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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. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Cervical radiculopathy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

2. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
>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
Increase; 200 g/day
Colposcopy - Endocervical curettage - and directed cervical biopsy

3. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Less abrupt onset and cessation of palpitations
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pain
Viral infection of the semicircular apparatus

4. What should be considered in younger patients with menorrhagia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Coag disorders
Regular bleeding at intervals of more than 35 days
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

5. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

6. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Slow progression of cervical cancer changes -Availability of effective early treatment
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
HPV testing -Pos=colposcopy -Neg=repeat pap smear

7. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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.
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. What are signs of pulmonary congestion?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

9. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pts with palpitations and dizziness - near syncope - or syncope

10. 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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cluster headache
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

11. What should preconception counseling include?
Generalized Anxiety disorder and panic disorder
Excessive bleeding in amount - duration - or both at irregular intervals
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
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

12. Define nephrotic range proteinuria
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
>3.5g of protein per 24hrs
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Upper sternal area burning pain - associated with a productive cough

13. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
DM - HTN - DVT - seizures - depression - or anxiety
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Excessive bleeding in amount - duration - or both at irregular intervals

14. What drugs do you use to treat H.pylori + PUD?
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.
Repeat Pap after infection treated
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

15. What are the three types of lice?
Albumin; low molecular weight proteins
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Hgb - Electrolytes - and TSH
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

16. 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.
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

17. What is a markers of CNS vertigo?
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
With a KOH wet mount preparation
Loop diuretics (Check serum K+ levels before drug admin)
Other brainstem or cranial nerve findings

18. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
HPV
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.
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

19. What is the goal of CHF treatment? What drugs should be used?
PVC or Premature atrial contraction (PAC)
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
35 (exception for postmenopausal women who have recently been started on HRT)
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

20. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
PE - MI - aortic dissection - pneumothorax
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
A central clear area

21. 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.
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
100mg; means patient can be trace protein positive and not be detected
Repeat Pap after infection treated

22. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
35 (exception for postmenopausal women who have recently been started on HRT)
24 hour halter
Upper sternal area burning pain - associated with a productive cough
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

23. What does treatment for migrans include?
Subarachnoid hemorrhage
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Molluscum contagiosum- pox virus

24. name the 4 emergent causes of chest pain
Streptococci
Wolff-Parkinson-White syndrome
PE - MI - aortic dissection - pneumothorax
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

25. Carcinoma in situ is generally referred to a gynecologist and requires ______
>150mg per 24hrs
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
Medication or chemical esophagitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

26. Name the skin lesion: pustule in association with a hair follice
Folliculitis
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.
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pancreatitis

27. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Loop diuretics (Check serum K+ levels before drug admin)
Common problem that resolves spontaneously and is most often seen in children and young adults
Less abrupt onset and cessation of palpitations
Nonulcer dyspepsia

28. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
Infectious esophagitis
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
MSK - pulmonary - GI - or psychological
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

29. Name the diagnosis of heartburn: regurgitation - dysphagia
GERD
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

30. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
GERD

31. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
35 (exception for postmenopausal women who have recently been started on HRT)
Coronary artery disease/ angina
Irregular bleeding between cycles

32. What is afterload?
100mg; means patient can be trace protein positive and not be detected
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
S. aureus- beta hemolytic streptococcus

33. Things that need to be included in history of shoulder pain
Staphylococcal scalded skin syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

34. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Hypertension - CAD - valvular heart disease
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

35. Predictors of cardiac etiology
PE - MI - aortic dissection - pneumothorax
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
MSK - pulmonary - GI - or psychological
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

36. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Possibility of Ischemic colitis
Supraspinatus and bicipital tendons

37. What are the indiciations for neuroimaging?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

38. Natural history of cervical cancer
>150mg per 24hrs
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

39. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
ACEi
Diuretics -BB -CCB -ACEi
Cholelithiasis

40. Name some medications that can cause proteinuria
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

41. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
DM - HTN - DVT - seizures - depression - or anxiety
Coronary artery disease/ angina

42. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
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

43. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
HIV and syphilis
Possibility of Ischemic colitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Pleurisy

44. What is the role of FSH in one's menstrual cycle
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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
Increase; 200 g/day

45. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

46. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pancreatitis
PVC or Premature atrial contraction (PAC)

47. 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)
Temporal arteritis-biopsy of the temporal artery
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

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
Warts
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
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.
Less than 80 ml of blood

49. What HPV serotypes are most commonly associated with cervical cancer?
Giardia
ACEi - ARBS - thiazide diuretics
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Serotypes 16 - 18 - 31 -52 -58

50. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Excessive bleeding in amount - duration - or both at irregular intervals
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Slow progression of cervical cancer changes -Availability of effective early treatment