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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. Describe the presentation of pericardial pain
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

2. 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.
Regular bleeding at intervals of more than 35 days
High blood pressure - focal neurologic defecit - or papilledema
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

3. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Bence-Jones
Associated with hypotension
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Adhesive capsulitis (frozen shoulder): most common in middle age women

4. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Scleroderma/polymyositis with secondary gastroesophageal reflux
Temporal arteritis-biopsy of the temporal artery
Tension headache

5. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Coronary artery disease/ angina
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

6. When is a lumbar puncture contraindicated?
>150mg per 24hrs
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
S. aureus- beta hemolytic streptococcus

7. Describe the presentation tracheobronchitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Furucnle
Upper sternal area burning pain - associated with a productive cough

8. What are the three major risk factors for heart failure?
CBC
Hypertension - CAD - valvular heart disease
Scleroderma/polymyositis with secondary gastroesophageal reflux
Generalized Anxiety disorder and panic disorder

9. 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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Non-cardiac causes of palpitations
Cluster headache
Influenza - Rhinovirus - Adenovirus - Parainfluenza

10. What diagnosis does the 'worse headache of my life' suggest?
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
Subarachnoid hemorrhage
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Nonulcer dyspepsia

11. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Less than 80 ml of blood
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Subarachnoid hemorrhage
Colposcopy - Endocervical curettage - and directed cervical biopsy

12. Prenatal visit schedule for low-risk pregnancies
Increase; 200 g/day
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Candida albicans
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

13. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
MSK - pulmonary - GI - or psychological
Staphylococcal scalded skin syndrome
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Colposcopy - Endocervical curettage - and directed cervical biopsy

14. What is benign transient proteinuria?
Medication or chemical esophagitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Common problem that resolves spontaneously and is most often seen in children and young adults
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

15. What is the mechanism of action for stimulant agents in treating constipation?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

16. History and PE for Pneumonia
Giardia
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
Hgb - Electrolytes - and TSH
ACEi

17. Uterine bleeding between regular cycles
Intermenstrual bleeding
Albumin; low molecular weight proteins
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.
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

18. What are the signs of malignant hypertension?
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
High blood pressure - focal neurologic defecit - or papilledema
Slow progression of cervical cancer changes -Availability of effective early treatment
PVC or Premature atrial contraction (PAC)

19. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Colposcopy - Endocervical curettage - and directed cervical biopsy
Possibility of Ischemic colitis

20. What are the indiciations for neuroimaging?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
LH surge triggers ovulation
>150mg per 24hrs
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

21. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Acute headache - ataxia - profuse nausea - and vomiting
Paroxysmal atrial fibrillation or supraventricular tachycardia
A central clear area

22. What are the signs of cerebral hemorrhage?
Folliculitis
Less than 80 ml of blood
Polymenorrhea
Acute headache - ataxia - profuse nausea - and vomiting

23. History for Sinusitis

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24. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

25. Describe the presentation of pneumonia
Rotator Cuff problem
Cellulitis
Chest pain during pneumonia or PE
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

26. What is the Barany maneuver?
Impetigo
HPV
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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

27. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Excessive bleeding in amount - duration - or both at irregular intervals
Variability in the time for follicle development during the proliferative phase
Possibility of Ischemic colitis

28. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Pts with palpitations and dizziness - near syncope - or syncope
Diuretics -BB -CCB -ACEi
Viral gastroenteritis
Bulk forming: Psyllium - Methycellulose - Polycarbophil

29. Cycle length variabilty is primarily due to what?
>150mg per 24hrs
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
Variability in the time for follicle development during the proliferative phase
Associated with hypotension

30. What are symptoms are CHF?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Subarachnoid hemorrhage
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

31. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
Viral infection of the semicircular apparatus
Scleroderma/polymyositis with secondary gastroesophageal reflux
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

32. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Viral gastroenteritis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Hypertension - CAD - valvular heart disease

33. Who should have Xray testing for shoulder pain?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Pain
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

34. Natural history of cervical cancer
Temporal arteritis-biopsy of the temporal artery
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
Increase; 200 g/day

35. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Possibility of Ischemic colitis
Regular bleeding at intervals of more than 35 days
Folliculitis

36. How can GERD (or esophageal motility disorders) lead to chest pain?
A central clear area
>3.5g of protein per 24hrs
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Varicella virus

37. 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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Scabies
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

38. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Repeat Pap after infection treated
Upper sternal area burning pain - associated with a productive cough
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

39. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Medication or chemical esophagitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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

40. What drugs do you use to treat H.pylori + PUD?
EGD
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
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

41. Tx of chronic or intermittent afibs
Lightheadedness - dizziness - syncope
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Anticoag with warfarin to prevent thromboembolism
ACEi

42. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
PVC or Premature atrial contraction (PAC)
Cervical radiculopathy
Less than 80 ml of blood
Echocardiogram

43. How to NSAIDs contribute to gastritis and ulcer formation?
MSK - pulmonary - GI - or psychological
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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.
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

44. What should preconception counseling include?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
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
Hypertension - CAD - valvular heart disease

45. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Kids: Rotavirus Adults: Norwalk Virus
Less than 3 stools per week
Folliculitis
S. aureus- beta hemolytic streptococcus

46. Four muscles of rotator cuff
Squamocolumnar junction=most common site of cervical cancer
PE - MI - aortic dissection - pneumothorax
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

47. Name some medications that can cause proteinuria
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Nonulcer dyspepsia

48. When should a patient get a stress test?
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
Regular bleeding at intervals of more than 35 days
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pain

49. 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
Furucnle
Possibility of Ischemic colitis
True
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

50. What is a markers of CNS vertigo?
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
Other brainstem or cranial nerve findings
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Squamocolumnar junction=most common site of cervical cancer

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