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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. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Generalized Anxiety disorder and panic disorder

2. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Irregular bleeding between cycles

3. Constipation: What are indications for lab testing?
Echocardiogram
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
Impetigo
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

4. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Presence of proteinuria on at least two separate ocassion
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. What are the three types of lice?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

6. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
S. Aureus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

7. What are the 2 psych disorders most commonly associated with palpitations?
Diuretics -BB -CCB -ACEi
Generalized Anxiety disorder and panic disorder
Less abrupt onset and cessation of palpitations
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

8. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Folliculitis
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
A 24hr urine protein collection and urine creatinine clearance determination
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

9. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Coag disorders
CBC
True
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

10. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
EGD
Nonulcer dyspepsia
Paroxysmal atrial fibrillation or supraventricular tachycardia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

11. What lab tests are recommended for newly diagnosed hypertensive patients?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Rotator Cuff problem
Tension headache
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

12. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

13. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Less than 3 stools per week
When the patient has symptoms in association with exercise or who describe chest pain or pressure
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

14. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Scleroderma/polymyositis with secondary gastroesophageal reflux

15. What should preconception counseling include?
Chest pain during pneumonia or PE
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
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.
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

16. Pain in shoulder when throwing - swimming - or serving a tennis ball
Intermenstrual bleeding
Adhesive capsulitis (frozen shoulder): most common in middle age women
Analgesic headache
Rotator cuff tendonitis

17. What type of imaging is need for chronic sinusitis?
CT
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Varicella virus
CBC

18. Define nephrotic range proteinuria
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
>3.5g of protein per 24hrs
Giardia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

19. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
When the patient has symptoms in association with exercise or who describe chest pain or pressure
RBC casts and old to moderate HTN
Cluster headache

20. Metrorrhagia
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.
Varicella virus
Rotator Cuff tendonitis
Irregular bleeding between cycles

21. Uterine bleeding between regular cycles
Giardia
Intermenstrual bleeding
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Variability in the time for follicle development during the proliferative phase

22. What is an acoustic neuroma?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Possibility of Ischemic colitis
Infectious esophagitis
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

23. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
MSK - pulmonary - GI - or psychological
Scabies
Possibility of Ischemic colitis

24. What is benign transient proteinuria?
Lightheadedness - dizziness - syncope
Echocardiogram
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Common problem that resolves spontaneously and is most often seen in children and young adults

25. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Temporal arteritis-biopsy of the temporal artery
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
S. Aureus
Colposcopy - Endocervical curettage - and directed cervical biopsy

26. Name types of laxatives
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
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

27. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Rotator Cuff problem
Less abrupt onset and cessation of palpitations
Generalized Anxiety disorder and panic disorder

28. HIgh risk pregnant patients should be evaluated for ____ and ____
Menorrhagia
S. Aureus
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
HIV and syphilis

29. What occurs after ovulation
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
Diuretics -BB -CCB -ACEi
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

30. What is the difference between a Holter monitor or an event monitor?
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
Diuretics -BB -CCB -ACEi
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
>150mg per 24hrs

31. At was quantity does urine dipstick test detect elevated protein?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Molluscum contagiosum- pox virus
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
100mg; means patient can be trace protein positive and not be detected

32. What medications can cause heart palpitations?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Echocardiogram
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

33. Four muscles of rotator cuff
Candida albicans
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Intermenstrual bleeding
MSK - pulmonary - GI - or psychological

34. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

35. How does systolic vs. diastolic heart failure present on the echocardiogram?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Peptic ulcer disease or gastritis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

36. How does CHF present on X-ray?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increase; 200 g/day
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.

37. 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
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
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
Pleurisy

38. What is the caUse of Meniere disease? What are the cardinal symptoms?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Associated with hypotension
True

39. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

40. Pneumonia tx: suitable for healthy adults less than 60
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Presence of proteinuria on at least two separate ocassion
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

41. What is the standard tool used for diagnosis of GERD?
BB or CCB - catheter ablation of identified bypass tract
RBC casts and old to moderate HTN
EGD
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

42. Describe the presentation of myocardial pain?
E. Coli O157:H7
BB or CCB - catheter ablation of identified bypass tract
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Higher filling presure - pulmonary congestion - and decreasd cardiac return

43. How to NSAIDs contribute to gastritis and ulcer formation?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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.
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

44. What are the three major risk factors for heart failure?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Hypertension - CAD - valvular heart disease
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 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

45. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
>3.5g of protein per 24hrs
Cholelithiasis
Less abrupt onset and cessation of palpitations
Hypertension - CAD - valvular heart disease

46. What are the physical exam signs of CHF?
Squamocolumnar junction=most common site of cervical cancer
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
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

47. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Bence-Jones
Rotator Cuff tendonitis
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
Possibility of Ischemic colitis

48. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
EGD
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

49. Who should have Xray testing for shoulder pain?
PE - MI - aortic dissection - pneumothorax
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

50. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Bence-Jones
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Streptococci