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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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1. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less abrupt onset and cessation of palpitations
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

2. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
S. aureus- beta hemolytic streptococcus
Furucnle
ACEi

3. Carcinoma in situ is generally referred to a gynecologist and requires ______
Slow progression of cervical cancer changes -Availability of effective early treatment
Variability in the time for follicle development during the proliferative phase
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

4. Diarrhea from custard filled pastries
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
Associated with hypotension
S. Aureus
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

5. After treatment of dysplasia - women need Pap smears every...
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pancreatitis
DM - HTN - DVT - seizures - depression - or anxiety
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

6. What are the indiciations for neuroimaging?
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
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

7. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Peptic ulcer disease or gastritis
Viral gastroenteritis
Rotator cuff tendonitis
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

8. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
CT
Variability in the time for follicle development during the proliferative phase
Coronary artery disease/ angina

9. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

10. patients with herpes zoster may experience what symptom before the rash appear?
A 24hr urine protein collection and urine creatinine clearance determination
Pain
Giardia
Less abrupt onset and cessation of palpitations

11. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Scabies
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Cluster headache

12. History for Sinusitis

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13. Uterine bleeding between regular cycles
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Dehydration - anemia - cardiac causes
Intermenstrual bleeding
>150mg per 24hrs

14. What are the three major risk factors for heart failure?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Hypertension - CAD - valvular heart disease
Possibility of Ischemic colitis

15. Constipation: What are indications for lab testing?
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
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
Non-cardiac causes of palpitations
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

16. Where does the development of abnormal cervical cells begin?
True
Serotypes 16 - 18 - 31 -52 -58
Giardia
Squamocolumnar junction=most common site of cervical cancer

17. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Diuretics -BB -CCB -ACEi
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

18. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
BB or CCB - catheter ablation of identified bypass tract
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
LH surge triggers ovulation

19. What is considered normal blood loss during a menstrual cycle?
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Rotator cuff tendonitis
Less than 80 ml of blood

20. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
RBC casts and old to moderate HTN
Echocardiogram
S. Aureus

21. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
100mg; means patient can be trace protein positive and not be detected
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Loop diuretics (Check serum K+ levels before drug admin)

22. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Pain
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.
Streptococci
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

23. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
High blood pressure - focal neurologic defecit - or papilledema
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

24. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Nonulcer dyspepsia
Less than 3 stools per week

25. What is the next best step if a patient has two or more positive dipstick tests?
PE - MI - aortic dissection - pneumothorax
A 24hr urine protein collection and urine creatinine clearance determination
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Pancreatitis

26. What is the standard tool used for diagnosis of GERD?
Impetigo
EGD
GERD
Wolff-Parkinson-White syndrome

27. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Adhesive capsulitis (frozen shoulder): most common in middle age women
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

28. What are the three types of lice?
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
Pain
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

29. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Anticoag with warfarin to prevent thromboembolism

30. 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
A central clear area
True
Diuretics -BB -CCB -ACEi
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

31. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Serotypes 16 - 18 - 31 -52 -58
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Coag disorders

32. What are symptoms are CHF?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

33. What medications can cause heart palpitations?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Candida albicans
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

34. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Analgesic headache
Non-cardiac causes of palpitations
Candida albicans
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

35. Name types of laxatives
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Rotator cuff tendonitis

36. Metrorrhagia
Pain
Irregular bleeding between cycles
Coag disorders
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

37. Describe the presentation of pericardial pain
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Kids: Rotavirus Adults: Norwalk Virus
100mg; means patient can be trace protein positive and not be detected
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

38. Describes what occurs during squamous metaplasia of the cervix.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
S. aureus- beta hemolytic streptococcus
GERD

39. PE for a patient getting an abnormal vaginal bleeding work up
Fever with frontal or maxillary tenderness
Less than 80 ml of blood
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

40. How to NSAIDs contribute to gastritis and ulcer formation?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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.
Excessive bleeding in amount - duration - or both at irregular intervals
Influenza - Rhinovirus - Adenovirus - Parainfluenza

41. What is the role of FSH in one's menstrual cycle
Pleurisy
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
Medication or chemical esophagitis

42. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hypertension - CAD - valvular heart disease
24 hour halter
Subarachnoid hemorrhage

43. Define nephrotic range proteinuria
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
>3.5g of protein per 24hrs
CT
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

44. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Viral infection of the semicircular apparatus
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

45. Define the patient population typically affected by orthostatic or postural proteinuria
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
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
Hgb - Electrolytes - and TSH

46. What are the features of glomerular nephritis
Wolff-Parkinson-White syndrome
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
RBC casts and old to moderate HTN
Coag disorders

47. Name 4 factors that predispose an individual to develop pneumonia.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
BB or CCB - catheter ablation of identified bypass tract
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

48. Regular bleeding at intervals of less than 21 days
Analgesic headache
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Fever with frontal or maxillary tenderness
Polymenorrhea

49. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
DM - HTN - DVT - seizures - depression - or anxiety
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

50. Who should have Xray testing for shoulder pain?
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

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