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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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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. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Scabies
Streptococci
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

2. Tx of chronic or intermittent afibs
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
Coag disorders
Anticoag with warfarin to prevent thromboembolism
Coronary artery disease/ angina

3. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Generalized Anxiety disorder and panic disorder
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

4. What are the secondly causes of glomerular disease?
GERD
Pancreatitis
Giardia
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

5. When is a lumbar puncture contraindicated?
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

6. Who should have Xray testing for shoulder pain?
E. Coli O157:H7
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

7. Clinical Manifestations of HTN
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Acute headache - ataxia - profuse nausea - and vomiting
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

8. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Warts
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Colposcopy - Endocervical curettage - and directed cervical biopsy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

9. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Pleurisy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
LH surge triggers ovulation

10. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Dehydration - anemia - cardiac causes
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
BB or CCB - catheter ablation of identified bypass tract

11. 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
>3.5g of protein per 24hrs
Excessive bleeding in amount - duration - or both at irregular intervals
Analgesic headache

12. Name 4 factors that predispose an individual to develop pneumonia.
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
HIV and syphilis
Anticoag with warfarin to prevent thromboembolism
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

13. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Peptic ulcer disease or gastritis
Serotypes 16 - 18 - 31 -52 -58
Molluscum contagiosum- pox virus
Albumin; low molecular weight proteins

14. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Wolff-Parkinson-White syndrome
Polymenorrhea

15. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Serotypes 16 - 18 - 31 -52 -58
Diuretics -BB -CCB -ACEi
Rotator Cuff problem
PE - MI - aortic dissection - pneumothorax

16. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
True
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

17. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Less than 3 stools per week

18. 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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

19. What are signs of pulmonary congestion?
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
Coag disorders
CT
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

20. When should invasive eletrophysiologic study should be considered?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
CBC
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

21. What places women at higher risk of getting cervical cancer?
Cluster headache
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
Less than 80 ml of blood
GERD

22. Describe the presentation of pericardial pain
Paroxysmal atrial fibrillation or supraventricular tachycardia
Increase; 200 g/day
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

23. 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.
Variability in the time for follicle development during the proliferative phase
Albumin; low molecular weight proteins
Tension headache
Bulk forming: Psyllium - Methycellulose - Polycarbophil

24. How does systolic vs. diastolic heart failure present on the echocardiogram?
Pleurisy
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
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

25. 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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Viral infection of the semicircular apparatus
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Scabies

26. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
>150mg per 24hrs
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

27. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral gastroenteritis
Rotator Cuff tendonitis

28. How can GERD (or esophageal motility disorders) lead to chest pain?
GERD
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

29. What are the symptoms of palpitations?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Lightheadedness - dizziness - syncope
Repeat Pap after infection treated
100mg; means patient can be trace protein positive and not be detected

30. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
GERD
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
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

31. Name the skin lesion: erythema - warmth - edema - pain - fever
Presence of proteinuria on at least two separate ocassion
Cellulitis
Staphylococcal scalded skin syndrome
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.

32. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Possibility of Ischemic colitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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
Repeat Pap after infection treated

33. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Less than 80 ml of blood
With a KOH wet mount preparation
Wolff-Parkinson-White syndrome

34. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
PVC or Premature atrial contraction (PAC)
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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. Oligomenorrhea
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
HPV
Regular bleeding at intervals of more than 35 days

36. What are symptoms are CHF?
Intermenstrual bleeding
BB or CCB - catheter ablation of identified bypass tract
PVC or Premature atrial contraction (PAC)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

37. What are the signs of malignant hypertension?
True
High blood pressure - focal neurologic defecit - or papilledema
Tension headache
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

38. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
These patients are associated with low renin states=less likely to respond to medication
Intermenstrual bleeding
Less abrupt onset and cessation of palpitations
Nonulcer dyspepsia

39. patients with herpes zoster may experience what symptom before the rash appear?
Fever with frontal or maxillary tenderness
Pancreatitis
Pain
S. Aureus

40. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
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
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

41. History for Sinusitis

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42. What are the two common clinical presentations of acute diarrhea?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

43. Why don't ACEi work well for the elderly and African Americans when treating HTN?
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
Cluster headache
These patients are associated with low renin states=less likely to respond to medication
Generalized Anxiety disorder and panic disorder

44. What is an acoustic neuroma?
Regular bleeding at intervals of more than 35 days
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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
Cluster headache

45. Lab testing for heart palpitation
Hgb - Electrolytes - and TSH
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

46. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Anticoag with warfarin to prevent thromboembolism
Regular bleeding at intervals of more than 35 days
Infectious esophagitis

47. What are the features of nephrotic syndrome?
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
S. aureus- beta hemolytic streptococcus
BB or CCB - catheter ablation of identified bypass tract
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

48. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Medication or chemical esophagitis
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

49. Diarrhea from custard filled pastries
Kids: Rotavirus Adults: Norwalk Virus
35 (exception for postmenopausal women who have recently been started on HRT)
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
S. Aureus

50. Uterine bleeding between regular cycles
Non-cardiac causes of palpitations
Intermenstrual bleeding
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

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