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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 leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
PVC or Premature atrial contraction (PAC)
Tension headache
Giardia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

2. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
LH surge triggers ovulation
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

3. Metrorrhagia
EGD
Cellulitis
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Irregular bleeding between cycles

4. Name 4 factors that predispose an individual to develop pneumonia.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Molluscum contagiosum- pox virus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

5. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
EGD
Tension headache
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Temporal arteritis-biopsy of the temporal artery

6. Shoulder pain with pain radiating to elbow
Regular bleeding at intervals of more than 35 days
Cervical radiculopathy
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
Intermenstrual bleeding

7. What does the classic ring worm lesion have?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
A central clear area
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Infectious esophagitis

8. 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
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
Cluster headache
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

9. 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.
Supraspinatus and bicipital tendons
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
Analgesic headache
Squamocolumnar junction=most common site of cervical cancer

10. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
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
Pts with palpitations and dizziness - near syncope - or syncope
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pleurisy

11. Chronic pain and shoulder stiffness with limited motion
Staphylococcal scalded skin syndrome
These patients are associated with low renin states=less likely to respond to medication
Lightheadedness - dizziness - syncope
Adhesive capsulitis (frozen shoulder): most common in middle age women

12. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

13. What are the common causes for laryngitis?
Hypertension - CAD - valvular heart disease
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Rotator Cuff problem

14. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

15. What are signs of pulmonary congestion?
Peptic ulcer disease or gastritis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

16. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Hypertension - CAD - valvular heart disease
Subarachnoid hemorrhage
Peptic ulcer disease or gastritis

17. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Increase; 200 g/day
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

18. What are the three major risk factors for heart failure?
>3.5g of protein per 24hrs
Kids: Rotavirus Adults: Norwalk Virus
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Hypertension - CAD - valvular heart disease

19. History for Sinusitis

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20. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Non-cardiac causes of palpitations
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

21. patients with herpes zoster may experience what symptom before the rash appear?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pain
HIV and syphilis
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

22. Name the skin lesion: honey colored crusts
Intermenstrual bleeding
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
Pancreatitis
Impetigo

23. What are the physical exam signs of CHF?
Common problem that resolves spontaneously and is most often seen in children and young adults
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
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

24. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
DM - HTN - DVT - seizures - depression - or anxiety
Warts
Associated with hypotension
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.

25. Oligomenorrhea
>3.5g of protein per 24hrs
Hypertension - CAD - valvular heart disease
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Regular bleeding at intervals of more than 35 days

26. Name some medications that can cause proteinuria
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Medication or chemical esophagitis
ACEi - ARBS - thiazide diuretics
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

27. Describe the presentation of pericardial pain
With a KOH wet mount preparation
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pleurisy
Giardia

28. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Giardia
Nonulcer dyspepsia
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

29. What is the caUse of Meniere disease? What are the cardinal symptoms?
LH surge triggers ovulation
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

30. What are the signs of cerebral hemorrhage?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Acute headache - ataxia - profuse nausea - and vomiting
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
Hgb - Electrolytes - and TSH

31. When does troponin rise following myocardial injury or infarction?
Cluster headache
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
S. aureus- beta hemolytic streptococcus
Presence of proteinuria on at least two separate ocassion

32. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Scleroderma/polymyositis with secondary gastroesophageal reflux
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Albumin; low molecular weight proteins

33. Constipation: What are indications for lab testing?
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
True
Presence of proteinuria on at least two separate ocassion

34. How does systolic vs. diastolic heart failure present on the echocardiogram?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
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
Pleurisy
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

35. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
E. Coli O157:H7
CBC

36. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
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

37. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Echocardiogram
Wolff-Parkinson-White syndrome
Bulk forming: Psyllium - Methycellulose - Polycarbophil

38. What are the consequences of diastolic dysfunction?
EGD
CBC
Higher filling presure - pulmonary congestion - and decreasd cardiac return
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

39. What test done in PE measures instability of shoulder?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Upper sternal area burning pain - associated with a productive cough

40. 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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Lightheadedness - dizziness - syncope

41. What occurs after ovulation
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
24 hour halter
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

42. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
Coronary artery disease/ angina

43. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Molluscum contagiosum- pox virus
Intermenstrual bleeding
Serotypes 16 - 18 - 31 -52 -58

44. Lab testing for heart palpitation
Rotator cuff tendonitis
Hgb - Electrolytes - and TSH
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

45. What are the signs of acute sinusitis?
Hypertension - CAD - valvular heart disease
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Fever with frontal or maxillary tenderness
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

46. What is a markers of CNS vertigo?
Tension headache
Other brainstem or cranial nerve findings
E. Coli O157:H7
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

47. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Bulk forming: Psyllium - Methycellulose - Polycarbophil
HPV
Rotator cuff tendonitis

48. Describe the presentation of angina?
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
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.
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
Hypertension - CAD - valvular heart disease

49. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Scleroderma/polymyositis with secondary gastroesophageal reflux
Anticoag with warfarin to prevent thromboembolism
RBC casts and old to moderate HTN
Molluscum contagiosum- pox virus

50. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Associated with hypotension
Adhesive capsulitis (frozen shoulder): most common in middle age women
Possibility of Ischemic colitis
Bence-Jones

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