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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. Carcinoma in situ is generally referred to a gynecologist and requires ______
Less than 3 stools per week
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Infectious esophagitis

2. What is a markers of CNS vertigo?
Peptic ulcer disease or gastritis
Other brainstem or cranial nerve findings
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
CBC

3. What are the signs of cerebral hemorrhage?
Irregular bleeding between cycles
Diuretics -BB -CCB -ACEi
Acute headache - ataxia - profuse nausea - and vomiting
Bence-Jones

4. Uterine bleeding between regular cycles
Intermenstrual bleeding
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
EGD
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

5. What medications can cause heart palpitations?
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Coronary artery disease/ angina

6. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pleurisy
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

7. How does systolic vs. diastolic heart failure present on the echocardiogram?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Coronary artery disease/ angina
Dehydration - anemia - cardiac causes
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

8. What are the most common viral causes of diarrhea in kids and adults?
Furucnle
Kids: Rotavirus Adults: Norwalk Virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Acute headache - ataxia - profuse nausea - and vomiting

9. When does troponin rise following myocardial injury or infarction?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

10. Pneumonia tx: suitable for healthy adults older than 60
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.
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

11. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Nonulcer dyspepsia
Hypertension - CAD - valvular heart disease
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

12. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Albumin; low molecular weight proteins
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Increase; 200 g/day
ACEi

13. Describe the presentation tracheobronchitis
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
Cervical radiculopathy
Upper sternal area burning pain - associated with a productive cough

14. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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.
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Scleroderma/polymyositis with secondary gastroesophageal reflux
35 (exception for postmenopausal women who have recently been started on HRT)

15. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
PVC or Premature atrial contraction (PAC)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Wolff-Parkinson-White syndrome

16. What places women at higher risk of getting cervical cancer?
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
Loop diuretics (Check serum K+ levels before drug admin)
Varicella virus
Serotypes 16 - 18 - 31 -52 -58

17. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
PVC or Premature atrial contraction (PAC)
Increase; 200 g/day
DM - HTN - DVT - seizures - depression - or anxiety
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

18. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
S. aureus- beta hemolytic streptococcus
Pain
Non-cardiac causes of palpitations

19. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
35 (exception for postmenopausal women who have recently been started on HRT)
Regular bleeding at intervals of more than 35 days
Varicella virus

20. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
PE - MI - aortic dissection - pneumothorax
Cluster headache
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
EGD

21. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
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
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
Bence-Jones
CBC

22. Initial treatment for Rhinosinusitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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
Generalized Anxiety disorder and panic disorder
Staphylococcal scalded skin syndrome

23. What lab tests are recommended for newly diagnosed hypertensive patients?
Irregular bleeding between cycles
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pts with palpitations and dizziness - near syncope - or syncope
HPV testing -Pos=colposcopy -Neg=repeat pap smear

24. 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
Molluscum contagiosum- pox virus
Pain
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

25. patients with herpes zoster may experience what symptom before the rash appear?
Kids: Rotavirus Adults: Norwalk Virus
Menorrhagia
Pain
Dehydration - anemia - cardiac causes

26. What are signs of pulmonary congestion?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Rotator cuff tendonitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

27. What should be considered in younger patients with menorrhagia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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.
EGD
Coag disorders

28. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
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.
Tension headache
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

29. Treatment for supraventricular tachycardias
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
BB or CCB - catheter ablation of identified bypass tract

30. What is the Epley maneuver?
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.
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
These patients are associated with low renin states=less likely to respond to medication

31. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Viral gastroenteritis
Presence of proteinuria on at least two separate ocassion

32. What is afterload?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
Streptococci

33. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
Rotator Cuff tendonitis
Analgesic headache
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

34. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
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

35. Clinical Manifestations of HTN
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Bence-Jones
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

36. 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
Hgb - Electrolytes - and TSH
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

37. After treatment of dysplasia - women need Pap smears every...
Impetigo
Bence-Jones
Temporal arteritis-biopsy of the temporal artery
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

38. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
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
Hypertension - CAD - valvular heart disease
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

39. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
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
PE - MI - aortic dissection - pneumothorax
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

40. Define the patient population typically affected by orthostatic or postural proteinuria
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Less than 3 stools per week
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

41. Name the skin lesion: honey colored crusts
Coronary artery disease/ angina
True
Serotypes 16 - 18 - 31 -52 -58
Impetigo

42. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Lightheadedness - dizziness - syncope
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

43. What are the indiciations for neuroimaging?
Pleurisy
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Hgb - Electrolytes - and TSH

44. Diagnostic Evaluation of Abnoraml vaginal bleeding
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
With a KOH wet mount preparation
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

45. What the consequences of decreased cardiac output?
CT
BB or CCB - catheter ablation of identified bypass tract
With a KOH wet mount preparation
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

46. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Medication or chemical esophagitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi - ARBS - thiazide diuretics

47. What are the signs of malignant hypertension?
Viral gastroenteritis
>150mg per 24hrs
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
High blood pressure - focal neurologic defecit - or papilledema

48. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
Generalized Anxiety disorder and panic disorder
BB or CCB - catheter ablation of identified bypass tract
Warts

49. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Rotator Cuff problem

50. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
With a KOH wet mount preparation
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
These patients are associated with low renin states=less likely to respond to medication