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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. 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
ACEi
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Varicella virus
Common problem that resolves spontaneously and is most often seen in children and young adults

2. Describes what occurs during squamous metaplasia of the cervix.
Folliculitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
35 (exception for postmenopausal women who have recently been started on HRT)

3. What are the features of nephrotic syndrome?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
MSK - pulmonary - GI - or psychological

4. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
BB or CCB - catheter ablation of identified bypass tract
Staphylococcal scalded skin syndrome
ACEi - ARBS - thiazide diuretics

5. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Influenza - Rhinovirus - Adenovirus - Parainfluenza

6. What places women at higher risk of getting cervical cancer?
Scabies
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
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

7. Difference between Pneumonia and Bronchitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Pleurisy
Echocardiogram

8. What is a markers of CNS vertigo?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Increase; 200 g/day
Other brainstem or cranial nerve findings
Hypertension - CAD - valvular heart disease

9. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Squamocolumnar junction=most common site of cervical cancer
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A 24hr urine protein collection and urine creatinine clearance determination
Pts with palpitations and dizziness - near syncope - or syncope

10. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
DM - HTN - DVT - seizures - depression - or anxiety
Staphylococcal scalded skin syndrome
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

11. 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
E. Coli O157:H7
Subarachnoid hemorrhage
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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.

12. MI - pericardial tamponade - PE - GI bleed - are...
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
With a KOH wet mount preparation
Associated with hypotension

13. What are the features of glomerular nephritis
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
RBC casts and old to moderate HTN
Cholelithiasis
Rotator cuff tendonitis

14. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Squamocolumnar junction=most common site of cervical cancer
PVC or Premature atrial contraction (PAC)
Hgb - Electrolytes - and TSH
Repeat Pap after infection treated

15. Constipation: What are indications for lab testing?
Infectious esophagitis
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
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
A 24hr urine protein collection and urine creatinine clearance determination

16. Irregular cycles with excessive flow - duration - or both
Presence of proteinuria on at least two separate ocassion
Menorrhagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
S. Aureus

17. How are fungal infections diagnosed?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
With a KOH wet mount preparation
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

18. 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
Furucnle
Giardia
CBC

19. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Chest pain during pneumonia or PE
Presence of proteinuria on at least two separate ocassion
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

20. Mainstay treatment for soft tissue inflammation (Shoulder)
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
Serotypes 16 - 18 - 31 -52 -58
Scabies
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

21. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Serotypes 16 - 18 - 31 -52 -58
GERD
Excessive bleeding in amount - duration - or both at irregular intervals

22. What is the peripheral caUse of vertigo?
Less than 3 stools per week
Wolff-Parkinson-White syndrome
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

23. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
S. Aureus
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

24. Describe the history and PE of patient presenting with common cold
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
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

25. What are the three types of lice?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

26. Clinical Manifestations of HTN
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
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
Streptococci

27. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Varicella virus
Diuretics -BB -CCB -ACEi
Adhesive capsulitis (frozen shoulder): most common in middle age women
Presence of proteinuria on at least two separate ocassion

28. What are the signs of acute sinusitis?
Less abrupt onset and cessation of palpitations
Fever with frontal or maxillary tenderness
Cellulitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

29. Define proteinuria
>150mg per 24hrs
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
S. aureus- beta hemolytic streptococcus
Cholelithiasis

30. What is an acoustic neuroma?
Cluster headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

31. After treatment of dysplasia - women need Pap smears every...
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

32. Carcinoma in situ is generally referred to a gynecologist and requires ______
True
HPV
100mg; means patient can be trace protein positive and not be detected
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

33. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Increase; 200 g/day
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Viral infection of the semicircular apparatus

34. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Wolff-Parkinson-White syndrome
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

35. SE Of Beta blockers?
Hgb - Electrolytes - and TSH
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Influenza - Rhinovirus - Adenovirus - Parainfluenza
100mg; means patient can be trace protein positive and not be detected

36. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
RBC casts and old to moderate HTN
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
Rotator cuff tendonitis

37. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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

38. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Squamocolumnar junction=most common site of cervical cancer
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Colposcopy - Endocervical curettage - and directed cervical biopsy
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

39. History for Sinusitis

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40. PE for a patient getting an abnormal vaginal bleeding work up
Pts with palpitations and dizziness - near syncope - or syncope
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Rotator Cuff problem
Presence of proteinuria on at least two separate ocassion

41. 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
CT
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
True

42. What drugs do you use to treat H.pylori + PUD?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Squamocolumnar junction=most common site of cervical cancer
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

43. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
LH surge triggers ovulation
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

44. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Tension headache

45. What is the caUse of Meniere disease? What are the cardinal symptoms?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Echocardiogram
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

46. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Tension headache
E. Coli O157:H7
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

47. Regular bleeding at intervals of less than 21 days
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hypertension - CAD - valvular heart disease
Polymenorrhea

48. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Giardia
CT
Regular bleeding at intervals of more than 35 days

49. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

50. What diagnosis does the 'worse headache of my life' suggest?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Subarachnoid hemorrhage
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus