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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. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Intermenstrual bleeding
Serotypes 16 - 18 - 31 -52 -58
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pts with palpitations and dizziness - near syncope - or syncope

2. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Echocardiogram
HIV and syphilis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

3. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Serotypes 16 - 18 - 31 -52 -58
Chest pain during pneumonia or PE
Nonulcer dyspepsia

4. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
35 (exception for postmenopausal women who have recently been started on HRT)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
LH surge triggers ovulation

5. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
100mg; means patient can be trace protein positive and not be detected
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
PE - MI - aortic dissection - pneumothorax

6. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Paroxysmal atrial fibrillation or supraventricular tachycardia
Kids: Rotavirus Adults: Norwalk Virus
100mg; means patient can be trace protein positive and not be detected

7. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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.
Bence-Jones
Temporal arteritis-biopsy of the temporal artery
Rotator Cuff problem

8. What type of imaging is need for chronic sinusitis?
CBC
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
S. aureus- beta hemolytic streptococcus
CT

9. Uterine bleeding between regular cycles
Giardia
Wolff-Parkinson-White syndrome
Intermenstrual bleeding
Excessive bleeding in amount - duration - or both at irregular intervals

10. Name some medications that can cause proteinuria
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Viral infection of the semicircular apparatus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

11. Name the skin lesion: honey colored crusts
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
Kids: Rotavirus Adults: Norwalk Virus
Impetigo
GERD

12. 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
Warts
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Scleroderma/polymyositis with secondary gastroesophageal reflux

13. Treatment for supraventricular tachycardias
S. Aureus
Staphylococcal scalded skin syndrome
Molluscum contagiosum- pox virus
BB or CCB - catheter ablation of identified bypass tract

14. 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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Fever with frontal or maxillary tenderness

15. What is an acoustic neuroma?
Wolff-Parkinson-White syndrome
Loop diuretics (Check serum K+ levels before drug admin)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

16. What is the preload?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Repeat Pap after infection treated
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

17. Shoulder pain with pain radiating to elbow
100mg; means patient can be trace protein positive and not be detected
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Menorrhagia
Cervical radiculopathy

18. Name types of laxatives
Loop diuretics (Check serum K+ levels before drug admin)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
CBC

19. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Intermenstrual bleeding
Slow progression of cervical cancer changes -Availability of effective early treatment

20. Vaccines that should be updated before planned pregnancy
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Rotator Cuff tendonitis
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Medication or chemical esophagitis

21. Carcinoma in situ is generally referred to a gynecologist and requires ______
S. aureus- beta hemolytic streptococcus
Pts with palpitations and dizziness - near syncope - or syncope
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

22. What is the next best step if a patient has two or more positive dipstick tests?
Associated with hypotension
A 24hr urine protein collection and urine creatinine clearance determination
Streptococci
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.

23. What are the features of glomerular nephritis
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
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
RBC casts and old to moderate HTN
Repeat Pap after infection treated

24. What should preconception counseling include?
Nonulcer dyspepsia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

25. What are the most common causes for the common cold?
RBC casts and old to moderate HTN
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Infectious esophagitis

26. 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
With a KOH wet mount preparation
Polymenorrhea
Less abrupt onset and cessation of palpitations

27. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Generalized Anxiety disorder and panic disorder
Irregular bleeding between cycles
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

28. HIgh risk pregnant patients should be evaluated for ____ and ____
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
HIV and syphilis
Varicella virus
24 hour halter

29. What lab tests are recommended for newly diagnosed hypertensive patients?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
GERD

30. Define nephrotic range proteinuria
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
>3.5g of protein per 24hrs
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Medication or chemical esophagitis

31. SE Of Beta blockers?
Scabies
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Fever with frontal or maxillary tenderness
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

32. Metrorrhagia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Common problem that resolves spontaneously and is most often seen in children and young adults
Irregular bleeding between cycles
Higher filling presure - pulmonary congestion - and decreasd cardiac return

33. Irregular cycles with excessive flow - duration - or both
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Associated with hypotension
Menorrhagia

34. What is the role of LH in the menstrual cycle
Coag disorders
Hypertension - CAD - valvular heart disease
LH surge triggers ovulation
Diuretics -BB -CCB -ACEi

35. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
DM - HTN - DVT - seizures - depression - or anxiety
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
ACEi - ARBS - thiazide diuretics
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

36. Four muscles of rotator cuff
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Polymenorrhea

37. Describe the presentation of myocardial pain?
Upper sternal area burning pain - associated with a productive cough
Squamocolumnar junction=most common site of cervical cancer
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

38. What medications can cause heart palpitations?
Acute headache - ataxia - profuse nausea - and vomiting
These patients are associated with low renin states=less likely to respond to medication
Pain
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

39. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
High blood pressure - focal neurologic defecit - or papilledema
Diuretics -BB -CCB -ACEi
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

40. After treatment of dysplasia - women need Pap smears every...
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
With a KOH wet mount preparation

41. 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
Rotator Cuff problem
Presence of proteinuria on at least two separate ocassion
Less than 3 stools per week

42. How can GERD (or esophageal motility disorders) lead to chest pain?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Bence-Jones
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

43. Pneumonia tx: suitable for healthy adults less than 60
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Presence of proteinuria on at least two separate ocassion
S. Aureus

44. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Furucnle
BB or CCB - catheter ablation of identified bypass tract
Infectious esophagitis

45. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Increase; 200 g/day

46. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Molluscum contagiosum- pox virus
Regular bleeding at intervals of more than 35 days
Analgesic headache
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

47. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Folliculitis
35 (exception for postmenopausal women who have recently been started on HRT)
PVC or Premature atrial contraction (PAC)
Squamocolumnar junction=most common site of cervical cancer

48. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Viral gastroenteritis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

49. What should blood work include for suspected heart failure?
Bence-Jones
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

50. Prenatal visit schedule for low-risk pregnancies
Hgb - Electrolytes - and TSH
Intermenstrual bleeding
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
Streptococci

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