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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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1. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pain
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

2. Why is the pap smear one of the most effective cancer screening tools?
Slow progression of cervical cancer changes -Availability of effective early treatment
HPV
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
HIV and syphilis

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

4. name the 4 emergent causes of chest pain
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
100mg; means patient can be trace protein positive and not be detected
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
PE - MI - aortic dissection - pneumothorax

5. Describe the presentation tracheobronchitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.
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
Upper sternal area burning pain - associated with a productive cough

6. What are the most common viral causes of diarrhea in kids and adults?
Folliculitis
Coronary artery disease/ angina
Kids: Rotavirus Adults: Norwalk Virus
A central clear area

7. What are the three types of lice?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Generalized Anxiety disorder and panic disorder

8. SE Of Beta blockers?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Colposcopy - Endocervical curettage - and directed cervical biopsy
Influenza - Rhinovirus - Adenovirus - Parainfluenza

9. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
S. aureus- beta hemolytic streptococcus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Bence-Jones
Loop diuretics (Check serum K+ levels before drug admin)

10. What are the signs of malignant hypertension?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
High blood pressure - focal neurologic defecit - or papilledema
Lightheadedness - dizziness - syncope
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

11. Diagnosis of HTN
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
MSK - pulmonary - GI - or psychological
PVC or Premature atrial contraction (PAC)

12. 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
Molluscum contagiosum- pox 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
Presence of proteinuria on at least two separate ocassion
Coag disorders

13. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
PVC or Premature atrial contraction (PAC)
Adhesive capsulitis (frozen shoulder): most common in middle age women
Bence-Jones

14. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

15. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Warts
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
PE - MI - aortic dissection - pneumothorax

16. How are fungal infections diagnosed?
ACEi - ARBS - thiazide diuretics
With a KOH wet mount preparation
Scabies
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

17. What the consequences of decreased cardiac output?
Viral gastroenteritis
Associated with hypotension
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

18. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Intermenstrual bleeding
Pts with palpitations and dizziness - near syncope - or syncope
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

19. Name the skin lesion: erythema - warmth - edema - pain - fever
Rotator cuff tendonitis
Cellulitis
Coronary artery disease/ angina
Tension headache

20. Difference between Pneumonia and Bronchitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Wolff-Parkinson-White syndrome
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
Chest pain during pneumonia or PE

21. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
GERD
CBC

22. Natural history of cervical cancer
E. Coli O157:H7
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Cellulitis

23. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Rotator Cuff problem
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

24. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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
>150mg per 24hrs
35 (exception for postmenopausal women who have recently been started on HRT)
CBC

25. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
High blood pressure - focal neurologic defecit - or papilledema
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
24 hour halter

26. Vaccines that should be updated before planned pregnancy
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
Chest pain during pneumonia or PE
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

27. How do you define persistent protein uria?
Cellulitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Presence of proteinuria on at least two separate ocassion
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

28. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
HIV and syphilis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Kids: Rotavirus Adults: Norwalk Virus

29. What should be considered in younger patients with menorrhagia
BB or CCB - catheter ablation of identified bypass tract
Regular bleeding at intervals of more than 35 days
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
Coag disorders

30. What should preconception counseling include?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
PVC or Premature atrial contraction (PAC)

31. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Polymenorrhea
Squamocolumnar junction=most common site of cervical cancer
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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

32. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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
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
Fever with frontal or maxillary tenderness

33. What is an acoustic neuroma?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Pancreatitis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

34. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
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
Non-cardiac causes of palpitations
Polymenorrhea

35. What are the features of glomerular nephritis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
RBC casts and old to moderate HTN
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hgb - Electrolytes - and TSH

36. HIgh risk pregnant patients should be evaluated for ____ and ____
GERD
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
DM - HTN - DVT - seizures - depression - or anxiety
HIV and syphilis

37. Four muscles of rotator cuff
35 (exception for postmenopausal women who have recently been started on HRT)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Medication or chemical esophagitis
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

38. Oligomenorrhea
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pleurisy
Candida albicans
Regular bleeding at intervals of more than 35 days

39. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
DM - HTN - DVT - seizures - depression - or anxiety
Intermenstrual bleeding

40. Regular bleeding at intervals of less than 21 days
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Upper sternal area burning pain - associated with a productive cough
Wolff-Parkinson-White syndrome
Polymenorrhea

41. What is benign transient proteinuria?
Cluster headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Common problem that resolves spontaneously and is most often seen in children and young adults

42. 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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Associated with hypotension
Warts
Infectious esophagitis

43. What are the signs of cerebral hemorrhage?
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
Anticoag with warfarin to prevent thromboembolism
Acute headache - ataxia - profuse nausea - and vomiting
>3.5g of protein per 24hrs

44. Uterine bleeding between regular cycles
Intermenstrual bleeding
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
True
Hypertension - CAD - valvular heart disease

45. Treatment for supraventricular tachycardias
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
BB or CCB - catheter ablation of identified bypass tract
With a KOH wet mount preparation
Folliculitis

46. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Colposcopy - Endocervical curettage - and directed cervical biopsy
Acute headache - ataxia - profuse nausea - and vomiting
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Viral gastroenteritis

47. Name the diagnosis of heartburn: regurgitation - dysphagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
GERD
Temporal arteritis-biopsy of the temporal artery

48. What type of imaging is need for chronic sinusitis?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
CT
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

49. 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
Folliculitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Repeat Pap after infection treated

50. What are symptoms are CHF?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Chest pain during pneumonia or PE
Cluster headache

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