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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. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Anticoag with warfarin to prevent thromboembolism
Loop diuretics (Check serum K+ levels before drug admin)
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

2. 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
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
Serotypes 16 - 18 - 31 -52 -58
Scabies
DM - HTN - DVT - seizures - depression - or anxiety

3. 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
Kids: Rotavirus Adults: Norwalk Virus
Analgesic headache
GERD

4. 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
Infectious esophagitis
ACEi
Molluscum contagiosum- pox virus
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

5. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Slow progression of cervical cancer changes -Availability of effective early treatment
Pts with palpitations and dizziness - near syncope - or syncope
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

6. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Serotypes 16 - 18 - 31 -52 -58
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

7. Shoulder pain with pain radiating to elbow
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
Cervical radiculopathy
HPV testing -Pos=colposcopy -Neg=repeat pap smear
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

8. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Rotator cuff tendonitis

9. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Regular bleeding at intervals of more than 35 days
Adhesive capsulitis (frozen shoulder): most common in middle age women
Rotator Cuff problem

10. Name the diagnosis of heartburn: severe constant mid abdominal pain
With a KOH wet mount preparation
Rotator Cuff tendonitis
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
Pancreatitis

11. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
24 hour halter
HPV testing -Pos=colposcopy -Neg=repeat pap smear
RBC casts and old to moderate HTN
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

12. 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.
Varicella virus
Hypertension - CAD - valvular heart disease
Tension headache
Anticoag with warfarin to prevent thromboembolism

13. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Nonulcer dyspepsia
Pancreatitis

14. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
24 hour halter
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
Loop diuretics (Check serum K+ levels before drug admin)

15. What the consequences of decreased cardiac output?
Viral gastroenteritis
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
Coronary artery disease/ angina
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

16. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Hgb - Electrolytes - and TSH
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

17. HIgh risk pregnant patients should be evaluated for ____ and ____
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
GERD
HIV and syphilis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

18. Define the patient population typically affected by orthostatic or postural proteinuria
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Intermenstrual bleeding
Nonulcer dyspepsia

19. 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
Warts
Associated with hypotension
Colposcopy - Endocervical curettage - and directed cervical biopsy

20. Constipation: What are indications for lab testing?
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
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
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.
Medication or chemical esophagitis

21. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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
Impetigo
Chest pain during pneumonia or PE

22. How to NSAIDs contribute to gastritis and ulcer formation?
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.
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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

23. What are the common causes for laryngitis?
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Kids: Rotavirus Adults: Norwalk Virus

24. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
High blood pressure - focal neurologic defecit - or papilledema
100mg; means patient can be trace protein positive and not be detected
Temporal arteritis-biopsy of the temporal artery
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

25. What diagnosis does the 'worse headache of my life' suggest?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Paroxysmal atrial fibrillation or supraventricular tachycardia
Subarachnoid hemorrhage
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

26. 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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
24 hour halter
Repeat Pap after infection treated

27. Diagnosis of HTN
Lightheadedness - dizziness - syncope
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
True
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

28. What type of imaging is need for chronic sinusitis?
Chest pain during pneumonia or PE
High blood pressure - focal neurologic defecit - or papilledema
Pts with palpitations and dizziness - near syncope - or syncope
CT

29. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Pain
RBC casts and old to moderate HTN
Impetigo

30. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Kids: Rotavirus Adults: Norwalk Virus
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. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Giardia
Other brainstem or cranial nerve findings
100mg; means patient can be trace protein positive and not be detected

32. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Nonulcer dyspepsia
DM - HTN - DVT - seizures - depression - or anxiety
Colposcopy - Endocervical curettage - and directed cervical biopsy
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. Diarrhea from custard filled pastries
S. Aureus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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.
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

34. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Slow progression of cervical cancer changes -Availability of effective early treatment
Streptococci
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. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Anticoag with warfarin to prevent thromboembolism
Cluster headache
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Kids: Rotavirus Adults: Norwalk Virus

36. Complete the sentence: pericarditis can cause frictional rub and......
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

37. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Diuretics -BB -CCB -ACEi
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

38. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
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
Folliculitis

39. Name 4 factors that predispose an individual to develop pneumonia.
Lightheadedness - dizziness - syncope
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
24 hour halter

40. What are the two common clinical presentations of acute diarrhea?
With a KOH wet mount preparation
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

41. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Associated with hypotension
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Candida albicans

42. Describes what occurs during squamous metaplasia of the cervix.
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Adhesive capsulitis (frozen shoulder): most common in middle age women
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

43. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Non-cardiac causes of palpitations

44. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Variability in the time for follicle development during the proliferative phase
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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

45. What are symptoms are CHF?
Viral gastroenteritis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
LH surge triggers ovulation

46. What are the indiciations for neuroimaging?
Furucnle
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Streptococci
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

47. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Pleurisy
ACEi
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

48. Pneumonia tx: suitable for healthy adults older than 60
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
High blood pressure - focal neurologic defecit - or papilledema
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

49. What are the primary glomerular diseases?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
When the patient has symptoms in association with exercise or who describe chest pain or pressure

50. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Furucnle
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart