive bleeding in amount - duration - or both at irregular intervals
Coag disorders

49. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Increase; 200 g/day
100mg; means patient can be trace protein positive and not be detected
True

50. What are the 2 psych disorders most commonly associated with palpitations?
Hgb - Electrolytes - and TSH
Medication or chemical esophagitis
Generalized Anxiety disorder and panic disorder
Diuretics -BB -CCB -ACEi