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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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. Define proteinuria
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
>150mg per 24hrs
Coag disorders

2. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
These patients are associated with low renin states=less likely to respond to medication
Chest pain during pneumonia or PE

3. Describe the presentation of myocardial pain?
Subarachnoid hemorrhage
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Nonulcer dyspepsia
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

4. Diagnosis of HTN
Cluster headache
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
GERD
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

5. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Streptococci
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
A 24hr urine protein collection and urine creatinine clearance determination
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

6. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Rotator Cuff problem
Anticoag with warfarin to prevent thromboembolism
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

7. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
HIV and syphilis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Common problem that resolves spontaneously and is most often seen in children and young adults

8. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Viral gastroenteritis
Supraspinatus and bicipital tendons
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

9. Name 4 factors that predispose an individual to develop pneumonia.
Cholelithiasis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Menorrhagia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

10. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
S. aureus- beta hemolytic streptococcus

11. How is constipation clinically defined?
These patients are associated with low renin states=less likely to respond to medication
Less than 3 stools per week
Fever with frontal or maxillary tenderness
Other brainstem or cranial nerve findings

12. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Colposcopy - Endocervical curettage - and directed cervical biopsy

13. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Scabies
Loop diuretics (Check serum K+ levels before drug admin)
Other brainstem or cranial nerve findings

14. Cycle length variabilty is primarily due to what?
Analgesic headache
CT
Variability in the time for follicle development during the proliferative phase
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

15. Describe the presentation tracheobronchitis
With a KOH wet mount preparation
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
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
Upper sternal area burning pain - associated with a productive cough

16. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
35 (exception for postmenopausal women who have recently been started on HRT)
Infectious esophagitis
Common problem that resolves spontaneously and is most often seen in children and young adults

17. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Slow progression of cervical cancer changes -Availability of effective early treatment
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.
Intermenstrual bleeding

18. Describes what occurs during squamous metaplasia of the cervix.
S. Aureus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Acute headache - ataxia - profuse nausea - and vomiting

19. What is a markers of CNS vertigo?
Common problem that resolves spontaneously and is most often seen in children and young adults
Impetigo
Other brainstem or cranial nerve findings
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

20. Name the skin lesion: erythema - warmth - edema - pain - fever
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Folliculitis
Cellulitis

21. Pneumothorax - sudden sharp chest pain - preceded by viral illness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pleurisy
LH surge triggers ovulation
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

22. Carcinoma in situ is generally referred to a gynecologist and requires ______
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Rotator cuff tendonitis
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

23. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Staphylococcal scalded skin syndrome
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

24. Pneumonia tx: suitable for healthy adults older than 60
Influenza - Rhinovirus - Adenovirus - Parainfluenza
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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

25. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Pleurisy
Pain
Slow progression of cervical cancer changes -Availability of effective early treatment

26. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
24 hour halter
Influenza - Rhinovirus - Adenovirus - Parainfluenza
DM - HTN - DVT - seizures - depression - or anxiety
Impetigo

27. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

28. Predictors of cardiac etiology
Infectious esophagitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

29. What are the physical exam signs of CHF?
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
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Subarachnoid hemorrhage

30. What are the most common causes for the common cold?
Intermenstrual bleeding
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
PVC or Premature atrial contraction (PAC)

31. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cholelithiasis

32. 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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Scabies
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
S. aureus- beta hemolytic streptococcus

33. What are the three types of lice?
Folliculitis
Loop diuretics (Check serum K+ levels before drug admin)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

34. What does the classic ring worm lesion have?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
A central clear area
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
A 24hr urine protein collection and urine creatinine clearance determination

35. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
ACEi - ARBS - thiazide diuretics
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
These patients are associated with low renin states=less likely to respond to medication

36. What are signs of pulmonary congestion?
Non-cardiac causes of palpitations
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

37. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Anticoag with warfarin to prevent thromboembolism
Upper sternal area burning pain - associated with a productive cough

38. When should invasive eletrophysiologic study should be considered?
Diuretics -BB -CCB -ACEi
Pain
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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.

39. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Coag disorders
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Non-cardiac causes of palpitations
Echocardiogram

40. What are the signs of cerebral hemorrhage?
Less abrupt onset and cessation of palpitations
Acute headache - ataxia - profuse nausea - and vomiting
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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.

41. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

42. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

43. How are fungal infections diagnosed?
Less than 80 ml of blood
CT
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
With a KOH wet mount preparation

44. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
>3.5g of protein per 24hrs
Rotator Cuff problem
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Peptic ulcer disease or gastritis

45. Metrorrhagia
Slow progression of cervical cancer changes -Availability of effective early treatment
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Subarachnoid hemorrhage
Irregular bleeding between cycles

46. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
MSK - pulmonary - GI - or psychological

47. What does treatment for migrans include?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

48. Describe the presentation of angina?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
S. aureus- beta hemolytic streptococcus
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
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

49. Four muscles of rotator cuff
Coronary artery disease/ angina
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Menorrhagia
Folliculitis

50. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
PVC or Premature atrial contraction (PAC)
Rotator cuff tendonitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

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