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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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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 are the physical exam signs of CHF?
ACEi - ARBS - thiazide diuretics
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Anticoag with warfarin to prevent thromboembolism

2. Chronic pain and shoulder stiffness with limited motion
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

3. What are the indiciations for neuroimaging?
Supraspinatus and bicipital tendons
Furucnle
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
Excessive bleeding in amount - duration - or both at irregular intervals

4. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Holter monitor: 24 hours - detect an arrhythmia; patient keeps a log of symptoms Event monitor: can be carried for 30 days or more and are patient activated at the time of symptoms; event recroding ca nbe transmitted by telephone to a monitoring symp
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Paroxysmal atrial fibrillation or supraventricular tachycardia

5. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
A 24hr urine protein collection and urine creatinine clearance determination
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Streptococci
Possibility of Ischemic colitis

6. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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
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
Infectious esophagitis
ACEi

7. Describe the presentation of pericardial pain
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Medication or chemical esophagitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

8. What are the three types of lice?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Presence of proteinuria on at least two separate ocassion
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Analgesic headache

9. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Fever with frontal or maxillary tenderness
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
MSK - pulmonary - GI - or psychological
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

11. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
PVC or Premature atrial contraction (PAC)
Varicella virus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

12. Things that need to be included in history of shoulder pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Excessive bleeding in amount - duration - or both at irregular intervals
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

13. Clinical Manifestations of HTN
Tension headache
RBC casts and old to moderate HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

14. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Infectious esophagitis
Furucnle

15. History and PE for Pneumonia
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
Excessive bleeding in amount - duration - or both at irregular intervals
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

16. What drugs do you use to treat H.pylori + PUD?
Dehydration - anemia - cardiac causes
Temporal arteritis-biopsy of the temporal artery
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

17. 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
Wolff-Parkinson-White syndrome
Albumin; low molecular weight proteins
Dehydration - anemia - cardiac causes

18. 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
Slow progression of cervical cancer changes -Availability of effective early treatment
Molluscum contagiosum- pox virus
DM - HTN - DVT - seizures - depression - or anxiety

19. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
PVC or Premature atrial contraction (PAC)
Coronary artery disease/ angina
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
100mg; means patient can be trace protein positive and not be detected

20. Describe the presentation of angina?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

21. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Supraspinatus and bicipital tendons
Anticoag with warfarin to prevent thromboembolism

22. Carcinoma in situ is generally referred to a gynecologist and requires ______
Less than 3 stools per week
Upper sternal area burning pain - associated with a productive cough
CBC
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

23. 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
Subarachnoid hemorrhage
Variability in the time for follicle development during the proliferative phase
Viral gastroenteritis

24. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pain
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

25. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
>150mg per 24hrs
S. Aureus
Rotator Cuff problem

26. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Colposcopy - Endocervical curettage - and directed cervical biopsy
>3.5g of protein per 24hrs
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

27. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

28. At was quantity does urine dipstick test detect elevated protein?
Scabies
Presence of proteinuria on at least two separate ocassion
100mg; means patient can be trace protein positive and not be detected
HIV and syphilis

29. Describe the presentation of myocardial 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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

30. What are symptoms are CHF?
Cervical radiculopathy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Serotypes 16 - 18 - 31 -52 -58
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

31. After treatment of dysplasia - women need Pap smears every...
Subarachnoid hemorrhage
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Peptic ulcer disease or gastritis

32. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Temporal arteritis-biopsy of the temporal artery
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

33. History for Sinusitis

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34. Predictors of cardiac etiology
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Variability in the time for follicle development during the proliferative phase
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Peptic ulcer disease or gastritis

35. What is the peripheral caUse of vertigo?
Acute headache - ataxia - profuse nausea - and vomiting
Pancreatitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

36. 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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
True

37. Pneumonia tx: suitable for healthy adults less than 60
Non-cardiac causes of palpitations
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
CBC
Variability in the time for follicle development during the proliferative phase

38. 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
Molluscum contagiosum- pox virus
Giardia
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
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

39. How is constipation clinically defined?
RBC casts and old to moderate HTN
PE - MI - aortic dissection - pneumothorax
HPV
Less than 3 stools per week

40. How do you know if heart palpitations are due to stimulant or medication use?
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
Medication or chemical esophagitis
Less abrupt onset and cessation of palpitations
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

41. Describe the presentation of pneumonia
Viral infection of the semicircular apparatus
Temporal arteritis-biopsy of the temporal artery
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.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

42. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
DM - HTN - DVT - seizures - depression - or anxiety
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

43. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Polymenorrhea
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

44. patients with herpes zoster may experience what symptom before the rash appear?
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
HPV
Pain
Tension headache

45. What lab tests are recommended for newly diagnosed hypertensive patients?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Chest pain during pneumonia or PE
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Squamocolumnar junction=most common site of cervical cancer

46. Four muscles of rotator cuff
High blood pressure - focal neurologic defecit - or papilledema
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
These patients are associated with low renin states=less likely to respond to medication
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

47. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Albumin; low molecular weight proteins
Cluster headache

48. Name 4 factors that predispose an individual to develop pneumonia.
Serotypes 16 - 18 - 31 -52 -58
Pts with palpitations and dizziness - near syncope - or syncope
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

49. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Presence of proteinuria on at least two separate ocassion
DM - HTN - DVT - seizures - depression - or anxiety

50. What are the consequences of diastolic dysfunction?
Increase; 200 g/day
EGD
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

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