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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.
Albumin; low molecular weight proteins
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
S. aureus- beta hemolytic streptococcus
Squamocolumnar junction=most common site of cervical cancer

2. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
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
Rotator Cuff problem
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

3. Pneumonia tx: suitable for healthy adults older than 60
Medication or chemical esophagitis
Coronary artery disease/ angina
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

4. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Molluscum contagiosum- pox virus
>3.5g of protein per 24hrs
Common problem that resolves spontaneously and is most often seen in children and young adults

5. History and PE for Pneumonia
Molluscum contagiosum- pox virus
PE - MI - aortic dissection - pneumothorax
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
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

6. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Echocardiogram
Other brainstem or cranial nerve findings
Medication or chemical esophagitis
Paroxysmal atrial fibrillation or supraventricular tachycardia

7. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Coronary artery disease/ angina
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

8. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Intermenstrual bleeding
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
Presence of proteinuria on at least two separate ocassion

9. What is the Barany maneuver?
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
Rotator Cuff tendonitis
Cholelithiasis
35 (exception for postmenopausal women who have recently been started on HRT)

10. What are the features of nephrotic syndrome?
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Streptococci
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

11. What are the most common viral causes of diarrhea in kids and adults?
ACEi - ARBS - thiazide diuretics
Kids: Rotavirus Adults: Norwalk Virus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

12. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
HPV
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Kids: Rotavirus Adults: Norwalk Virus

13. What does orthostatic positional changes that bring on dizziness suggest?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Dehydration - anemia - cardiac causes
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

14. What does treatment for migrans include?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

15. Complete the sentence: pericarditis can cause frictional rub and......
Analgesic headache
Streptococci
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

16. What type of imaging is need for chronic sinusitis?
CT
Bence-Jones
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Less abrupt onset and cessation of palpitations

17. 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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
HIV and syphilis
Molluscum contagiosum- pox virus
Scleroderma/polymyositis with secondary gastroesophageal reflux

18. HIgh risk pregnant patients should be evaluated for ____ and ____
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Irregular bleeding between cycles
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
HIV and syphilis

19. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
E. Coli O157:H7
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

20. Predictors of cardiac etiology
Fever with frontal or maxillary tenderness
35 (exception for postmenopausal women who have recently been started on HRT)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

21. How are fungal infections diagnosed?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
>150mg per 24hrs
24 hour halter
With a KOH wet mount preparation

22. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
E. Coli O157:H7

23. Who should have Xray testing for shoulder pain?
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

24. Four muscles of rotator cuff
Associated with hypotension
Anticoag with warfarin to prevent thromboembolism
E. Coli O157:H7
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

25. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Less than 80 ml of blood
Peptic ulcer disease or gastritis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

26. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
ACEi
Acute headache - ataxia - profuse nausea - and vomiting
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
Streptococci

27. Initial treatment for Rhinosinusitis
RBC casts and old to moderate HTN
Higher filling presure - pulmonary congestion - and decreasd cardiac return
True
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

28. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Tension headache
Upper sternal area burning pain - associated with a productive cough
Lightheadedness - dizziness - syncope

29. 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
Staphylococcal scalded skin syndrome
Rotator Cuff problem
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.

30. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Streptococci
Serotypes 16 - 18 - 31 -52 -58
Dehydration - anemia - cardiac causes

31. What diagnosis does the 'worse headache of my life' suggest?
E. Coli O157:H7
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
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
Subarachnoid hemorrhage

32. What is benign transient 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
Polymenorrhea
Common problem that resolves spontaneously and is most often seen in children and young adults
Less abrupt onset and cessation of palpitations

33. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Lightheadedness - dizziness - syncope
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
Medication or chemical esophagitis
Cervical radiculopathy

34. 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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Warts
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
Chest pain during pneumonia or PE

35. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Staphylococcal scalded skin syndrome
Viral infection of the semicircular apparatus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
HPV testing -Pos=colposcopy -Neg=repeat pap smear

36. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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

37. Mainstay treatment for soft tissue inflammation (Shoulder)
24 hour halter
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
True

38. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
E. Coli O157:H7
Tension headache
Intermenstrual bleeding
Infectious esophagitis

39. 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
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
ACEi
E. Coli O157:H7
Candida albicans

40. What are the features of glomerular nephritis
Cervical radiculopathy
Rotator Cuff tendonitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
RBC casts and old to moderate HTN

41. Diarrhea from custard filled pastries
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Increasing fluid (8 - 8oz glasses of water/day) -fiber
S. Aureus
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

42. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Pts with palpitations and dizziness - near syncope - or syncope
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Analgesic headache
Hypertension - CAD - valvular heart disease
Impetigo

44. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Squamocolumnar junction=most common site of cervical cancer
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
PVC or Premature atrial contraction (PAC)
MSK - pulmonary - GI - or psychological

45. What are the physical exam signs of CHF?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Cellulitis
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

46. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Bence-Jones
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Rotator Cuff problem
Chest pain during pneumonia or PE

47. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Common problem that resolves spontaneously and is most often seen in children and young adults
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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
Medication or chemical esophagitis

48. What lab tests are recommended for newly diagnosed hypertensive patients?
Giardia
Nonulcer dyspepsia
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

49. Treatment for supraventricular tachycardias
Fever with frontal or maxillary tenderness
BB or CCB - catheter ablation of identified bypass tract
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 24hr urine protein collection and urine creatinine clearance determination

50. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
S. aureus- beta hemolytic streptococcus
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
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