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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 skin lesion: honey colored crusts
Generalized Anxiety disorder and panic disorder
Streptococci
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Impetigo

2. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Viral gastroenteritis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Less than 80 ml of blood

3. Uterine bleeding between regular cycles
Intermenstrual bleeding
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Less than 3 stools per week
RBC casts and old to moderate HTN

4. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
HIV and syphilis
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

5. What is considered normal blood loss during a menstrual cycle?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Less than 80 ml of blood
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

6. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
>150mg per 24hrs
Echocardiogram
HPV testing -Pos=colposcopy -Neg=repeat pap smear

7. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Rotator Cuff problem
Colposcopy - Endocervical curettage - and directed cervical biopsy
Cellulitis

8. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Coronary artery disease/ angina
ACEi
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

9. 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.
Pleurisy
Tension headache
Serotypes 16 - 18 - 31 -52 -58
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

10. Diarrhea from custard filled pastries
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
Pleurisy
High blood pressure - focal neurologic defecit - or papilledema
S. Aureus

11. Oligomenorrhea
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
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
Regular bleeding at intervals of more than 35 days

12. What HPV serotypes are most commonly associated with cervical cancer?
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.
Associated with hypotension
Serotypes 16 - 18 - 31 -52 -58
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

13. What are the secondly causes of glomerular disease?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Increase; 200 g/day
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

14. What are the signs of cerebral hemorrhage?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Common problem that resolves spontaneously and is most often seen in children and young adults
Acute headache - ataxia - profuse nausea - and vomiting

15. What the consequences of decreased cardiac output?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
ACEi
Candida albicans
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

16. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Coronary artery disease/ angina
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Repeat Pap after infection treated

17. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Cholelithiasis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

18. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Analgesic headache
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Common problem that resolves spontaneously and is most often seen in children and young adults

19. Carcinoma in situ is generally referred to a gynecologist and requires ______
Polymenorrhea
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

20. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Viral gastroenteritis
Common problem that resolves spontaneously and is most often seen in children and young adults
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

21. 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
Subarachnoid hemorrhage
True
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

22. What is the peripheral caUse of vertigo?
DM - HTN - DVT - seizures - depression - or anxiety
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
E. Coli O157:H7
Higher filling presure - pulmonary congestion - and decreasd cardiac return

23. What does treatment for migrans include?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Less than 80 ml of blood
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
Anticoag with warfarin to prevent thromboembolism

24. What are the physical exam signs of CHF?
Streptococci
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

25. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Intermenstrual bleeding
Peptic ulcer disease or gastritis
Dehydration - anemia - cardiac causes
HPV testing -Pos=colposcopy -Neg=repeat pap smear

26. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Intermenstrual bleeding
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

27. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
Staphylococcal scalded skin syndrome
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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

28. Chronic pain and shoulder stiffness with limited motion
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
Less abrupt onset and cessation of palpitations
Adhesive capsulitis (frozen shoulder): most common in middle age women
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

29. What is the mechanism of action for stimulant agents in treating constipation?
Less than 3 stools per week
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
True
100mg; means patient can be trace protein positive and not be detected

30. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

31. Why is the pap smear one of the most effective cancer screening tools?
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Slow progression of cervical cancer changes -Availability of effective early treatment
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

32. Difference between Pneumonia and Bronchitis
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
Pain
Menorrhagia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

33. When does troponin rise following myocardial injury or infarction?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Colposcopy - Endocervical curettage - and directed cervical biopsy
LH surge triggers ovulation

34. Describes what occurs during squamous metaplasia of the cervix.
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.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

35. What is the caUse of benign positional vertigo?
Variability in the time for follicle development during the proliferative phase
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
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.
Subarachnoid hemorrhage

36. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
Tension headache

37. Who should have Xray testing for shoulder pain?
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
Pleurisy
CBC
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

38. What places women at higher risk of getting cervical cancer?
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Upper sternal area burning pain - associated with a productive cough
Nonulcer dyspepsia

39. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
ACEi

40. How is constipation clinically defined?
Less than 3 stools per week
Folliculitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Bence-Jones

41. 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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Dehydration - anemia - cardiac causes
Temporal arteritis-biopsy of the temporal artery

42. Pneumonia tx: suitable for healthy adults older than 60
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
S. Aureus
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

43. patients with herpes zoster may experience what symptom before the rash appear?
Pain
PE - MI - aortic dissection - pneumothorax
Wolff-Parkinson-White syndrome
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

44. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Fever with frontal or maxillary tenderness
Staphylococcal scalded skin syndrome
Giardia
PVC or Premature atrial contraction (PAC)

45. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Chest pain during pneumonia or PE
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

46. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
100mg; means patient can be trace protein positive and not be detected
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

47. What is the next best step if a patient has two or more positive dipstick tests?
Folliculitis
Common problem that resolves spontaneously and is most often seen in children and young adults
A 24hr urine protein collection and urine creatinine clearance determination
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

48. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
ACEi
Fever with frontal or maxillary tenderness

49. What should preconception counseling include?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Temporal arteritis-biopsy of the temporal artery
Slow progression of cervical cancer changes -Availability of effective early treatment

50. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
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
Polymenorrhea