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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 are the two common clinical presentations of acute diarrhea?
Other brainstem or cranial nerve findings
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Anticoag with warfarin to prevent thromboembolism

2. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
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
PE - MI - aortic dissection - pneumothorax
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

3. What are the features of nephrotic syndrome?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Cervical radiculopathy

4. What are the most common causes for the common cold?
Common problem that resolves spontaneously and is most often seen in children and young adults
Furucnle
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

5. Name the diagnosis of heartburn: severe constant mid abdominal pain
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Pancreatitis

6. What treatments are the cornerstone for treating cases of functional constipation?
Wolff-Parkinson-White syndrome
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

7. When should a patient get a stress test?
35 (exception for postmenopausal women who have recently been started on HRT)
>150mg per 24hrs
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Nonulcer dyspepsia

8. Define the patient population typically affected by orthostatic or postural proteinuria
Viral infection of the semicircular apparatus
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
Presence of proteinuria on at least two separate ocassion
High blood pressure - focal neurologic defecit - or papilledema

9. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Chest pain during pneumonia or PE
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Furucnle

10. How can GERD (or esophageal motility disorders) lead to chest pain?
Impetigo
Regular bleeding at intervals of more than 35 days
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Less abrupt onset and cessation of palpitations

11. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Furucnle
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi - ARBS - thiazide diuretics
HPV

12. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
EGD
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
Chest pain during pneumonia or PE

13. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Slow progression of cervical cancer changes -Availability of effective early treatment
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

14. Diagnostic Evaluation of Abnoraml vaginal bleeding
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Irregular bleeding between cycles
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

15. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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
Generalized Anxiety disorder and panic disorder
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

16. What are the secondly causes of glomerular disease?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
35 (exception for postmenopausal women who have recently been started on HRT)
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

17. 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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

18. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
>3.5g of protein per 24hrs
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
Scabies

19. name the 4 emergent causes of chest pain
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
PE - MI - aortic dissection - pneumothorax
Peptic ulcer disease or gastritis
Irregular bleeding between cycles

20. Diarrhea from custard filled pastries
Streptococci
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Wolff-Parkinson-White syndrome
S. Aureus

21. What is the next best step if a patient has two or more positive dipstick tests?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
A 24hr urine protein collection and urine creatinine clearance determination
Repeat Pap after infection treated
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

22. Define proteinuria
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Irregular bleeding between cycles
>150mg per 24hrs
Less than 80 ml of blood

23. What are the common causes for laryngitis?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Less abrupt onset and cessation of palpitations

24. What test done in PE measures instability of shoulder?
DM - HTN - DVT - seizures - depression - or anxiety
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
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.
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

25. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

26. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Impetigo
Loop diuretics (Check serum K+ levels before drug admin)

27. What is the peripheral caUse of vertigo?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Bence-Jones
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

28. History for Sinusitis

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29. Vaccines that should be updated before planned pregnancy
Slow progression of cervical cancer changes -Availability of effective early treatment
BB or CCB - catheter ablation of identified bypass tract
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

30. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pleurisy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bence-Jones

31. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Folliculitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

32. How are fungal infections diagnosed?
High blood pressure - focal neurologic defecit - or papilledema
With a KOH wet mount preparation
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)

33. What is the caUse of benign positional vertigo?
PE - MI - aortic dissection - pneumothorax
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.
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

34. When should invasive eletrophysiologic study should be considered?
Streptococci
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
CT

35. patients with herpes zoster may experience what symptom before the rash appear?
HIV and syphilis
Pain
Cellulitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

36. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Excessive bleeding in amount - duration - or both at irregular intervals
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Pain

37. What is the standard tool used for diagnosis of GERD?
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
Rotator Cuff tendonitis
EGD
PVC or Premature atrial contraction (PAC)

38. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Increase; 200 g/day
Echocardiogram
24 hour halter
Fever with frontal or maxillary tenderness

39. 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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
24 hour halter
E. Coli O157:H7

40. What should preconception counseling include?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
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

41. Where does the development of abnormal cervical cells begin?
E. Coli O157:H7
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Squamocolumnar junction=most common site of cervical cancer

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
ACEi - ARBS - thiazide diuretics
Hypertension - CAD - valvular heart disease
CBC

43. What lab tests are recommended for newly diagnosed hypertensive patients?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
BB or CCB - catheter ablation of identified bypass tract
Bence-Jones
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

44. Discomfort with abducting the arm past 90 degress
Streptococci
Rotator Cuff tendonitis
Less than 80 ml of blood
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

45. Treatment for supraventricular tachycardias
Fever with frontal or maxillary tenderness
Common problem that resolves spontaneously and is most often seen in children and young adults
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.
BB or CCB - catheter ablation of identified bypass tract

46. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Wolff-Parkinson-White syndrome

47. Initial treatment for Rhinosinusitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

48. What are the 2 psych disorders most commonly associated with palpitations?
High blood pressure - focal neurologic defecit - or papilledema
Generalized Anxiety disorder and panic disorder
Hgb - Electrolytes - and TSH
Viral gastroenteritis

49. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Squamocolumnar junction=most common site of cervical cancer
Viral infection of the semicircular apparatus

50. Tx of chronic or intermittent afibs
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Repeat Pap after infection treated
Anticoag with warfarin to prevent thromboembolism