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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. 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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Hgb - Electrolytes - and TSH

2. MI - pericardial tamponade - PE - GI bleed - are...
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Associated with hypotension
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

3. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
35 (exception for postmenopausal women who have recently been started on HRT)
Pancreatitis
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
MSK - pulmonary - GI - or psychological

4. What is the standard tool used for diagnosis of GERD?
Hgb - Electrolytes - and TSH
Excessive bleeding in amount - duration - or both at irregular intervals
EGD
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

5. When is a lumbar puncture contraindicated?
Coronary artery disease/ angina
Less than 80 ml of blood
Nonulcer dyspepsia
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

6. What is the Epley maneuver?
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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

7. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pancreatitis

8. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Varicella virus
DM - HTN - DVT - seizures - depression - or anxiety
Molluscum contagiosum- pox virus
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

9. Describe the history and PE of patient presenting with common cold
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Anticoag with warfarin to prevent thromboembolism
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

10. What are the common causes for laryngitis?
RBC casts and old to moderate HTN
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Folliculitis

11. Why is the pap smear one of the most effective cancer screening tools?
ACEi - ARBS - thiazide diuretics
Slow progression of cervical cancer changes -Availability of effective early treatment
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Nonulcer dyspepsia

12. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Associated with hypotension
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Streptococci

13. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
These patients are associated with low renin states=less likely to respond to medication
Scleroderma/polymyositis with secondary gastroesophageal reflux
Rotator cuff tendonitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

14. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Menorrhagia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Colposcopy - Endocervical curettage - and directed cervical biopsy

15. How is constipation clinically defined?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Less than 3 stools per week
Furucnle
Subarachnoid hemorrhage

16. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

17. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
GERD
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

18. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Lightheadedness - dizziness - syncope
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. Isolated - extra pounding beats
Viral gastroenteritis
Coronary artery disease/ angina
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
PVC or Premature atrial contraction (PAC)

20. What are the indiciations for neuroimaging?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Medication or chemical esophagitis

21. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Impetigo

22. What HPV serotypes are most commonly associated with cervical cancer?
Varicella virus
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
Serotypes 16 - 18 - 31 -52 -58

23. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Lightheadedness - dizziness - syncope
Non-cardiac causes of palpitations
Coronary artery disease/ angina

24. Describe the presentation of 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
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
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
Coronary artery disease/ angina

25. How to NSAIDs contribute to gastritis and ulcer formation?
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.
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
HIV and syphilis

26. Describe the presentation tracheobronchitis
Upper sternal area burning pain - associated with a productive cough
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Infectious esophagitis

27. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Peptic ulcer disease or gastritis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

28. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Repeat Pap after infection treated
Viral gastroenteritis
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Infectious esophagitis

29. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Scabies
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

30. 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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Medication or chemical esophagitis
Common problem that resolves spontaneously and is most often seen in children and young adults

31. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Infectious esophagitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

32. What are the signs of acute sinusitis?
Non-cardiac causes of palpitations
Fever with frontal or maxillary tenderness
Slow progression of cervical cancer changes -Availability of effective early treatment
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

33. 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
CBC
Cluster headache
Scabies
With a KOH wet mount preparation

34. Pneumonia tx: suitable for healthy adults older than 60
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

35. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
>150mg per 24hrs
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
Supraspinatus and bicipital tendons

36. What are the features of glomerular nephritis
Less than 80 ml of blood
RBC casts and old to moderate HTN
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
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

37. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bulk forming: Psyllium - Methycellulose - Polycarbophil

38. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Viral infection of the semicircular apparatus

39. Describe the presentation of pneumonia
Candida albicans
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Increasing fluid (8 - 8oz glasses of water/day) -fiber
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

40. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Pancreatitis
Squamocolumnar junction=most common site of cervical cancer
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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.

41. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
High blood pressure - focal neurologic defecit - or papilledema
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Infectious esophagitis

42. What are the 2 psych disorders most commonly associated with palpitations?
Rotator cuff tendonitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Generalized Anxiety disorder and panic disorder
Increase; 200 g/day

43. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
These patients are associated with low renin states=less likely to respond to medication
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

44. How does systolic vs. diastolic heart failure present on the echocardiogram?
DM - HTN - DVT - seizures - depression - or anxiety
Cervical radiculopathy
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
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. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Chest pain during pneumonia or PE
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

46. After treatment of dysplasia - women need Pap smears every...
E. Coli O157:H7
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Impetigo
Adhesive capsulitis (frozen shoulder): most common in middle age women

47. What are the physical exam signs of CHF?
S. aureus- beta hemolytic streptococcus
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
E. Coli O157:H7
Common problem that resolves spontaneously and is most often seen in children and young adults

48. What does treatment for migrans include?
Candida albicans
Presence of proteinuria on at least two separate ocassion
Loop diuretics (Check serum K+ levels before drug admin)
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

49. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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

50. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Subarachnoid hemorrhage
Wolff-Parkinson-White syndrome
Echocardiogram

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