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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 are the four classes of medications that are most commonly used for 1st line agents in HTN?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Diuretics -BB -CCB -ACEi

2. Describe the history and PE of patient presenting with common cold
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
Common problem that resolves spontaneously and is most often seen in children and young adults
100mg; means patient can be trace protein positive and not be detected
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

3. What diagnosis does the 'worse headache of my life' suggest?
35 (exception for postmenopausal women who have recently been started on HRT)
Other brainstem or cranial nerve findings
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Subarachnoid hemorrhage

4. 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.
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

5. 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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Varicella virus
Dehydration - anemia - cardiac causes
Paroxysmal atrial fibrillation or supraventricular tachycardia

6. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Rotator Cuff tendonitis
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

7. What is the peripheral caUse of vertigo?
HPV
Temporal arteritis-biopsy of the temporal artery
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

8. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Medication or chemical esophagitis
ACEi
PE - MI - aortic dissection - pneumothorax
Cholelithiasis

9. What does orthostatic positional changes that bring on dizziness suggest?
Non-cardiac causes of palpitations
Dehydration - anemia - cardiac causes
Molluscum contagiosum- pox virus
Echocardiogram

10. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Bence-Jones
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

11. Name types of laxatives
Hypertension - CAD - valvular heart disease
Diuretics -BB -CCB -ACEi
Kids: Rotavirus Adults: Norwalk Virus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

12. Predictors of cardiac etiology
Hypertension - CAD - valvular heart disease
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
S. Aureus
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

13. What the consequences of decreased cardiac output?
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
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

14. Chronic pain and shoulder stiffness with limited motion
Adhesive capsulitis (frozen shoulder): most common in middle age women
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Scabies
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

15. MI - pericardial tamponade - PE - GI bleed - are...
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Associated with hypotension
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
A 24hr urine protein collection and urine creatinine clearance determination

16. 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
S. Aureus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

17. Regular bleeding at intervals of less than 21 days
Polymenorrhea
Associated with hypotension
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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

18. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Generalized Anxiety disorder and panic disorder
Cluster headache
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
Echocardiogram

19. Treatment for supraventricular tachycardias
PVC or Premature atrial contraction (PAC)
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
BB or CCB - catheter ablation of identified bypass tract
Less than 3 stools per week

20. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Nonulcer dyspepsia
Giardia

21. What are the indiciations for neuroimaging?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
Serotypes 16 - 18 - 31 -52 -58
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

22. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Cholelithiasis

23. What is the difference between a Holter monitor or an event monitor?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
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
CT

24. What is the caUse of Meniere disease? What are the cardinal symptoms?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
EGD

25. History and PE for Pneumonia
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
Impetigo
Candida albicans
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

26. What microganism is causing this array of presentations: Mild - crampy - nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Candida albicans
E. Coli O157:H7
24 hour halter

27. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Squamocolumnar junction=most common site of cervical cancer
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Diuretics -BB -CCB -ACEi

28. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
Rotator Cuff tendonitis
Irregular bleeding between cycles
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

29. Describe the presentation tracheobronchitis
Warts
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Upper sternal area burning pain - associated with a productive cough

30. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
>150mg per 24hrs
Regular bleeding at intervals of more than 35 days
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
24 hour halter

31. Tx of chronic or intermittent afibs
Diuretics -BB -CCB -ACEi
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Anticoag with warfarin to prevent thromboembolism
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

32. History for Sinusitis

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33. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Common problem that resolves spontaneously and is most often seen in children and young adults
RBC casts and old to moderate HTN

34. Menometrorrhagia
PVC or Premature atrial contraction (PAC)
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
Excessive bleeding in amount - duration - or both at irregular intervals
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

35. What is the role of LH in the menstrual cycle
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Irregular bleeding between cycles

36. 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
These patients are associated with low renin states=less likely to respond to medication
Repeat Pap after infection treated
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

37. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Intermenstrual bleeding
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

38. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
Kids: Rotavirus Adults: Norwalk Virus
Medication or chemical esophagitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
ACEi

39. 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.
Rotator Cuff problem
Supraspinatus and bicipital tendons
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Pts with palpitations and dizziness - near syncope - or syncope

40. What are the 2 psych disorders most commonly associated with palpitations?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Chest pain during pneumonia or PE
Generalized Anxiety disorder and panic disorder

41. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
True

42. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
Pleurisy
Cholelithiasis
Albumin; low molecular weight proteins

43. How does CHF present on X-ray?
Molluscum contagiosum- pox virus
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Coag disorders
Acute headache - ataxia - profuse nausea - and vomiting

44. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Medication or chemical esophagitis

45. Pneumothorax - sudden sharp chest pain - preceded by viral illness
A central clear area
Pleurisy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

46. Uterine bleeding between regular cycles
Intermenstrual bleeding
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
S. Aureus
24 hour halter

47. What are the consequences of diastolic dysfunction?
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
Coronary artery disease/ angina
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

48. At was quantity does urine dipstick test detect elevated protein?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
E. Coli O157:H7
100mg; means patient can be trace protein positive and not be detected
Fever with frontal or maxillary tenderness

49. Diarrhea is defined as an ____ in stool weight to more than ____g per day
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Increase; 200 g/day
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Warts

50. What should blood work include for suspected heart failure?
CBC
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
These patients are associated with low renin states=less likely to respond to medication
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

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