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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. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Colposcopy - Endocervical curettage - and directed cervical biopsy
S. Aureus

2. Who should have Xray testing for shoulder pain?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Regular bleeding at intervals of more than 35 days
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
35 (exception for postmenopausal women who have recently been started on HRT)

3. Irregular cycles with excessive flow - duration - or both
Pancreatitis
Menorrhagia
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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

4. Pain in shoulder when throwing - swimming - or serving a tennis ball
Cervical radiculopathy
Regular bleeding at intervals of more than 35 days
Rotator cuff tendonitis
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

5. How does CHF present on X-ray?
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

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
Varicella virus
ACEi
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Rotator cuff tendonitis

7. What should preconception counseling include?
Nonulcer dyspepsia
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
Non-cardiac causes of palpitations
Dehydration - anemia - cardiac causes

8. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Temporal arteritis-biopsy of the temporal artery
Rotator Cuff problem

9. Name some medications that can cause proteinuria
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi
Tension headache
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

10. When is a lumbar puncture contraindicated?
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
GERD
Cholelithiasis

11. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
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
Rotator Cuff problem

12. Where does the development of abnormal cervical cells begin?
Albumin; low molecular weight proteins
A central clear area
Wolff-Parkinson-White syndrome
Squamocolumnar junction=most common site of cervical cancer

13. What is afterload?
RBC casts and old to moderate HTN
Pleurisy
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

14. What is the difference between a Holter monitor or an event monitor?
24 hour halter
GERD
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
Furucnle

15. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

16. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Hgb - Electrolytes - and TSH
Higher filling presure - pulmonary congestion - and decreasd cardiac return

17. 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 tendonitis
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

18. Why is the pap smear one of the most effective cancer screening tools?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

19. When should invasive eletrophysiologic study should be considered?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
RBC casts and old to moderate HTN
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.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

20. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Infectious esophagitis
Streptococci
Associated with hypotension

21. Initial treatment for Rhinosinusitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
S. aureus- beta hemolytic streptococcus
Cluster headache

22. What is the Epley maneuver?
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
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
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
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.

23. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Slow progression of cervical cancer changes -Availability of effective early treatment
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pts with palpitations and dizziness - near syncope - or syncope

24. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
LH surge triggers ovulation

25. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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.
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

26. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
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
Viral infection of the semicircular apparatus
24 hour halter

27. What are the symptoms of palpitations?
Polymenorrhea
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Lightheadedness - dizziness - syncope

28. Carcinoma in situ is generally referred to a gynecologist and requires ______
HPV testing -Pos=colposcopy -Neg=repeat pap smear
DM - HTN - DVT - seizures - depression - or anxiety
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

29. 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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Temporal arteritis-biopsy of the temporal artery
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

30. What is a markers of CNS vertigo?
Bence-Jones
Other brainstem or cranial nerve findings
Increase; 200 g/day
Rotator Cuff tendonitis

31. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
E. Coli O157:H7
CT
Impetigo

32. What is the goal of CHF treatment? What drugs should be used?
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Scleroderma/polymyositis with secondary gastroesophageal reflux
EGD

33. History for Sinusitis

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34. Name the skin lesion: pustule in association with a hair follice
Folliculitis
Chest pain during pneumonia or PE
Associated with hypotension
Possibility of Ischemic colitis

35. What is the Barany maneuver?
True
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
Coag disorders
S. Aureus

36. What HPV serotypes are most commonly associated with cervical cancer?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Medication or chemical esophagitis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Serotypes 16 - 18 - 31 -52 -58

37. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
35 (exception for postmenopausal women who have recently been started on HRT)
PE - MI - aortic dissection - pneumothorax
Adhesive capsulitis (frozen shoulder): most common in middle age women

38. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
LH surge triggers ovulation
Cluster headache

39. What is the preload?
Other brainstem or cranial nerve findings
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Pancreatitis

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
With a KOH wet mount preparation
ACEi - ARBS - thiazide diuretics
True
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

41. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
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
Streptococci
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

42. What occurs after ovulation
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
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

43. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Albumin; low molecular weight proteins
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Nonulcer dyspepsia

44. What are the physical exam signs of CHF?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pleurisy
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
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

45. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Acute headache - ataxia - profuse nausea - and vomiting
Supraspinatus and bicipital tendons
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

46. Describes what occurs during squamous metaplasia of the cervix.
Increase; 200 g/day
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Acute headache - ataxia - profuse nausea - and vomiting
Non-cardiac causes of palpitations

47. 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.
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Repeat Pap after infection treated
Viral infection of the semicircular apparatus

48. What type of imaging is need for chronic sinusitis?
CT
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Upper sternal area burning pain - associated with a productive cough
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

49. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
HIV and syphilis
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

50. Treatment for supraventricular tachycardias
Paroxysmal atrial fibrillation or supraventricular tachycardia
BB or CCB - catheter ablation of identified bypass tract
Supraspinatus and bicipital tendons
Stabilize on oxygen - nitroglycerin - morphine for pain - aspirin (to decrease mortality by 20%) - clopidogrel or ticolodipine. (beta blockers - heparin - nitrates - ACEi - thrombolytics (if <75 with ST segment elevation - and a history consistent wi

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