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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. Metrorrhagia
Irregular bleeding between cycles
HPV testing -Pos=colposcopy -Neg=repeat pap smear
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

2. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Rotator cuff tendonitis
Less than 80 ml of blood
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

3. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
Temporal arteritis-biopsy of the temporal artery
Cellulitis
Varicella virus
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

4. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Coronary artery disease/ angina
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
Candida albicans
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

5. 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
Cluster headache
ACEi
Squamocolumnar junction=most common site of cervical cancer
True

6. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
LH surge triggers ovulation
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Loop diuretics (Check serum K+ levels before drug admin)
Warts

7. What are the features of glomerular nephritis
CT
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
RBC casts and old to moderate HTN
Scleroderma/polymyositis with secondary gastroesophageal reflux

8. What occurs after ovulation
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)
Giardia
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

9. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

10. Where does the development of abnormal cervical cells begin?
Squamocolumnar junction=most common site of cervical cancer
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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

11. 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.
Tension headache
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
Folliculitis
Other brainstem or cranial nerve findings

12. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Squamocolumnar junction=most common site of cervical cancer
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Menorrhagia

13. Isolated - extra pounding beats
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
24 hour halter
PVC or Premature atrial contraction (PAC)

14. Chronic pain and shoulder stiffness with limited motion
Less than 3 stools per week
Fever with frontal or maxillary tenderness
Adhesive capsulitis (frozen shoulder): most common in middle age women
Nonulcer dyspepsia

15. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Rotator Cuff tendonitis

16. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pain

17. What is the next best step if a patient has two or more positive dipstick tests?
Variability in the time for follicle development during the proliferative phase
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
A 24hr urine protein collection and urine creatinine clearance determination
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

18. What the consequences of decreased cardiac output?
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
E. Coli O157:H7
Less abrupt onset and cessation of palpitations
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

19. 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
RBC casts and old to moderate HTN
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Squamocolumnar junction=most common site of cervical cancer

20. Vaccines that should be updated before planned pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
True
S. aureus- beta hemolytic streptococcus

21. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Slow progression of cervical cancer changes -Availability of effective early treatment
DM - HTN - DVT - seizures - depression - or anxiety
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Supraspinatus and bicipital tendons

22. Name the diagnosis of heartburn: severe constant mid abdominal pain
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Medication or chemical esophagitis
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Pancreatitis

23. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Loop diuretics (Check serum K+ levels before drug admin)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

24. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
>3.5g of protein per 24hrs
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Echocardiogram
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

25. How do you know if heart palpitations are due to stimulant or medication use?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Less abrupt onset and cessation of palpitations
Bulk forming: Psyllium - Methycellulose - Polycarbophil

26. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Viral infection of the semicircular apparatus
Supraspinatus and bicipital tendons
These patients are associated with low renin states=less likely to respond to medication
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

27. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Dehydration - anemia - cardiac causes
Less abrupt onset and cessation of palpitations
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

28. What is the caUse of benign positional vertigo?
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.
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
Pain
Slow progression of cervical cancer changes -Availability of effective early treatment

29. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

30. What is the preload?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Repeat Pap after infection treated
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Higher filling presure - pulmonary congestion - and decreasd cardiac return

31. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Polymenorrhea
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
Warts

32. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Wolff-Parkinson-White 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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Viral gastroenteritis

33. Menometrorrhagia
Excessive bleeding in amount - duration - or both at irregular intervals
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
35 (exception for postmenopausal women who have recently been started on HRT)
Bulk forming: Psyllium - Methycellulose - Polycarbophil

34. What should blood work include for suspected heart failure?
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

35. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Associated with hypotension
Streptococci
Less than 3 stools per week

36. Pneumonia tx: suitable for healthy adults older than 60
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Regular bleeding at intervals of more than 35 days

37. Describes what occurs during squamous metaplasia of the cervix.
ACEi
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

38. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Coag disorders

39. Describe the presentation of pneumonia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
E. Coli O157:H7

40. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Dehydration - anemia - cardiac causes
Furucnle
Diuretics -BB -CCB -ACEi
Viral infection of the semicircular apparatus

41. Why is the pap smear one of the most effective cancer screening tools?
BB or CCB - catheter ablation of identified bypass tract
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Slow progression of cervical cancer changes -Availability of effective early treatment
HPV testing -Pos=colposcopy -Neg=repeat pap smear

42. Describe the presentation of angina?
S. Aureus
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Albumin; low molecular weight proteins

43. Name types of laxatives
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Medication or chemical esophagitis

44. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Candida albicans

45. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Upper sternal area burning pain - associated with a productive cough
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Candida albicans

46. What is the role of FSH in one's menstrual cycle
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Other brainstem or cranial nerve findings
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Temporal arteritis-biopsy of the temporal artery

47. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Peptic ulcer disease or gastritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Loop diuretics (Check serum K+ levels before drug admin)

48. Natural history of cervical cancer
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
100mg; means patient can be trace protein positive and not be detected
Pancreatitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

49. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
CBC
Medication or chemical esophagitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Tension headache

50. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Pancreatitis
Scleroderma/polymyositis with secondary gastroesophageal reflux
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

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