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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. 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.
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
Repeat Pap after infection treated
Infectious esophagitis
True

2. Define proteinuria
High blood pressure - focal neurologic defecit - or papilledema
Presence of proteinuria on at least two separate ocassion
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
>150mg per 24hrs

3. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Excessive bleeding in amount - duration - or both at irregular intervals
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Echocardiogram

4. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Cellulitis
Viral infection of the semicircular apparatus
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

5. Prenatal visit schedule for low-risk pregnancies
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
Acute headache - ataxia - profuse nausea - and vomiting
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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

6. Oligomenorrhea
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
Echocardiogram
Regular bleeding at intervals of more than 35 days
Temporal arteritis-biopsy of the temporal artery

7. MI - pericardial tamponade - PE - GI bleed - are...
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Coag disorders
Associated with hypotension

8. What type of imaging is need for chronic sinusitis?
Irregular bleeding between cycles
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.
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
CT

9. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

10. HIgh risk pregnant patients should be evaluated for ____ and ____
Hgb - Electrolytes - and TSH
HIV and syphilis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

11. What are the consequences of diastolic dysfunction?
E. Coli O157:H7
CBC
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Scabies

12. How does CHF present on X-ray?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Possibility of Ischemic colitis

13. What are the signs of acute sinusitis?
Menorrhagia
Fever with frontal or maxillary tenderness
Paroxysmal atrial fibrillation or supraventricular tachycardia
Associated with hypotension

14. Isolated - extra pounding beats
Folliculitis
Serotypes 16 - 18 - 31 -52 -58
Diuretics -BB -CCB -ACEi
PVC or Premature atrial contraction (PAC)

15. What medications can cause heart palpitations?
BB or CCB - catheter ablation of identified bypass tract
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Candida albicans
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

16. History for Sinusitis

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17. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
Analgesic headache
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

18. name the 4 emergent causes of chest pain
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Presence of proteinuria on at least two separate ocassion
PE - MI - aortic dissection - pneumothorax

19. Pneumonia tx: suitable for healthy adults less than 60
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
35 (exception for postmenopausal women who have recently been started on HRT)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

20. Who should have Xray testing for shoulder pain?
Infectious esophagitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Associated with hypotension
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.

21. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
HPV testing -Pos=colposcopy -Neg=repeat pap smear

22. What test done in PE measures instability of shoulder?
Giardia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Nonulcer dyspepsia

23. What is the next best step if a patient has two or more positive dipstick tests?
Irregular bleeding between cycles
A 24hr urine protein collection and urine creatinine clearance determination
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

24. Initial treatment for Rhinosinusitis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Furucnle
Dehydration - anemia - cardiac causes
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

25. What are the three types of lice?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

26. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Loop diuretics (Check serum K+ levels before drug admin)
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

27. How is constipation clinically defined?
Less than 3 stools per week
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
A central clear area

28. 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.
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
Tension headache
PVC or Premature atrial contraction (PAC)
Serotypes 16 - 18 - 31 -52 -58

29. Diagnostic Evaluation of Abnoraml vaginal bleeding
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Variability in the time for follicle development during the proliferative phase
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

30. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Less than 3 stools per week
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Pleurisy

31. Diarrhea from custard filled pastries
S. Aureus
Hgb - Electrolytes - and TSH
Acute headache - ataxia - profuse nausea - and vomiting
100mg; means patient can be trace protein positive and not be detected

32. Pain in shoulder when throwing - swimming - or serving a tennis ball
CBC
Rotator cuff tendonitis
Possibility of Ischemic colitis
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

33. What drugs do you use to treat H.pylori + PUD?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Viral infection of the semicircular apparatus
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

34. Metrorrhagia
Irregular bleeding between cycles
Streptococci
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

35. Name the skin lesion: honey colored crusts
Supraspinatus and bicipital tendons
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
Impetigo
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

36. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Scabies
Intermenstrual bleeding
Chest pain during pneumonia or PE

37. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
>3.5g of protein per 24hrs
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
True

38. What should blood work include for suspected heart failure?
Rotator Cuff tendonitis
Nonulcer dyspepsia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

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
E. Coli O157:H7
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
PVC or Premature atrial contraction (PAC)
Less than 80 ml of blood

40. What should preconception counseling include?
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
MSK - pulmonary - GI - or psychological
Cellulitis

41. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
35 (exception for postmenopausal women who have recently been started on HRT)

42. What occurs after ovulation
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

43. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Associated with hypotension
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Viral gastroenteritis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

44. What is the difference between a Holter monitor or an event monitor?
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Albumin; low molecular weight proteins
Viral gastroenteritis

45. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Squamocolumnar junction=most common site of cervical cancer
Chest pain during pneumonia or PE

46. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
35 (exception for postmenopausal women who have recently been started on HRT)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Wolff-Parkinson-White syndrome
CBC

47. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Lightheadedness - dizziness - syncope
CT
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

48. What is the Epley maneuver?
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
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
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.
24 hour halter

49. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Loop diuretics (Check serum K+ levels before drug admin)
HPV
Hypertension - CAD - valvular heart disease

50. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
HPV
With a KOH wet mount preparation