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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. HIgh risk pregnant patients should be evaluated for ____ and ____
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Non-cardiac causes of palpitations
HIV and syphilis

2. 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.
Menorrhagia
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Repeat Pap after infection treated
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

3. Tx of chronic or intermittent afibs
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Squamocolumnar junction=most common site of cervical cancer
Anticoag with warfarin to prevent thromboembolism

4. 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
Temporal arteritis-biopsy of the temporal artery
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Varicella virus
Warts

5. What should preconception counseling include?
A central clear area
Candida albicans
Common problem that resolves spontaneously and is most often seen in children and young adults
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

6. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Acute headache - ataxia - profuse nausea - and vomiting
Candida albicans
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil

7. Oligomenorrhea
Squamocolumnar junction=most common site of cervical cancer
Furucnle
Upper sternal area burning pain - associated with a productive cough
Regular bleeding at intervals of more than 35 days

8. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
BB or CCB - catheter ablation of identified bypass tract
Colposcopy - Endocervical curettage - and directed cervical biopsy

9. Name types of laxatives
24 hour halter
Irregular bleeding between cycles
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

10. What are the indiciations for neuroimaging?
Tension headache
Anticoag with warfarin to prevent thromboembolism
Serotypes 16 - 18 - 31 -52 -58
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

11. SE Of Beta blockers?
Lightheadedness - dizziness - syncope
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

12. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Molluscum contagiosum- pox virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cluster headache
Anticoag with warfarin to prevent thromboembolism

13. What are the signs of acute sinusitis?
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
EGD
Fever with frontal or maxillary tenderness
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

14. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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
Cluster headache
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Less than 3 stools per week

15. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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.

16. What are the signs of cerebral hemorrhage?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Acute headache - ataxia - profuse nausea - and vomiting
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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

17. MI - pericardial tamponade - PE - GI bleed - are...
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
PVC or Premature atrial contraction (PAC)
Repeat Pap after infection treated
Associated with hypotension

18. What the consequences of decreased cardiac output?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Scabies
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
Irregular bleeding between cycles

19. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Rotator Cuff tendonitis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Impetigo
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

20. How does systolic vs. diastolic heart failure present on the echocardiogram?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
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
Possibility of Ischemic colitis

21. How is constipation clinically defined?
Less than 3 stools per week
>150mg per 24hrs
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

22. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Scabies
DM - HTN - DVT - seizures - depression - or anxiety
Bence-Jones
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

23. What is benign transient proteinuria?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Common problem that resolves spontaneously and is most often seen in children and young adults
Tension headache
Other brainstem or cranial nerve findings

24. What test done in PE measures instability of shoulder?
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
LH surge triggers ovulation
Less abrupt onset and cessation of palpitations
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

25. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
These patients are associated with low renin states=less likely to respond to medication
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

26. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Less than 80 ml of blood
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

27. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Bence-Jones
HPV testing -Pos=colposcopy -Neg=repeat pap smear
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

28. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

29. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

30. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Scabies
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
Regular bleeding at intervals of more than 35 days

31. PE for a patient getting an abnormal vaginal bleeding work up
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Influenza - Rhinovirus - Adenovirus - Parainfluenza

32. Diagnostic Evaluation of Abnoraml vaginal bleeding
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest 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

33. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Giardia
Temporal arteritis-biopsy of the temporal artery

34. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Increasing fluid (8 - 8oz glasses of water/day) -fiber
CT

35. What is the peripheral caUse of vertigo?
Medication or chemical esophagitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Chest pain during pneumonia or PE
Temporal arteritis-biopsy of the temporal artery

36. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
S. Aureus
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
>3.5g of protein per 24hrs

37. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Fever with frontal or maxillary tenderness
Upper sternal area burning pain - associated with a productive cough
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Folliculitis

38. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Candida albicans
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
PVC or Premature atrial contraction (PAC)

39. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Upper sternal area burning pain - associated with a productive cough
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Less than 3 stools per week

40. Chronic pain and shoulder stiffness with limited motion
Giardia
Common problem that resolves spontaneously and is most often seen in children and young adults
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

41. What are signs of pulmonary congestion?
Rotator Cuff tendonitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Serotypes 16 - 18 - 31 -52 -58

42. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Dehydration - anemia - cardiac causes
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

43. Complete the sentence: pericarditis can cause frictional rub and......
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

44. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Rotator Cuff tendonitis
Possibility of Ischemic colitis
Squamocolumnar junction=most common site of cervical cancer
Coag disorders

45. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Giardia
Pancreatitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

46. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
35 (exception for postmenopausal women who have recently been started on HRT)

47. Describe the presentation of myocardial pain?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

48. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
35 (exception for postmenopausal women who have recently been started on HRT)

49. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Warts
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

50. Define the patient population typically affected by orthostatic or postural proteinuria
>3.5g of protein per 24hrs
HPV
Scleroderma/polymyositis with secondary gastroesophageal reflux
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