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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 Barany maneuver?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Less than 3 stools per week
ACEi - ARBS - thiazide diuretics
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

2. What the consequences of decreased cardiac output?
Coag disorders
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
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
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

3. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Wolff-Parkinson-White syndrome
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

4. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Fever with frontal or maxillary tenderness
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

5. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Pleurisy
Paroxysmal atrial fibrillation or supraventricular tachycardia
Analgesic 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

6. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Less abrupt onset and cessation of palpitations
Medication or chemical esophagitis
Analgesic headache

7. History and PE for Pneumonia
S. Aureus
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
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

8. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Furucnle
Temporal arteritis-biopsy of the temporal artery
>150mg per 24hrs

9. What are the primary glomerular diseases?
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

10. Natural history of cervical cancer
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Supraspinatus and bicipital tendons
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

11. Describe the presentation of angina?
Less than 3 stools per week
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Temporal arteritis-biopsy of the temporal artery
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

12. What are the most common viral causes of diarrhea in kids and adults?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Non-cardiac causes of palpitations
Kids: Rotavirus Adults: Norwalk Virus

13. How do you define persistent protein uria?
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
PVC or Premature atrial contraction (PAC)
Presence of proteinuria on at least two separate ocassion
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

14. What are the three major risk factors for heart failure?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Hypertension - CAD - valvular heart disease
Streptococci

15. What does the classic ring worm lesion have?
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
A central clear area
Coronary artery disease/ angina
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

16. What are the features of nephrotic syndrome?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
PVC or Premature atrial contraction (PAC)
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Streptococci

17. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Less than 80 ml of blood
Pts with palpitations and dizziness - near syncope - or syncope
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

18. What test done in PE measures instability of shoulder?
Wolff-Parkinson-White syndrome
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
HPV

19. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
Irregular bleeding between cycles
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Repeat Pap after infection treated

20. What are the physical exam signs of CHF?
Cluster headache
Dehydration - anemia - cardiac causes
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

21. Pain in shoulder when throwing - swimming - or serving a tennis ball
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Adhesive capsulitis (frozen shoulder): most common in middle age women
Rotator cuff tendonitis
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

22. Why is the pap smear one of the most effective cancer screening tools?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Upper sternal area burning pain - associated with a productive cough
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Slow progression of cervical cancer changes -Availability of effective early treatment

23. Chronic pain and shoulder stiffness with limited motion
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Adhesive capsulitis (frozen shoulder): most common in middle age women
Cluster headache
ACEi - ARBS - thiazide diuretics

24. What is the preload?
Echocardiogram
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Paroxysmal atrial fibrillation or supraventricular tachycardia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

25. Pneumonia tx: suitable for healthy adults less than 60
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.
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Analgesic headache
24 hour halter

26. Things that need to be included in history of shoulder pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Pancreatitis
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Adhesive capsulitis (frozen shoulder): most common in middle age women

27. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Albumin; low molecular weight proteins
True
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

28. Describe the history and PE of patient presenting with common cold
Slow progression of cervical cancer changes -Availability of effective early treatment
Cholelithiasis
E. Coli O157:H7
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

29. How to NSAIDs contribute to gastritis and ulcer formation?
Wolff-Parkinson-White syndrome
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.
CBC
Viral infection of the semicircular apparatus

30. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Albumin; low molecular weight proteins
Regular bleeding at intervals of more than 35 days
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Pleurisy

31. When should a patient get a stress test?
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
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.
Pleurisy
When the patient has symptoms in association with exercise or who describe chest pain or pressure

32. Metrorrhagia
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
Irregular bleeding between cycles
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

33. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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.

34. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
HPV
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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.
Diuretics -BB -CCB -ACEi

35. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
CBC
Viral infection of the semicircular apparatus
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

36. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Fever with frontal or maxillary tenderness
100mg; means patient can be trace protein positive and not be detected

37. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Furucnle
Variability in the time for follicle development during the proliferative phase
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

38. Mainstay treatment for soft tissue inflammation (Shoulder)
Medication or chemical esophagitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Molluscum contagiosum- pox virus
Hypertension - CAD - valvular heart disease

39. What drugs do you use to treat H.pylori + PUD?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Cervical radiculopathy

40. 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
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Warts

41. Where does the development of abnormal cervical cells begin?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Rotator Cuff problem
Intermenstrual bleeding
Squamocolumnar junction=most common site of cervical cancer

42. How do you know if heart palpitations are due to stimulant or medication use?
Less abrupt onset and cessation of palpitations
Lightheadedness - dizziness - syncope
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
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

43. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Excessive bleeding in amount - duration - or both at irregular intervals
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Echocardiogram

44. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
ACEi
Streptococci
Pain

45. What is the goal of CHF treatment? What drugs should be used?
Diuretics -BB -CCB -ACEi
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

46. What are the consequences of diastolic dysfunction?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Temporal arteritis-biopsy of the temporal artery

47. Shoulder pain with pain radiating to elbow
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Supraspinatus and bicipital tendons
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
Cervical radiculopathy

48. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Coag disorders
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

49. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Scleroderma/polymyositis with secondary gastroesophageal reflux
24 hour halter
S. aureus- beta hemolytic streptococcus

50. Define the patient population typically affected by orthostatic or postural proteinuria
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
GERD
CBC
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

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