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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Rotator Cuff tendonitis
Viral infection of the semicircular apparatus

2. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
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
Streptococci
RBC casts and old to moderate HTN
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

3. What is afterload?
Subarachnoid hemorrhage
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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
BB or CCB - catheter ablation of identified bypass tract

4. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.

5. What is the next best step if a patient has two or more positive dipstick tests?
These patients are associated with low renin states=less likely to respond to medication
A 24hr urine protein collection and urine creatinine clearance determination
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Polymenorrhea

6. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Possibility of Ischemic colitis
S. aureus- beta hemolytic streptococcus
Kids: Rotavirus Adults: Norwalk Virus

7. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
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
ACEi

8. 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.
Molluscum contagiosum- pox virus
HPV
True
Tension headache

9. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Upper sternal area burning pain - associated with a productive cough
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Common problem that resolves spontaneously and is most often seen in children and young adults
Viral gastroenteritis

10. What are the common causes for laryngitis?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

11. How does systolic vs. diastolic heart failure present on the echocardiogram?
Other brainstem or cranial nerve findings
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Chest pain during pneumonia or PE

12. When does troponin rise following myocardial injury or infarction?
Hypertension - CAD - valvular heart disease
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

13. How does CHF present on X-ray?
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

14. Treatment for supraventricular tachycardias
Squamocolumnar junction=most common site of cervical cancer
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
BB or CCB - catheter ablation of identified bypass tract
RBC casts and old to moderate HTN

15. What should blood work include for suspected heart failure?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Less abrupt onset and cessation of palpitations
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Candida albicans

16. 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
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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Varicella virus
Generalized Anxiety disorder and panic disorder

17. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
Albumin; low molecular weight proteins
ACEi - ARBS - thiazide diuretics
Presence of proteinuria on at least two separate ocassion

18. What is the role of FSH in one's menstrual cycle
With a KOH wet mount preparation
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
ACEi - ARBS - thiazide diuretics

19. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Wolff-Parkinson-White syndrome
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Possibility of Ischemic colitis

20. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
Generalized Anxiety disorder and panic disorder
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

21. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
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.
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

22. What is the preload?
CT
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Anticoag with warfarin to prevent thromboembolism
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

23. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Presence of proteinuria on at least two separate ocassion
Loop diuretics (Check serum K+ levels before drug admin)
Streptococci
Pts with palpitations and dizziness - near syncope - or syncope

24. How is constipation clinically defined?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
Less than 3 stools per week
>150mg per 24hrs

25. How do you know if heart palpitations are due to stimulant or medication use?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Scabies
Less abrupt onset and cessation of palpitations
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

26. What are the most common viral causes of diarrhea in kids and adults?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Molluscum contagiosum- pox virus
Kids: Rotavirus Adults: Norwalk Virus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

27. What are the signs of malignant hypertension?
Cluster headache
High blood pressure - focal neurologic defecit - or papilledema
Viral gastroenteritis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

28. At was quantity does urine dipstick test detect elevated protein?
Albumin; low molecular weight proteins
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
100mg; means patient can be trace protein positive and not be detected
Temporal arteritis-biopsy of the temporal artery

29. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Medication or chemical esophagitis

30. What are the signs of cerebral hemorrhage?
Regular bleeding at intervals of more than 35 days
Acute headache - ataxia - profuse nausea - and vomiting
Serotypes 16 - 18 - 31 -52 -58
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

31. 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.
Repeat Pap after infection treated
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
GERD
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

32. What are the features of glomerular nephritis
Medication or chemical esophagitis
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
RBC casts and old to moderate HTN
Acute headache - ataxia - profuse nausea - and vomiting

33. Describe the presentation of myocardial pain?
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Rotator cuff tendonitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza

34. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
Staphylococcal scalded skin syndrome
Infectious esophagitis
With a KOH wet mount preparation

35. 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
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.
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

36. What are the three types of lice?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pleurisy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Kids: Rotavirus Adults: Norwalk Virus

37. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Bence-Jones
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Menorrhagia

38. What is the standard tool used for diagnosis of GERD?
Intermenstrual bleeding
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
EGD

39. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Hypertension - CAD - valvular heart disease
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
Pleurisy
Paroxysmal atrial fibrillation or supraventricular tachycardia

40. What medications can cause heart palpitations?
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
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Peptic ulcer disease or gastritis

41. What does treatment for migrans include?
Adhesive capsulitis (frozen shoulder): most common in middle age women
Polymenorrhea
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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

42. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Chest pain during pneumonia or PE
Folliculitis
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

43. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Diuretics -BB -CCB -ACEi
Nonulcer dyspepsia
HPV testing -Pos=colposcopy -Neg=repeat pap smear

44. What drugs do you use to treat H.pylori + PUD?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
Viral infection of the semicircular apparatus
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

45. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
CT
PVC or Premature atrial contraction (PAC)

46. Describe the presentation of pericardial pain
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.

47. Uterine bleeding between regular cycles
Intermenstrual bleeding
DM - HTN - DVT - seizures - depression - or anxiety
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Cluster headache

48. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

49. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

50. Name the skin lesion: erythema - warmth - edema - pain - fever
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
E. Coli O157:H7
EGD
Cellulitis

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