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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. What lab tests are recommended for newly diagnosed hypertensive patients?
Coronary artery disease/ angina
CT
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

2. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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
Rotator Cuff tendonitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Common problem that resolves spontaneously and is most often seen in children and young adults

3. What are the features of glomerular nephritis
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Cervical radiculopathy
RBC casts and old to moderate HTN

4. Why is the pap smear one of the most effective cancer screening tools?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Slow progression of cervical cancer changes -Availability of effective early treatment
Variability in the time for follicle development during the proliferative phase
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

5. Describe the presentation of pneumonia
Polymenorrhea
Anticoag with warfarin to prevent thromboembolism
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

6. What are the signs of cerebral hemorrhage?
Variability in the time for follicle development during the proliferative phase
Rotator cuff tendonitis
Acute headache - ataxia - profuse nausea - and vomiting
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

7. Metrorrhagia
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
True
Irregular bleeding between cycles

8. HIgh risk pregnant patients should be evaluated for ____ and ____
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
HIV and syphilis
DM - HTN - DVT - seizures - depression - or anxiety
Hypertension - CAD - valvular heart disease

9. Describe the presentation of pericardial pain
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
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.
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

10. Who should have Xray testing for shoulder pain?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

11. Things that need to be included in history of shoulder pain
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
Impetigo
Anticoag with warfarin to prevent thromboembolism
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

12. Describe the history and PE of patient presenting with common cold
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Cervical radiculopathy

13. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
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
MSK - pulmonary - GI - or psychological
Viral gastroenteritis
Scleroderma/polymyositis with secondary gastroesophageal reflux

14. What is the mechanism of action for stimulant agents in treating constipation?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

15. What are the consequences of diastolic dysfunction?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Acute headache - ataxia - profuse nausea - and vomiting

16. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Rotator cuff tendonitis
Non-cardiac causes of palpitations
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.
RBC casts and old to moderate HTN

17. Where does the development of abnormal cervical cells begin?
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Viral gastroenteritis
Squamocolumnar junction=most common site of cervical cancer

18. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Presence of proteinuria on at least two separate ocassion
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

19. What are symptoms are CHF?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Hgb - Electrolytes - and TSH
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Impetigo

20. Diagnosis of HTN
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Adhesive capsulitis (frozen shoulder): most common in middle age women
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Coronary artery disease/ angina

22. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Intermenstrual bleeding
DM - HTN - DVT - seizures - depression - or anxiety
Chest pain during pneumonia or PE
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

23. How can GERD (or esophageal motility disorders) lead to chest pain?
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
DM - HTN - DVT - seizures - depression - or anxiety
Dehydration - anemia - cardiac causes
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

24. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Impetigo
Acute headache - ataxia - profuse nausea - and vomiting
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
ACEi - ARBS - thiazide diuretics

25. Pneumonia tx: suitable for healthy adults older than 60
Pleurisy
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.
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Influenza - Rhinovirus - Adenovirus - Parainfluenza

26. What is the caUse of benign positional vertigo?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Supraspinatus and bicipital tendons
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.

27. Name some medications that can cause proteinuria
Upper sternal area burning pain - associated with a productive cough
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
100mg; means patient can be trace protein positive and not be detected

28. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Albumin; low molecular weight proteins

29. What does orthostatic positional changes that bring on dizziness suggest?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Intermenstrual bleeding
Acute headache - ataxia - profuse nausea - and vomiting
Dehydration - anemia - cardiac causes

30. How do you define persistent protein uria?
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
Squamocolumnar junction=most common site of cervical cancer
Presence of proteinuria on at least two separate ocassion
Furucnle

31. 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
Temporal arteritis-biopsy of the temporal artery
Variability in the time for follicle development during the proliferative phase
Staphylococcal scalded skin syndrome

32. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Infectious esophagitis
Peptic ulcer disease or gastritis
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

33. Describe the presentation of angina?
Increase; 200 g/day
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

34. Name the skin lesion: honey colored crusts
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Impetigo
Serotypes 16 - 18 - 31 -52 -58

35. What treatments are the cornerstone for treating cases of functional constipation?
RBC casts and old to moderate HTN
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Increasing fluid (8 - 8oz glasses of water/day) -fiber

36. 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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

37. What are the 2 psych disorders most commonly associated with palpitations?
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
Generalized Anxiety disorder and panic disorder
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.
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

38. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Coronary artery disease/ angina
Rotator cuff tendonitis

39. Name the skin lesion: erythema - warmth - edema - pain - fever
Giardia
Cellulitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

40. What is the Barany maneuver?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Slow progression of cervical cancer changes -Availability of effective early treatment
Intermenstrual bleeding
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

41. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

42. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Molluscum contagiosum- pox virus
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
S. aureus- beta hemolytic streptococcus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

43. What are the indiciations for neuroimaging?
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
>150mg per 24hrs
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

44. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Rotator Cuff problem

45. What are the physical exam signs of CHF?
Possibility of Ischemic colitis
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
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.
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

46. What is the peripheral caUse of vertigo?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Giardia
Echocardiogram

47. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

48. How does systolic vs. diastolic heart failure present on the echocardiogram?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
Fever with frontal or maxillary tenderness
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

49. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

50. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Tension headache
Colposcopy - Endocervical curettage - and directed cervical biopsy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

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