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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. Describes what occurs during squamous metaplasia of the cervix.
Cholelithiasis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Subarachnoid hemorrhage
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

2. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Staphylococcal scalded skin syndrome

3. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
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

4. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Candida albicans
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
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

5. When does troponin rise following myocardial injury or infarction?
Viral infection of the semicircular apparatus
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

6. Chronic pain and shoulder stiffness with limited motion
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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
Viral infection of the semicircular apparatus
Adhesive capsulitis (frozen shoulder): most common in middle age women

7. What should blood work include for suspected heart failure?
Pts with palpitations and dizziness - near syncope - or syncope
Loop diuretics (Check serum K+ levels before drug admin)
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
CBC

8. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Anticoag with warfarin to prevent thromboembolism
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
LH surge triggers ovulation

9. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pts with palpitations and dizziness - near syncope - or syncope
Colposcopy - Endocervical curettage - and directed cervical biopsy
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

10. What are the most common viral causes of diarrhea in kids and adults?
Kids: Rotavirus Adults: Norwalk Virus
DM - HTN - DVT - seizures - depression - or anxiety
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
BB or CCB - catheter ablation of identified bypass tract

11. Four muscles of rotator cuff
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
GERD
Associated with hypotension
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

12. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Upper sternal area burning pain - associated with a productive cough
EGD
RBC casts and old to moderate HTN
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

13. Menometrorrhagia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Excessive bleeding in amount - duration - or both at irregular intervals
Diuretics -BB -CCB -ACEi
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

14. Carcinoma in situ is generally referred to a gynecologist and requires ______
DM - HTN - DVT - seizures - depression - or anxiety
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

15. Describe the presentation of angina?
35 (exception for postmenopausal women who have recently been started on HRT)
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
Bence-Jones
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

16. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

17. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Temporal arteritis-biopsy of the temporal artery
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
S. Aureus
HPV

18. Name types of laxatives
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
True
E. Coli O157:H7
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

19. What test done in PE measures instability of shoulder?
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
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
Pancreatitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

20. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Lightheadedness - dizziness - syncope
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Possibility of Ischemic colitis
Peptic ulcer disease or gastritis

21. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
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.
Loop diuretics (Check serum K+ levels before drug admin)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

22. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Repeat Pap after infection treated
Upper sternal area burning pain - associated with a productive cough
Pancreatitis
Loop diuretics (Check serum K+ levels before drug admin)

23. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Variability in the time for follicle development during the proliferative phase
High blood pressure - focal neurologic defecit - or papilledema
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Medication or chemical esophagitis

24. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Intermenstrual bleeding
Viral gastroenteritis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

25. How is constipation clinically defined?
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Less than 3 stools per week
Scleroderma/polymyositis with secondary gastroesophageal reflux

26. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
HIV and syphilis
Polymenorrhea
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

27. Name the skin lesion: erythema - warmth - edema - pain - fever
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pts with palpitations and dizziness - near syncope - or syncope
Cellulitis
Bence-Jones

28. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Common problem that resolves spontaneously and is most often seen in children and young adults
Regular bleeding at intervals of more than 35 days
Echocardiogram

29. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Analgesic headache

30. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

31. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Fever with frontal or maxillary tenderness
Hypertension - CAD - valvular heart disease
A central clear area

32. Cycle length variabilty is primarily due to what?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Variability in the time for follicle development during the proliferative phase
Non-cardiac causes of palpitations

33. Lab testing for heart palpitation
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
Pancreatitis
Hgb - Electrolytes - and TSH
ACEi

34. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Cervical radiculopathy
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

35. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
LH surge triggers ovulation
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

36. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
LH surge triggers ovulation
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Paroxysmal atrial fibrillation or supraventricular tachycardia

37. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Supraspinatus and bicipital tendons
24 hour halter
Regular bleeding at intervals of more than 35 days
Pts with palpitations and dizziness - near syncope - or syncope

38. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
When the patient has symptoms in association with exercise or who describe chest pain or pressure
A 24hr urine protein collection and urine creatinine clearance determination
Scabies

39. Where does the development of abnormal cervical cells begin?
Supraspinatus and bicipital tendons
High blood pressure - focal neurologic defecit - or papilledema
Hgb - Electrolytes - and TSH
Squamocolumnar junction=most common site of cervical cancer

40. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Folliculitis
Albumin; low molecular weight proteins
DM - HTN - DVT - seizures - depression - or anxiety

41. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
When the patient has symptoms in association with exercise or who describe chest pain or pressure
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

42. What are the physical exam signs of CHF?
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
BB or CCB - catheter ablation of identified bypass tract
DM - HTN - DVT - seizures - depression - or anxiety
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

43. What are the primary glomerular diseases?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Giardia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

44. patients with herpes zoster may experience what symptom before the rash appear?
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
Pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

45. What type of imaging is need for chronic sinusitis?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
CT
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

46. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
PVC or Premature atrial contraction (PAC)
Candida albicans
Presence of proteinuria on at least two separate ocassion
Coag disorders

47. What diagnosis does the 'worse headache of my life' suggest?
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Subarachnoid hemorrhage

48. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Common problem that resolves spontaneously and is most often seen in children and young adults
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Paroxysmal atrial fibrillation or supraventricular tachycardia

49. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
CBC
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

50. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Less than 80 ml of blood
Adhesive capsulitis (frozen shoulder): most common in middle age women
When the patient has symptoms in association with exercise or who describe chest pain or pressure