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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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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. Natural history of cervical cancer
HIV and syphilis
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
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

2. Mainstay treatment for soft tissue inflammation (Shoulder)
Adhesive capsulitis (frozen shoulder): most common in middle age women
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
LH surge triggers ovulation
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

3. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Serotypes 16 - 18 - 31 -52 -58
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

4. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Tension headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Wolff-Parkinson-White syndrome
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

5. What are the consequences of diastolic dysfunction?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Higher filling presure - pulmonary congestion - and decreasd cardiac return
A 24hr urine protein collection and urine creatinine clearance determination
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

6. 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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Varicella virus

7. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Common problem that resolves spontaneously and is most often seen in children and young adults
Folliculitis
HPV
Chest pain during pneumonia or PE

8. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
BB or CCB - catheter ablation of identified bypass tract
Cluster headache
Candida albicans
Medication or chemical esophagitis

9. How to NSAIDs contribute to gastritis and ulcer formation?
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Excessive bleeding in amount - duration - or both at irregular intervals
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.

10. History for Sinusitis

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11. Define proteinuria
Wolff-Parkinson-White syndrome
>150mg per 24hrs
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.
Paroxysmal atrial fibrillation or supraventricular tachycardia

12. Chronic pain and shoulder stiffness with limited motion
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Folliculitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Adhesive capsulitis (frozen shoulder): most common in middle age women

13. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Non-cardiac causes of palpitations
Fever with frontal or maxillary tenderness

14. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Squamocolumnar junction=most common site of cervical cancer
A central clear area
Molluscum contagiosum- pox virus
Viral gastroenteritis

15. What are symptoms are CHF?
Less abrupt onset and cessation of palpitations
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

16. Carcinoma in situ is generally referred to a gynecologist and requires ______
Cervical radiculopathy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

17. What does the classic ring worm lesion have?
Generalized Anxiety disorder and panic disorder
Cluster headache
Coronary artery disease/ angina
A central clear area

18. Describe the presentation of pericardial pain
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Irregular bleeding between cycles

19. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Rotator cuff tendonitis
Chest pain during pneumonia or PE
35 (exception for postmenopausal women who have recently been started on HRT)

20. 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
Slow progression of cervical cancer changes -Availability of effective early treatment
A central clear area
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
E. Coli O157:H7

21. 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
PVC or Premature atrial contraction (PAC)
Cervical radiculopathy
Warts
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

22. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Peptic ulcer disease or gastritis
Echocardiogram
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

23. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Cluster headache
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Pts with palpitations and dizziness - near syncope - or syncope
Generalized Anxiety disorder and panic disorder

24. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Rotator cuff tendonitis

25. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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.
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

26. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Common problem that resolves spontaneously and is most often seen in children and young adults
Irregular bleeding between cycles

27. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Analgesic headache
Cellulitis

28. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
A 24hr urine protein collection and urine creatinine clearance determination
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

29. Define nephrotic range proteinuria
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
Pts with palpitations and dizziness - near syncope - or syncope
ACEi
>3.5g of protein per 24hrs

30. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
35 (exception for postmenopausal women who have recently been started on HRT)
Regular bleeding at intervals of more than 35 days

31. How are fungal infections diagnosed?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
With a KOH wet mount preparation

32. What are the two common clinical presentations of acute diarrhea?
ACEi - ARBS - thiazide diuretics
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Cholelithiasis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

33. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Staphylococcal scalded skin syndrome
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
Dehydration - anemia - cardiac causes

34. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Other brainstem or cranial nerve findings
Variability in the time for follicle development during the proliferative phase
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

35. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Possibility of Ischemic colitis
>3.5g of protein per 24hrs
Upper sternal area burning pain - associated with a productive cough
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

36. Isolated - extra pounding beats
Polymenorrhea
PVC or Premature atrial contraction (PAC)
Slow progression of cervical cancer changes -Availability of effective early treatment
Folliculitis

37. What are the three types of lice?
Hypertension - CAD - valvular heart disease
Slow progression of cervical cancer changes -Availability of effective early treatment
CT
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

38. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Coronary artery disease/ angina
Scleroderma/polymyositis with secondary gastroesophageal reflux
Regular bleeding at intervals of more than 35 days

39. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Coag disorders
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
DM - HTN - DVT - seizures - depression - or anxiety
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

40. What diagnosis does the 'worse headache of my life' suggest?
Diuretics -BB -CCB -ACEi
Hgb - Electrolytes - and TSH
Warts
Subarachnoid hemorrhage

41. What is the Barany maneuver?
PVC or Premature atrial contraction (PAC)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

42. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Scleroderma/polymyositis with secondary gastroesophageal reflux
LH surge triggers ovulation
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

43. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Repeat Pap after infection treated
Menorrhagia
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
Nonulcer dyspepsia

44. Where does the development of abnormal cervical cells begin?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Squamocolumnar junction=most common site of cervical cancer
Temporal arteritis-biopsy of the temporal artery

45. Prenatal visit schedule for low-risk pregnancies
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
Nonulcer dyspepsia
S. aureus- beta hemolytic streptococcus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

46. What should blood work include for suspected heart failure?
Diuretics -BB -CCB -ACEi
Excessive bleeding in amount - duration - or both at irregular intervals
Pancreatitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

47. How do you define persistent protein uria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Presence of proteinuria on at least two separate ocassion
These patients are associated with low renin states=less likely to respond to medication
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

48. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Rotator Cuff tendonitis
Giardia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

49. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

50. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
EGD
Less than 80 ml of blood
ACEi

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