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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
Pancreatitis
Varicella virus
Generalized Anxiety disorder and panic disorder
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

2. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
S. Aureus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Staphylococcal scalded skin syndrome

3. What are the 2 psych disorders most commonly associated with palpitations?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Variability in the time for follicle development during the proliferative phase
Generalized Anxiety disorder and panic disorder
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

4. What is the caUse of Meniere disease? What are the cardinal symptoms?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Increase; 200 g/day
Increasing fluid (8 - 8oz glasses of water/day) -fiber

5. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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.
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Bulk forming: Psyllium - Methycellulose - Polycarbophil

6. History for Sinusitis

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7. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Furucnle
Common problem that resolves spontaneously and is most often seen in children and young adults

8. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Infectious esophagitis
S. aureus- beta hemolytic streptococcus
When the patient has symptoms in association with exercise or who describe chest pain or pressure

9. Uterine bleeding between regular cycles
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
Intermenstrual bleeding

10. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
HIV and syphilis
Medication or chemical esophagitis
Common problem that resolves spontaneously and is most often seen in children and young adults
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

11. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Bence-Jones
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

12. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
DM - HTN - DVT - seizures - depression - or anxiety
Serotypes 16 - 18 - 31 -52 -58
Polymenorrhea

13. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Bence-Jones
True

14. What are the secondly causes of glomerular disease?
PVC or Premature atrial contraction (PAC)
Medication or chemical esophagitis
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

15. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Staphylococcal scalded skin syndrome
GERD
HPV
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

16. What are the indiciations for neuroimaging?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

17. What does treatment for migrans include?
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
Cellulitis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

18. What should be considered in younger patients with menorrhagia
Folliculitis
CBC
Coag disorders
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

19. Chronic pain and shoulder stiffness with limited motion
Regular bleeding at intervals of more than 35 days
Adhesive capsulitis (frozen shoulder): most common in middle age women
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.
Scleroderma/polymyositis with secondary gastroesophageal reflux

20. What is the goal of CHF treatment? What drugs should be used?
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
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

21. 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
A 24hr urine protein collection and urine creatinine clearance determination
E. Coli O157:H7
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

22. Natural history of cervical cancer
Pts with palpitations and dizziness - near syncope - or syncope
MSK - pulmonary - GI - or psychological
Viral gastroenteritis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

23. What is the role of FSH in one's menstrual cycle
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Molluscum contagiosum- pox virus

24. At was quantity does urine dipstick test detect elevated protein?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
100mg; means patient can be trace protein positive and not be detected
Rotator Cuff problem

25. Describe the presentation of myocardial pain?
Pain
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Increasing fluid (8 - 8oz glasses of water/day) -fiber

26. Name the skin lesion: honey colored crusts
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Impetigo
Rotator cuff tendonitis
Infectious esophagitis

27. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
ACEi - ARBS - thiazide diuretics
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
Chest pain during pneumonia or PE
Scleroderma/polymyositis with secondary gastroesophageal reflux

28. HIgh risk pregnant patients should be evaluated for ____ and ____
Subarachnoid hemorrhage
>3.5g of protein per 24hrs
Viral gastroenteritis
HIV and syphilis

29. What is the difference between a Holter monitor or an event monitor?
Infectious esophagitis
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
Cluster headache
Irregular bleeding between cycles

30. What are signs of pulmonary congestion?
Presence of proteinuria on at least two separate ocassion
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
100mg; means patient can be trace protein positive and not be detected

31. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
With a KOH wet mount preparation
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

32. What diagnosis does the 'worse headache of my life' suggest?
Candida albicans
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Subarachnoid hemorrhage
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

33. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Coronary artery disease/ angina
Menorrhagia

34. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
Pleurisy
Lightheadedness - dizziness - syncope
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

35. Prenatal visit schedule for low-risk pregnancies
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
High blood pressure - focal neurologic defecit - or papilledema
Menorrhagia

36. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
PVC or Premature atrial contraction (PAC)

37. What places women at higher risk of getting cervical cancer?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Intermenstrual bleeding

38. What are the symptoms of palpitations?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
ACEi - ARBS - thiazide diuretics
Lightheadedness - dizziness - syncope
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

39. What is the mechanism of action for stimulant agents in treating constipation?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Coronary artery disease/ angina
Wolff-Parkinson-White syndrome
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

40. How does CHF present on X-ray?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
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

41. How are fungal infections diagnosed?
Albumin; low molecular weight proteins
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
With a KOH wet mount preparation
Polymenorrhea

42. Tx of chronic or intermittent afibs
Streptococci
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Anticoag with warfarin to prevent thromboembolism

43. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
Repeat Pap after infection treated
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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

44. Treatment for supraventricular tachycardias
ACEi - ARBS - thiazide diuretics
Coag disorders
BB or CCB - catheter ablation of identified bypass tract
CT

45. Metrorrhagia
Irregular bleeding between cycles
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
MSK - pulmonary - GI - or psychological
PE - MI - aortic dissection - pneumothorax

46. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
Excessive bleeding in amount - duration - or both at irregular intervals
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Rotator Cuff problem

47. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
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.
Increase; 200 g/day
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

48. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Peptic ulcer disease or gastritis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Serotypes 16 - 18 - 31 -52 -58

49. Where does the development of abnormal cervical cells begin?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Furucnle
Squamocolumnar junction=most common site of cervical cancer
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

50. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fever with frontal or maxillary tenderness
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day