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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Where does the development of abnormal cervical cells begin?
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
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
Associated with hypotension
Squamocolumnar junction=most common site of cervical cancer

2. What are the two common clinical presentations of acute diarrhea?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Peptic ulcer disease or gastritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

3. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Lightheadedness - dizziness - syncope
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
ACEi - ARBS - thiazide diuretics

4. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Rotator cuff tendonitis
Excessive bleeding in amount - duration - or both at irregular intervals

5. Describe the history and PE of patient presenting with common cold
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
Non-cardiac causes of palpitations
PE - MI - aortic dissection - pneumothorax
Peptic ulcer disease or gastritis

6. Complete the sentence: pericarditis can cause frictional rub and......
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
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

7. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Nonulcer dyspepsia
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

8. When should invasive eletrophysiologic study should be considered?
PVC or Premature atrial contraction (PAC)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

9. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Less abrupt onset and cessation of palpitations
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Streptococci
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

10. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Rotator Cuff tendonitis
Albumin; low molecular weight proteins
RBC casts and old to moderate HTN

11. History and PE for Pneumonia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Chest pain during pneumonia or PE
Medication or chemical esophagitis

12. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Coronary artery disease/ angina
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
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

13. Irregular cycles with excessive flow - duration - or both
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
A 24hr urine protein collection and urine creatinine clearance determination
Scabies
Menorrhagia

14. Define proteinuria
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
>150mg per 24hrs
Hgb - Electrolytes - and TSH

15. Natural history of cervical cancer
Polymenorrhea
Pts with palpitations and dizziness - near syncope - or syncope
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Affects 60% of patients with asymptomatic proteinuria; patients are usually <30 - secrete less than 2g protein/day: proteinuria occurs in the upright - but not supine position

16. What is the caUse of Meniere disease? What are the cardinal symptoms?
Less than 80 ml of blood
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

17. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
BB or CCB - catheter ablation of identified bypass tract
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Wolff-Parkinson-White syndrome
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

18. What are the three major risk factors for heart failure?
Cellulitis
Affects 60% of patients with asymptomatic proteinuria; patients are usually <30 - secrete less than 2g protein/day: proteinuria occurs in the upright - but not supine position
S. aureus- beta hemolytic streptococcus
Hypertension - CAD - valvular heart disease

19. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

20. How to NSAIDs contribute to gastritis and ulcer formation?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Increase; 200 g/day
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.
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

21. Why is the pap smear one of the most effective cancer screening tools?
Serotypes 16 - 18 - 31 -52 -58
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

22. What does treatment for migrans include?
Slow progression of cervical cancer changes -Availability of effective early treatment
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Pleurisy

23. 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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Wolff-Parkinson-White syndrome
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

24. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Cluster headache
Scleroderma/polymyositis with secondary gastroesophageal reflux
Medication or chemical esophagitis
Pancreatitis

25. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Supraspinatus and bicipital tendons
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.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
24 hour halter

26. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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.
Wolff-Parkinson-White syndrome
Less than 80 ml of blood

27. Chronic pain and shoulder stiffness with limited motion
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
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
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

28. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
RBC casts and old to moderate HTN
Candida albicans
S. aureus- beta hemolytic streptococcus

29. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Wolff-Parkinson-White syndrome
Common problem that resolves spontaneously and is most often seen in children and young adults

30. HIgh risk pregnant patients should be evaluated for ____ and ____
With a KOH wet mount preparation
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Rotator cuff tendonitis
HIV and syphilis

31. How do you define persistent protein uria?
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
Cholelithiasis
Presence of proteinuria on at least two separate ocassion
HPV testing -Pos=colposcopy -Neg=repeat pap smear

32. What lab tests are recommended for newly diagnosed hypertensive patients?
DM - HTN - DVT - seizures - depression - or anxiety
Paroxysmal atrial fibrillation or supraventricular tachycardia
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Possibility of Ischemic colitis

33. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
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
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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

34. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Pancreatitis

35. Name the skin lesion: pustule in association with a hair follice
Pts with palpitations and dizziness - near syncope - or syncope
Less than 3 stools per week
PE - MI - aortic dissection - pneumothorax
Folliculitis

36. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Paroxysmal atrial fibrillation or supraventricular tachycardia
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral infection of the semicircular apparatus

37. Uterine bleeding between regular cycles
Furucnle
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Hypertension - CAD - valvular heart disease
Intermenstrual bleeding

38. patients with herpes zoster may experience what symptom before the rash appear?
>150mg per 24hrs
Pain
Irregular bleeding between cycles
Cholelithiasis

39. Describes what occurs during squamous metaplasia of the cervix.
Loop diuretics (Check serum K+ levels before drug admin)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
PE - MI - aortic dissection - pneumothorax
Kids: Rotavirus Adults: Norwalk Virus

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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
E. Coli O157:H7
Acute headache - ataxia - profuse nausea - and vomiting
True

41. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
With a KOH wet mount preparation
Repeat Pap after infection treated
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

42. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Fever with frontal or maxillary tenderness
HPV
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

43. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

44. Prenatal visit schedule for low-risk pregnancies
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
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

45. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Possibility of Ischemic colitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Excessive bleeding in amount - duration - or both at irregular intervals

46. What should blood work include for suspected heart failure?
Viral gastroenteritis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Higher filling presure - pulmonary congestion - and decreasd cardiac return
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

47. What the consequences of decreased cardiac output?
A 24hr urine protein collection and urine creatinine clearance determination
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
>3.5g of protein per 24hrs
Irregular bleeding between cycles

48. What drugs do you use to treat H.pylori + PUD?
Intermenstrual bleeding
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

49. Shoulder pain with pain radiating to elbow
Impetigo
Cervical radiculopathy
Hypertension - CAD - valvular heart disease
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

50. Things that need to be included in history of shoulder pain
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Echocardiogram
Possibility of Ischemic colitis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)