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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. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Echocardiogram
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Rotator Cuff tendonitis

2. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Peptic ulcer disease or gastritis
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

3. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A central clear area
Candida albicans
Pleurisy

4. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Rotator Cuff tendonitis
Associated with hypotension

5. When should invasive eletrophysiologic study should be considered?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

6. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Wolff-Parkinson-White syndrome
Folliculitis
Temporal arteritis-biopsy of the temporal artery

7. What are the primary glomerular diseases?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

8. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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
Variability in the time for follicle development during the proliferative phase
Rotator cuff tendonitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

9. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Coronary artery disease/ angina
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
RBC casts and old to moderate HTN

10. History and PE for Pneumonia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Kids: Rotavirus Adults: Norwalk Virus

11. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Cellulitis
Supraspinatus and bicipital tendons
Coronary artery disease/ angina

12. At was quantity does urine dipstick test detect elevated protein?
Serotypes 16 - 18 - 31 -52 -58
Impetigo
100mg; means patient can be trace protein positive and not be detected
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

13. Initial treatment for Rhinosinusitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Supraspinatus and bicipital tendons
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

14. SE Of Beta blockers?
Kids: Rotavirus Adults: Norwalk Virus
24 hour halter
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

15. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Non-cardiac causes of palpitations
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
Medication or chemical esophagitis
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

16. Describe the presentation of pneumonia
Impetigo
Viral gastroenteritis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

17. 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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Repeat Pap after infection treated
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pleurisy

18. Define nephrotic range proteinuria
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Loop diuretics (Check serum K+ levels before drug admin)
>3.5g of protein per 24hrs
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

19. What type of imaging is need for chronic sinusitis?
These patients are associated with low renin states=less likely to respond to medication
Chest pain during pneumonia or PE
Pleurisy
CT

20. Irregular cycles with excessive flow - duration - or both
Presence of proteinuria on at least two separate ocassion
HIV and syphilis
Menorrhagia
MSK - pulmonary - GI - or psychological

21. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
35 (exception for postmenopausal women who have recently been started on HRT)
Irregular bleeding between cycles
24 hour halter

22. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Giardia

23. Describe the history and PE of patient presenting with common cold
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
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Acute headache - ataxia - profuse nausea - and vomiting

24. Define proteinuria
Staphylococcal scalded skin syndrome
>150mg per 24hrs
Viral infection of the semicircular apparatus
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

25. What are the 2 psych disorders most commonly associated with palpitations?
100mg; means patient can be trace protein positive and not be detected
Generalized Anxiety disorder and panic disorder
Giardia
Bulk forming: Psyllium - Methycellulose - Polycarbophil

26. What are the three types of lice?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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

27. Shoulder pain with pain radiating to elbow
Wolff-Parkinson-White syndrome
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Cervical radiculopathy
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

28. Why is the pap smear one of the most effective cancer screening tools?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Slow progression of cervical cancer changes -Availability of effective early treatment
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

29. Lab testing for heart palpitation
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Hgb - Electrolytes - and TSH
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

30. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Streptococci
Cholelithiasis
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

31. Describe the presentation of pericardial pain
True
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Slow progression of cervical cancer changes -Availability of effective early treatment
Adhesive capsulitis (frozen shoulder): most common in middle age women

32. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Furucnle
Regular bleeding at intervals of more than 35 days
With a KOH wet mount preparation

33. 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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Loop diuretics (Check serum K+ levels before drug admin)
>150mg per 24hrs

34. Name the diagnosis of heartburn: regurgitation - dysphagia
Viral infection of the semicircular apparatus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
GERD
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

35. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
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

36. What are the three major risk factors for heart failure?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Hypertension - CAD - valvular heart disease
Other brainstem or cranial nerve findings
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

37. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Hgb - Electrolytes - and TSH
Colposcopy - Endocervical curettage - and directed cervical biopsy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

38. What treatments are the cornerstone for treating cases of functional constipation?
CT
Increasing fluid (8 - 8oz glasses of water/day) -fiber
100mg; means patient can be trace protein positive and not be detected
A central clear area

39. Tx of chronic or intermittent afibs
Non-cardiac causes of palpitations
Anticoag with warfarin to prevent thromboembolism
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
CT

40. HIgh risk pregnant patients should be evaluated for ____ and ____
>150mg per 24hrs
Pts with palpitations and dizziness - near syncope - or syncope
True
HIV and syphilis

41. How do you define persistent protein uria?
Echocardiogram
Presence of proteinuria on at least two separate ocassion
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

42. Describes what occurs during squamous metaplasia of the cervix.
Pancreatitis
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

43. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
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
Candida albicans
MSK - pulmonary - GI - or psychological
Menorrhagia

44. What the consequences of decreased cardiac output?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Rotator Cuff tendonitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

45. Prenatal visit schedule for low-risk pregnancies
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
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Infectious esophagitis

46. After treatment of dysplasia - women need Pap smears every...
High blood pressure - focal neurologic defecit - or papilledema
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
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

47. Regular bleeding at intervals of less than 21 days
Nonulcer dyspepsia
Polymenorrhea
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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.

48. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Adhesive capsulitis (frozen shoulder): most common in middle age women
PVC or Premature atrial contraction (PAC)
Medication or chemical esophagitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

49. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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.
Non-cardiac causes of palpitations
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

50. What are the symptoms of palpitations?
Staphylococcal scalded skin syndrome
Lightheadedness - dizziness - syncope
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
35 (exception for postmenopausal women who have recently been started on HRT)