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Subjects : health-sciences, family-medicine

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1. What is the Epley maneuver?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Acute headache - ataxia - profuse nausea - and vomiting
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.
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

2. What is the goal of CHF treatment? What drugs should be used?
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
Pancreatitis
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
Chest pain during pneumonia or PE

3. How does CHF present on X-ray?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Bulk forming: Psyllium - Methycellulose - Polycarbophil
ACEi - ARBS - thiazide diuretics
Molluscum contagiosum- pox virus

4. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
Rotator Cuff problem
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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

5. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
Less than 80 ml of blood
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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. name the 4 emergent causes of chest pain
ACEi
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
PE - MI - aortic dissection - pneumothorax
Medication or chemical esophagitis

7. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Peptic ulcer disease or gastritis
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
Bence-Jones

8. How do you know if heart palpitations are due to stimulant or medication use?
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
E. Coli O157:H7
BB or CCB - catheter ablation of identified bypass tract
Less abrupt onset and cessation of palpitations

9. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Acute headache - ataxia - profuse nausea - and vomiting
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

10. What are the features of nephrotic syndrome?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

11. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
S. aureus- beta hemolytic streptococcus
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
DM - HTN - DVT - seizures - depression - or anxiety

12. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Anticoag with warfarin to prevent thromboembolism
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

13. 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
BB or CCB - catheter ablation of identified bypass tract
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Acute headache - ataxia - profuse nausea - and vomiting

14. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

15. What places women at higher risk of getting cervical cancer?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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

16. What are signs of pulmonary congestion?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
MSK - pulmonary - GI - or psychological
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

17. 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
Repeat Pap after infection treated
Scabies
Viral infection of the semicircular apparatus
35 (exception for postmenopausal women who have recently been started on HRT)

18. 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
Streptococci
Pain
Lightheadedness - dizziness - syncope

19. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Echocardiogram
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

20. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Possibility of Ischemic colitis
24 hour halter

21. What should be considered in younger patients with menorrhagia
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Furucnle
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Coag disorders

22. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Cervical radiculopathy
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Chest pain during pneumonia or PE

23. Clinical Manifestations of HTN
Coronary artery disease/ angina
Associated with hypotension
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

24. What is the next best step if a patient has two or more positive dipstick tests?
A central clear area
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
A 24hr urine protein collection and urine creatinine clearance determination

25. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
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
MSK - pulmonary - GI - or psychological
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Coronary artery disease/ angina

26. Diarrhea is defined as an ____ in stool weight to more than ____g per day
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Increase; 200 g/day
Candida albicans

27. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Loop diuretics (Check serum K+ levels before drug admin)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

28. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Pts with palpitations and dizziness - near syncope - or syncope
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
High blood pressure - focal neurologic defecit - or papilledema

29. Oligomenorrhea
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Regular bleeding at intervals of more than 35 days
Viral infection of the semicircular apparatus

30. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Upper sternal area burning pain - associated with a productive cough
DM - HTN - DVT - seizures - depression - or anxiety
Candida albicans
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

31. When should a patient get a stress test?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pancreatitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
When the patient has symptoms in association with exercise or who describe chest pain or pressure

32. Define proteinuria
Squamocolumnar junction=most common site of cervical cancer
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
>150mg per 24hrs

33. What is benign transient proteinuria?
Common problem that resolves spontaneously and is most often seen in children and young adults
Coronary artery disease/ angina
Rotator Cuff tendonitis
Serotypes 16 - 18 - 31 -52 -58

34. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Chest pain during pneumonia or PE
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Varicella virus
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

35. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Pleurisy
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
Upper sternal area burning pain - associated with a productive cough

36. What is the standard tool used for diagnosis of GERD?
EGD
Colposcopy - Endocervical curettage - and directed cervical biopsy
Viral infection of the semicircular apparatus
Variability in the time for follicle development during the proliferative phase

37. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
E. Coli O157:H7
Squamocolumnar junction=most common site of cervical cancer
HPV testing -Pos=colposcopy -Neg=repeat pap smear

38. Describe the history and PE of patient presenting with common cold
Possibility of Ischemic colitis
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
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

39. What are the signs of cerebral 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
Upper sternal area burning pain - associated with a productive cough
Acute headache - ataxia - profuse nausea - and vomiting
Coag disorders

40. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Impetigo

41. What the consequences of decreased cardiac output?
Less than 3 stools per week
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
DM - HTN - DVT - seizures - depression - or anxiety
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

42. What is the peripheral caUse of vertigo?
S. Aureus
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

43. What is the role of LH in the menstrual cycle
ACEi
Chest pain during pneumonia or PE
LH surge triggers ovulation
Folliculitis

44. What are the features of glomerular nephritis
RBC casts and old to moderate HTN
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A central clear area
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

45. What are symptoms are CHF?
Nonulcer dyspepsia
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
ACEi
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

46. Difference between Pneumonia and Bronchitis
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
Other brainstem or cranial nerve findings
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
DM - HTN - DVT - seizures - depression - or anxiety

47. Chronic pain and shoulder stiffness with limited motion
Polymenorrhea
Adhesive capsulitis (frozen shoulder): most common in middle age women
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

48. 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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Rotator Cuff problem

49. What are the two common clinical presentations of acute diarrhea?
LH surge triggers ovulation
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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

50. Why is the pap smear one of the most effective cancer screening tools?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Slow progression of cervical cancer changes -Availability of effective early treatment
High blood pressure - focal neurologic defecit - or papilledema
Excessive bleeding in amount - duration - or both at irregular intervals

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