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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. Regular bleeding at intervals of less than 21 days
CBC
Associated with hypotension
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
Polymenorrhea

2. Things that need to be included in history of shoulder pain
Cholelithiasis
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

3. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Adhesive capsulitis (frozen shoulder): most common in middle age women
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
True
Streptococci

4. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
RBC casts and old to moderate HTN
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

5. What is an acoustic neuroma?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

6. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Bence-Jones
Irregular bleeding between cycles
Coag disorders
Coronary artery disease/ angina

7. History and PE for Pneumonia
Variability in the time for follicle development during the proliferative phase
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
EGD

8. Prenatal visit schedule for low-risk pregnancies
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
MSK - pulmonary - GI - or psychological
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

9. 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
Impetigo
Viral infection of the semicircular apparatus
Less than 80 ml of blood

10. What treatments are the cornerstone for treating cases of functional constipation?
Anticoag with warfarin to prevent thromboembolism
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

11. Name the skin lesion: pustule in association with a hair follice
Tension headache
Folliculitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

12. Why is the pap smear one of the most effective cancer screening tools?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

13. 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
Bence-Jones
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
Common problem that resolves spontaneously and is most often seen in children and young adults

14. What are the secondly causes of glomerular disease?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Possibility of Ischemic colitis

15. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
Viral infection of the semicircular apparatus
HIV and syphilis
Presence of proteinuria on at least two separate ocassion
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

16. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Scabies
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
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

17. Initial treatment for Rhinosinusitis
ACEi - ARBS - thiazide diuretics
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

18. What are the features of nephrotic syndrome?
Subarachnoid hemorrhage
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
CBC
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

19. Name the skin lesion: honey colored crusts
Kids: Rotavirus Adults: Norwalk Virus
Impetigo
Supraspinatus and bicipital tendons
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

20. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Scabies
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

21. What are the symptoms of palpitations?
Generalized Anxiety disorder and panic disorder
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Lightheadedness - dizziness - syncope
Loop diuretics (Check serum K+ levels before drug admin)

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

23. What is the goal of CHF treatment? What drugs should be used?
ACEi - ARBS - thiazide diuretics
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
LH surge triggers ovulation
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

24. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Rotator Cuff problem
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
Repeat Pap after infection treated

25. PE for a patient getting an abnormal vaginal bleeding work up
A 24hr urine protein collection and urine creatinine clearance determination
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

26. 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
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Bulk forming: Psyllium - Methycellulose - Polycarbophil
PE - MI - aortic dissection - pneumothorax

27. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
With a KOH wet mount preparation
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Wolff-Parkinson-White syndrome
Impetigo

28. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Colposcopy - Endocervical curettage - and directed cervical biopsy
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Squamocolumnar junction=most common site of cervical cancer
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

29. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
ACEi
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

30. Describe the presentation of pneumonia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

31. Vaccines that should be updated before planned pregnancy
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
HIV and syphilis
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

32. Cycle length variabilty is primarily due to what?
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Medication or chemical esophagitis
Variability in the time for follicle development during the proliferative phase

33. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Scleroderma/polymyositis with secondary gastroesophageal reflux
DM - HTN - DVT - seizures - depression - or anxiety
Increase; 200 g/day
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

34. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
MSK - pulmonary - GI - or psychological
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
>3.5g of protein per 24hrs
Diuretics -BB -CCB -ACEi

35. History for Acute bronchitis
Analgesic headache
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Folliculitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

36. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Albumin; low molecular weight proteins
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

37. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
RBC casts and old to moderate HTN
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

38. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
True
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Associated with hypotension

39. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
PVC or Premature atrial contraction (PAC)
Rotator Cuff problem
24 hour halter
Loop diuretics (Check serum K+ levels before drug admin)

40. 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.
LH surge triggers ovulation
GERD
Repeat Pap after infection treated
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

41. Predictors of cardiac etiology
Loop diuretics (Check serum K+ levels before drug admin)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

42. Pneumonia tx: suitable for healthy adults older than 60
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Nonulcer dyspepsia
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

43. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Temporal arteritis-biopsy of the temporal artery

44. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Lightheadedness - dizziness - syncope
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
Medication or chemical esophagitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

45. 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
Varicella virus
HIV and syphilis
HPV
Lightheadedness - dizziness - syncope

46. What lab tests are recommended for newly diagnosed hypertensive patients?
Coag disorders
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Menorrhagia

47. Diagnostic Evaluation of Abnoraml vaginal bleeding
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
HIV and syphilis
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
Viral gastroenteritis

48. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

49. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Staphylococcal scalded skin syndrome
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Bulk forming: Psyllium - Methycellulose - Polycarbophil

50. Who should have Xray testing for shoulder pain?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Staphylococcal scalded skin syndrome

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