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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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1. Carcinoma in situ is generally referred to a gynecologist and requires ______
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
PVC or Premature atrial contraction (PAC)
Temporal arteritis-biopsy of the temporal artery

2. Cycle length variabilty is primarily due to what?
Giardia
Squamocolumnar junction=most common site of cervical cancer
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.
Variability in the time for follicle development during the proliferative phase

3. Discomfort with abducting the arm past 90 degress
Non-cardiac causes of palpitations
Rotator Cuff tendonitis
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
Irregular bleeding between cycles

4. Define nephrotic range proteinuria
Increase; 200 g/day
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
HPV
>3.5g of protein per 24hrs

5. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Coronary artery disease/ angina
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
Echocardiogram

6. What are the primary glomerular diseases?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Serotypes 16 - 18 - 31 -52 -58
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

7. Difference between Pneumonia and Bronchitis
E. Coli O157:H7
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Common problem that resolves spontaneously and is most often seen in children and young adults
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

8. What is the caUse of benign positional vertigo?
Bence-Jones
Scabies
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.
Scleroderma/polymyositis with secondary gastroesophageal reflux

9. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
HPV
Pts with palpitations and dizziness - near syncope - or syncope
Infectious esophagitis
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

10. 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
Varicella virus
A 24hr urine protein collection and urine creatinine clearance determination
Tension headache

11. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Squamocolumnar junction=most common site of cervical cancer
Furucnle
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
Staphylococcal scalded skin syndrome

12. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
PE - MI - aortic dissection - pneumothorax
A central clear area
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

13. What places women at higher risk of getting cervical cancer?
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
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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.

14. What test done in PE measures instability of shoulder?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Staphylococcal scalded skin syndrome

15. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Giardia
Pts with palpitations and dizziness - near syncope - or syncope
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

16. Describe the presentation of pericardial pain
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Impetigo
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

17. Metrorrhagia
Irregular bleeding between cycles
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pancreatitis

18. What are the signs of malignant hypertension?
Infectious esophagitis
High blood pressure - focal neurologic defecit - or papilledema
Diuretics -BB -CCB -ACEi
100mg; means patient can be trace protein positive and not be detected

19. What are the common causes for laryngitis?
Loop diuretics (Check serum K+ levels before drug admin)
EGD
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

20. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Furucnle
Molluscum contagiosum- pox virus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

21. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Viral gastroenteritis
HPV
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

22. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
ACEi
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
HIV and syphilis
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

23. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Coronary artery disease/ angina
Anticoag with warfarin to prevent thromboembolism
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

24. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
These patients are associated with low renin states=less likely to respond to medication
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Coronary artery disease/ angina

25. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bence-Jones
CBC
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

26. What are the features of nephrotic syndrome?
Impetigo
Cluster headache
Hypertension - CAD - valvular heart disease
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

27. Name the diagnosis of heartburn: regurgitation - dysphagia
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
GERD
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

28. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Bence-Jones
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

29. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Increase; 200 g/day
S. aureus- beta hemolytic streptococcus

30. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
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.
LH surge triggers ovulation
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

31. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Less than 80 ml of blood
Increase; 200 g/day
Diuretics -BB -CCB -ACEi
Presence of proteinuria on at least two separate ocassion

32. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
24 hour halter
Variability in the time for follicle development during the proliferative phase
ACEi
Loop diuretics (Check serum K+ levels before drug admin)

33. How do you define persistent protein uria?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Colposcopy - Endocervical curettage - and directed cervical biopsy
Presence of proteinuria on at least two separate ocassion
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

34. Describes what occurs during squamous metaplasia of the cervix.
PVC or Premature atrial contraction (PAC)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Rotator Cuff tendonitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

35. MI - pericardial tamponade - PE - GI bleed - are...
Cellulitis
ACEi
Associated with hypotension
>3.5g of protein per 24hrs

36. How are fungal infections diagnosed?
With a KOH wet mount preparation
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
CBC

37. Describe the presentation of myocardial pain?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Staphylococcal scalded skin syndrome
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

38. What is the goal of CHF treatment? What drugs should be used?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

39. 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.
E. Coli O157:H7
Repeat Pap after infection treated
>3.5g of protein per 24hrs
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

40. 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
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
ACEi - ARBS - thiazide diuretics
True

41. Complete the sentence: pericarditis can cause frictional rub and......
Other brainstem or cranial nerve findings
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

42. 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.
Tension headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Giardia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

43. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Menorrhagia
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
Rotator Cuff tendonitis

44. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Generalized Anxiety disorder and panic disorder
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

45. What occurs after ovulation
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

46. What is the role of FSH in one's menstrual cycle
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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: 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

47. Four muscles of rotator cuff
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.
Pain
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Bence-Jones

48. What are the signs of acute sinusitis?
Less abrupt onset and cessation of palpitations
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Fever with frontal or maxillary tenderness

49. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Streptococci
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

50. What are the physical exam signs of CHF?
Cellulitis
Loop diuretics (Check serum K+ levels before drug admin)
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

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