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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
Colposcopy - Endocervical curettage - and directed cervical biopsy
With a KOH wet mount preparation
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

2. Describe the presentation of myocardial pain?
Wolff-Parkinson-White syndrome
Paroxysmal atrial fibrillation or supraventricular tachycardia
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Tension headache

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Pain
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Bence-Jones

4. What should blood work include for suspected heart failure?
>150mg per 24hrs
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Other brainstem or cranial nerve findings

5. What is the goal of CHF treatment? What drugs should be used?
Furucnle
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
Hypertension - CAD - valvular heart disease
EGD

6. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Cellulitis
>150mg per 24hrs

7. 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
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
With a KOH wet mount preparation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

8. How are fungal infections diagnosed?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Squamocolumnar junction=most common site of cervical cancer
With a KOH wet mount preparation
Polymenorrhea

9. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Rotator Cuff problem
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Scleroderma/polymyositis with secondary gastroesophageal reflux
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.

10. 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.
Chest pain during pneumonia or PE
Supraspinatus and bicipital tendons
Cluster headache
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

11. How do you define persistent protein uria?
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Presence of proteinuria on at least two separate ocassion

12. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
S. aureus- beta hemolytic streptococcus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
35 (exception for postmenopausal women who have recently been started on HRT)

13. After treatment of dysplasia - women need Pap smears every...
Colposcopy - Endocervical curettage - and directed cervical biopsy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

14. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Adhesive capsulitis (frozen shoulder): most common in middle age women
These patients are associated with low renin states=less likely to respond to medication
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

15. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
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
Temporal arteritis-biopsy of the temporal artery
Hgb - Electrolytes - and TSH
BB or CCB - catheter ablation of identified bypass tract

16. Describe the presentation of angina?
Tension headache
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
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

17. What is the Barany maneuver?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

18. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Rotator Cuff problem

19. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Upper sternal area burning pain - associated with a productive cough
Increase; 200 g/day
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. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
HPV
ACEi - ARBS - thiazide diuretics
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

21. Pain in shoulder when throwing - swimming - or serving a tennis ball
PE - MI - aortic dissection - pneumothorax
Rotator cuff tendonitis
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
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

22. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Serotypes 16 - 18 - 31 -52 -58
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

23. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Hgb - Electrolytes - and TSH
Cholelithiasis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

24. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Common problem that resolves spontaneously and is most often seen in children and young adults
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Chest pain during pneumonia or PE

25. Metrorrhagia
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Irregular bleeding between cycles
Pain
PVC or Premature atrial contraction (PAC)

26. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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
High blood pressure - focal neurologic defecit - or papilledema
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
Adhesive capsulitis (frozen shoulder): most common in middle age women

27. What medications can cause heart palpitations?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Less than 3 stools per week
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

28. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Infectious esophagitis
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
ACEi - ARBS - thiazide diuretics
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

29. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Regular bleeding at intervals of more than 35 days
Pleurisy
HIV and syphilis
Nonulcer dyspepsia

30. What is the preload?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Cellulitis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

31. When should invasive eletrophysiologic study should be considered?
True
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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
Rotator cuff tendonitis

32. When does troponin rise following myocardial injury or infarction?
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
Candida albicans
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
>150mg per 24hrs

33. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Medication or chemical esophagitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

34. Diarrhea is defined as an ____ in stool weight to more than ____g per day
HIV and syphilis
Increase; 200 g/day
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

35. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Polymenorrhea
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

36. Name types of laxatives
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Other brainstem or cranial nerve findings
A central clear area
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

37. Name the diagnosis of heartburn: regurgitation - dysphagia
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
GERD
Coronary artery disease/ angina
Rotator Cuff tendonitis

38. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Diuretics -BB -CCB -ACEi
Nonulcer dyspepsia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

39. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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

40. 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
Hgb - Electrolytes - and TSH
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
Anticoag with warfarin to prevent thromboembolism

41. History and PE for Pneumonia
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Pain
Wolff-Parkinson-White syndrome
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

42. Who should have Xray testing for shoulder pain?
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
S. Aureus
Intermenstrual bleeding
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

43. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

44. What are the consequences of diastolic dysfunction?
Streptococci
S. aureus- beta hemolytic streptococcus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

45. What are the 2 psych disorders most commonly associated with palpitations?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Viral gastroenteritis
Generalized Anxiety disorder and panic disorder

46. Constipation: What are indications for lab testing?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
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
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
Analgesic headache

47. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
Intermenstrual bleeding
PVC or Premature atrial contraction (PAC)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

48. Mainstay treatment for soft tissue inflammation (Shoulder)
Echocardiogram
Staphylococcal scalded skin syndrome
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

49. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
BB or CCB - catheter ablation of identified bypass tract
Analgesic headache
Upper sternal area burning pain - associated with a productive cough

50. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Subarachnoid hemorrhage
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Cellulitis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

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