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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. 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.
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Less abrupt onset and cessation of palpitations
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

2. 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
Streptococci
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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.

3. What is the caUse of Meniere disease? What are the cardinal symptoms?
Peptic ulcer disease or gastritis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Serotypes 16 - 18 - 31 -52 -58
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

4. Name types of laxatives
Cluster headache
EGD
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

5. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Candida albicans
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

6. 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
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 abrupt onset and cessation of palpitations
Folliculitis

7. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Streptococci
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
HPV testing -Pos=colposcopy -Neg=repeat pap smear

8. What diagnosis does the 'worse headache of my life' suggest?
Folliculitis
Subarachnoid hemorrhage
Slow progression of cervical cancer changes -Availability of effective early treatment
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

9. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Supraspinatus and bicipital tendons
Less than 3 stools per week
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

10. Name the diagnosis of heartburn: severe constant mid abdominal pain
Dehydration - anemia - cardiac causes
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Pancreatitis

11. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Cholelithiasis
Warts
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

12. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
DM - HTN - DVT - seizures - depression - or anxiety
Paroxysmal atrial fibrillation or supraventricular tachycardia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Repeat Pap after infection treated

13. SE Of Beta blockers?
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Cluster headache
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

14. Describe the history and PE of patient presenting with common cold
Cellulitis
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
A 24hr urine protein collection and urine creatinine clearance determination
CBC

15. Describe the presentation of myocardial pain?
100mg; means patient can be trace protein positive and not be detected
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
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

16. What is the Epley maneuver?
Echocardiogram
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.
Serotypes 16 - 18 - 31 -52 -58
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

17. What lab tests are recommended for newly diagnosed hypertensive patients?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
S. aureus- beta hemolytic streptococcus
Furucnle

18. Name the skin lesion: pustule in association with a hair follice
RBC casts and old to moderate HTN
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
Pleurisy
Folliculitis

19. What is the standard tool used for diagnosis of GERD?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
A central clear area
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
EGD

20. Diagnosis of HTN
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Hgb - Electrolytes - and TSH
Chest pain during pneumonia or PE

21. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

22. Pneumothorax - sudden sharp chest pain - preceded by viral illness
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 BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pleurisy

23. Discomfort with abducting the arm past 90 degress
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
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
Rotator Cuff tendonitis

24. 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
Medication or chemical esophagitis
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
Varicella virus

25. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Albumin; low molecular weight proteins
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

26. What are the consequences of diastolic dysfunction?
Dehydration - anemia - cardiac causes
HIV and syphilis
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Scleroderma/polymyositis with secondary gastroesophageal reflux

27. Name some medications that can cause proteinuria
Lightheadedness - dizziness - syncope
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough
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

28. Lab testing for heart palpitation
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.
35 (exception for postmenopausal women who have recently been started on HRT)
Hgb - Electrolytes - and TSH
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

29. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
PVC or Premature atrial contraction (PAC)

30. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
MSK - pulmonary - GI - or psychological
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
Possibility of Ischemic colitis
35 (exception for postmenopausal women who have recently been started on HRT)

31. What are symptoms are CHF?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Echocardiogram
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

32. Things that need to be included in history of shoulder pain
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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)
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

33. 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
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Peptic ulcer disease or gastritis
Molluscum contagiosum- pox virus

34. At was quantity does urine dipstick test detect elevated protein?
High blood pressure - focal neurologic defecit - or papilledema
>3.5g of protein per 24hrs
100mg; means patient can be trace protein positive and not be detected
Influenza - Rhinovirus - Adenovirus - Parainfluenza

35. Name 4 factors that predispose an individual to develop pneumonia.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Non-cardiac causes of palpitations
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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

36. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
Cellulitis
>150mg per 24hrs
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

37. What is a markers of CNS vertigo?
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Other brainstem or cranial nerve findings
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

38. Define the patient population typically affected by orthostatic or postural proteinuria
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Less than 3 stools per week
Rotator Cuff problem

39. How to NSAIDs contribute to gastritis and ulcer formation?
PE - MI - aortic dissection - pneumothorax
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Temporal arteritis-biopsy of the temporal artery
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.

40. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Wolff-Parkinson-White syndrome
S. Aureus
Tension headache

41. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
E. Coli O157:H7
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

42. Mainstay treatment for soft tissue inflammation (Shoulder)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
Repeat Pap after infection treated
Bence-Jones

43. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Rotator Cuff tendonitis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

44. What are the three types of lice?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Scabies

45. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Loop diuretics (Check serum K+ levels before drug admin)
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
Serotypes 16 - 18 - 31 -52 -58

46. Metrorrhagia
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
Irregular bleeding between cycles
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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

47. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Supraspinatus and bicipital tendons
Staphylococcal scalded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

48. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

49. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
ACEi - ARBS - thiazide diuretics
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
Nonulcer dyspepsia

50. Why is the pap smear one of the most effective cancer screening tools?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Adhesive capsulitis (frozen shoulder): most common in middle age women

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