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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. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
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
ACEi - ARBS - thiazide diuretics
Giardia

2. Name the skin lesion: honey colored crusts
Dehydration - anemia - cardiac causes
S. Aureus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Impetigo

3. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Dehydration - anemia - cardiac causes
Candida albicans
>3.5g of protein per 24hrs
Rotator Cuff tendonitis

4. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Subarachnoid hemorrhage
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
Supraspinatus and bicipital tendons

5. 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.
Slow progression of cervical cancer changes -Availability of effective early treatment
Furucnle
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

6. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Scabies
Possibility of Ischemic colitis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

7. Define the patient population typically affected by orthostatic or postural proteinuria
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Intermenstrual bleeding
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
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

8. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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

9. name the 4 emergent causes of chest pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
PE - MI - aortic dissection - pneumothorax
>150mg per 24hrs
Anticoag with warfarin to prevent thromboembolism

10. SE Of Beta blockers?
Peptic ulcer disease or gastritis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

11. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pts with palpitations and dizziness - near syncope - or syncope
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Possibility of Ischemic colitis

12. patients with herpes zoster may experience what symptom before the rash appear?
Scleroderma/polymyositis with secondary gastroesophageal reflux
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.
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.
Pain

13. What is the difference between a Holter monitor or an event monitor?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
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.

14. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Viral infection of the semicircular apparatus
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

15. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
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
Serotypes 16 - 18 - 31 -52 -58
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

16. What are the most common causes for the common cold?
Acute headache - ataxia - profuse nausea - and vomiting
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

17. 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)
Infectious esophagitis
Polymenorrhea
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Pts with palpitations and dizziness - near syncope - or syncope
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Menorrhagia

19. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Staphylococcal scalded skin syndrome

20. Cycle length variabilty is primarily due to what?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Variability in the time for follicle development during the proliferative phase
Other brainstem or cranial nerve findings
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
GERD
Cervical radiculopathy
Coronary artery disease/ angina
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

22. Discomfort with abducting the arm past 90 degress
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Rotator Cuff tendonitis
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. aureus- beta hemolytic streptococcus

23. What should preconception counseling include?
Menorrhagia
HPV
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

24. Diagnostic Evaluation of Abnoraml vaginal bleeding
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
BB or CCB - catheter ablation of identified bypass tract
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

25. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
HPV
DM - HTN - DVT - seizures - depression - or anxiety

26. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pancreatitis
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Chest pain during pneumonia or PE

27. Regular bleeding at intervals of less than 21 days
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Polymenorrhea
DM - HTN - DVT - seizures - depression - or anxiety
Influenza - Rhinovirus - Adenovirus - Parainfluenza

28. What are the two common clinical presentations of acute diarrhea?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

29. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Staphylococcal scalded skin syndrome
True
Hgb - Electrolytes - and TSH

30. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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
DM - HTN - DVT - seizures - depression - or anxiety
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

31. What does orthostatic positional changes that bring on dizziness suggest?
Menorrhagia
Lightheadedness - dizziness - syncope
Dehydration - anemia - cardiac causes
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

32. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Giardia
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

33. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Pts with palpitations and dizziness - near syncope - or syncope
Presence of proteinuria on at least two separate ocassion
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Scleroderma/polymyositis with secondary gastroesophageal reflux

34. Uterine bleeding between regular cycles
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
Presence of proteinuria on at least two separate ocassion
Intermenstrual bleeding
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

35. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Pain
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Furucnle

36. What are the primary glomerular diseases?
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
35 (exception for postmenopausal women who have recently been started on HRT)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

37. Name some medications that can cause proteinuria
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

38. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
24 hour halter
Viral gastroenteritis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Dehydration - anemia - cardiac causes

39. Tx of chronic or intermittent afibs
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Anticoag with warfarin to prevent thromboembolism
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

40. How do you define persistent protein uria?
Wolff-Parkinson-White syndrome
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
CT
Presence of proteinuria on at least two separate ocassion

41. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Pain
Pancreatitis

42. How to NSAIDs contribute to gastritis and ulcer formation?
Giardia
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.
Scleroderma/polymyositis with secondary gastroesophageal reflux
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

43. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Variability in the time for follicle development during the proliferative phase
Higher filling presure - pulmonary congestion - and decreasd cardiac return
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

44. What occurs after ovulation
High blood pressure - focal neurologic defecit - or papilledema
Analgesic headache
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

45. Name types of laxatives
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

46. Chronic pain and shoulder stiffness with limited motion
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Adhesive capsulitis (frozen shoulder): most common in middle age women

47. What does treatment for migrans include?
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
Pancreatitis
Hypertension - CAD - valvular heart disease
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

48. 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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Warts
PVC or Premature atrial contraction (PAC)
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

49. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
>150mg per 24hrs
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
24 hour halter
DM - HTN - DVT - seizures - depression - or anxiety

50. What is the preload?
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Giardia
CT