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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. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Warts
Streptococci
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

2. When should a patient get a stress test?
BB or CCB - catheter ablation of identified bypass tract
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
PVC or Premature atrial contraction (PAC)

3. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Coronary artery disease/ angina
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
Hypertension - CAD - valvular heart disease

4. 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
Upper sternal area burning pain - associated with a productive cough
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

5. Define the patient population typically affected by orthostatic or postural proteinuria
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Slow progression of cervical cancer changes -Availability of effective early treatment
>150mg per 24hrs
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

6. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Rotator cuff tendonitis
Menorrhagia
Pleurisy
Tension headache

7. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Molluscum contagiosum- pox virus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

8. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Irregular bleeding between cycles
Staphylococcal scalded skin syndrome
35 (exception for postmenopausal women who have recently been started on HRT)
Paroxysmal atrial fibrillation or supraventricular tachycardia

9. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
24 hour halter
Infectious esophagitis
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
Warts

10. Regular bleeding at intervals of less than 21 days
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Polymenorrhea
Subarachnoid hemorrhage
Streptococci

11. What lab tests are recommended for newly diagnosed hypertensive patients?
Kids: Rotavirus Adults: Norwalk Virus
Bence-Jones
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

12. Metrorrhagia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Irregular bleeding between cycles
Lightheadedness - dizziness - syncope
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

13. What are symptoms are CHF?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Pleurisy
Chest pain during pneumonia or PE

14. What should be considered in younger patients with menorrhagia
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
Chest pain during pneumonia or PE
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Coag disorders

15. Name the diagnosis of heartburn: regurgitation - dysphagia
PE - MI - aortic dissection - pneumothorax
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
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
GERD

16. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Impetigo
Medication or chemical esophagitis
Dehydration - anemia - cardiac causes

17. 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
Cholelithiasis
MSK - pulmonary - GI - or psychological
Cellulitis

18. Name the skin lesion: pustule in association with a hair follice
Acute headache - ataxia - profuse nausea - and vomiting
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Molluscum contagiosum- pox virus
Folliculitis

19. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Coag disorders
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi
Folliculitis

20. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
>150mg per 24hrs
Peptic ulcer disease or gastritis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

21. What does the classic ring worm lesion have?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
A central clear area
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
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

22. What is the preload?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Chest pain during pneumonia or PE
Slow progression of cervical cancer changes -Availability of effective early treatment
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

23. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
HPV testing -Pos=colposcopy -Neg=repeat pap smear
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

24. What are the primary glomerular diseases?
These patients are associated with low renin states=less likely to respond to medication
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
S. aureus- beta hemolytic streptococcus
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

25. What test done in PE measures instability of shoulder?
Intermenstrual bleeding
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Varicella virus

26. What are the signs of malignant hypertension?
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
High blood pressure - focal neurologic defecit - or papilledema
24 hour halter

27. What is the mechanism of action for stimulant agents in treating constipation?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Nonulcer dyspepsia
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Infectious esophagitis

28. What is the goal of CHF treatment? What drugs should be used?
Variability in the time for follicle development during the proliferative phase
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
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
Increase; 200 g/day

29. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
Loop diuretics (Check serum K+ levels before drug admin)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Serotypes 16 - 18 - 31 -52 -58

30. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
35 (exception for postmenopausal women who have recently been started on HRT)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Less abrupt onset and cessation of palpitations

31. Treatment for supraventricular tachycardias
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
Intermenstrual bleeding
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
BB or CCB - catheter ablation of identified bypass tract

32. When does troponin rise following myocardial injury or infarction?
True
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. Aureus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

33. 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
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
Temporal arteritis-biopsy of the temporal artery
With a KOH wet mount preparation
E. Coli O157:H7

34. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
True

35. What is a markers of CNS vertigo?
Adhesive capsulitis (frozen shoulder): most common in middle age women
With a KOH wet mount preparation
Other brainstem or cranial nerve findings
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

36. Constipation: What are indications for lab testing?
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

37. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Associated with hypotension

38. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
MSK - pulmonary - GI - or psychological
E. Coli O157:H7
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

39. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Medication or chemical esophagitis

40. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Adhesive capsulitis (frozen shoulder): most common in middle age women
BB or CCB - catheter ablation of identified bypass tract
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

41. Where does the development of abnormal cervical cells begin?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Slow progression of cervical cancer changes -Availability of effective early treatment
True
Squamocolumnar junction=most common site of cervical cancer

42. Describe the history and PE of patient presenting with common cold
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
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
Hgb - Electrolytes - and TSH

43. History for Sinusitis

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44. Name the diagnosis of heartburn: severe constant mid abdominal pain
Excessive bleeding in amount - duration - or both at irregular intervals
Pancreatitis
Lightheadedness - dizziness - syncope
These patients are associated with low renin states=less likely to respond to medication

45. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Furucnle
Pleurisy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Peptic ulcer disease or gastritis

46. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Diuretics -BB -CCB -ACEi

47. How can GERD (or esophageal motility disorders) lead to chest pain?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Varicella virus
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
S. aureus- beta hemolytic streptococcus

48. Mainstay treatment for soft tissue inflammation (Shoulder)
Possibility of Ischemic colitis
GERD
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

49. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
>3.5g of protein per 24hrs
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

50. Menometrorrhagia
Pain
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Excessive bleeding in amount - duration - or both at irregular intervals
Colposcopy - Endocervical curettage - and directed cervical biopsy

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