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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
True
Temporal arteritis-biopsy of the temporal artery
Colposcopy - Endocervical curettage - and directed cervical biopsy

2. What are the physical exam signs of CHF?
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
HIV and syphilis

3. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Generalized Anxiety disorder and panic disorder

4. Define the patient population typically affected by orthostatic or postural proteinuria
MSK - pulmonary - GI - or psychological
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
Scabies
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

5. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
LH surge triggers ovulation
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
Coronary artery disease/ angina
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

6. Pneumonia tx: suitable for healthy adults less than 60
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
High blood pressure - focal neurologic defecit - or papilledema
Scabies
>3.5g of protein per 24hrs

7. Name 4 factors that predispose an individual to develop pneumonia.
Scabies
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

8. What are symptoms are CHF?
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

9. Four muscles of rotator cuff
Cluster headache
RBC casts and old to moderate HTN
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Coag disorders

10. 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
100mg; means patient can be trace protein positive and not be detected
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
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
Molluscum contagiosum- pox virus

11. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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.
Anticoag with warfarin to prevent thromboembolism
A central clear area

12. MI - pericardial tamponade - PE - GI bleed - are...
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Associated with hypotension
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

13. What is the standard tool used for diagnosis of GERD?
Infectious esophagitis
EGD
Non-cardiac causes of palpitations
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

14. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Excessive bleeding in amount - duration - or both at irregular intervals
Pleurisy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

15. Oligomenorrhea
Anticoag with warfarin to prevent thromboembolism
Menorrhagia
Albumin; low molecular weight proteins
Regular bleeding at intervals of more than 35 days

16. Diagnostic Evaluation of Abnoraml vaginal bleeding
Common problem that resolves spontaneously and is most often seen in children and young adults
Medication or chemical esophagitis
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
Lightheadedness - dizziness - syncope

17. Name some medications that can cause proteinuria
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl 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
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

18. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Medication or chemical esophagitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear

19. What does treatment for migrans include?
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
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
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Cluster headache

20. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Infectious esophagitis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

21. Where does the development of abnormal cervical cells begin?
LH surge triggers ovulation
Serotypes 16 - 18 - 31 -52 -58
Squamocolumnar junction=most common site of cervical cancer
Hypertension - CAD - valvular heart disease

22. What are the symptoms of palpitations?
Fever with frontal or maxillary tenderness
Lightheadedness - dizziness - syncope
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
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

23. At was quantity does urine dipstick test detect elevated protein?
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
100mg; means patient can be trace protein positive and not be detected
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
A central clear area

24. Name the skin lesion: honey colored crusts
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Varicella virus

25. Lab testing for heart palpitation
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Hgb - Electrolytes - and TSH
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

26. History for Sinusitis

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27. Complete the sentence: pericarditis can cause frictional rub and......
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
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
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Polymenorrhea

28. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
S. aureus- beta hemolytic streptococcus
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
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

29. Discomfort with abducting the arm past 90 degress
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Viral infection of the semicircular apparatus
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
Rotator Cuff tendonitis

30. History for Acute bronchitis
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

31. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Analgesic headache
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Rotator Cuff problem
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

32. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
Pleurisy

33. Describe the presentation of pericardial pain
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
With a KOH wet mount preparation

34. Name the skin lesion: pustule in association with a hair follice
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
Folliculitis
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

35. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Cholelithiasis

36. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
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
MSK - pulmonary - GI - or psychological
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

37. 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
Hypertension - CAD - valvular heart disease
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

38. Describes what occurs during squamous metaplasia of the cervix.
Upper sternal area burning pain - associated with a productive cough
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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

39. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
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
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

40. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
S. aureus- beta hemolytic streptococcus
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
ACEi - ARBS - thiazide diuretics
35 (exception for postmenopausal women who have recently been started on HRT)

41. Pneumonia tx: suitable for healthy adults older than 60
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Albumin; low molecular weight proteins
Excessive bleeding in amount - duration - or both at irregular intervals

42. What is the goal of CHF treatment? What drugs should be used?
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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
Wolff-Parkinson-White syndrome

43. What is the peripheral caUse of vertigo?
>150mg per 24hrs
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
ACEi
Loop diuretics (Check serum K+ levels before drug admin)

44. Treatment for supraventricular tachycardias
Acute headache - ataxia - profuse nausea - and vomiting
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
Polymenorrhea
BB or CCB - catheter ablation of identified bypass tract

45. 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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
100mg; means patient can be trace protein positive and not be detected
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

46. What test done in PE measures instability of shoulder?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Excessive bleeding in amount - duration - or both at irregular intervals

47. Predictors of cardiac etiology
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
ACEi - ARBS - thiazide diuretics

48. What the consequences of decreased cardiac output?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Streptococci
Paroxysmal atrial fibrillation or supraventricular tachycardia

49. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
100mg; means patient can be trace protein positive and not be detected
LH surge triggers ovulation
Wolff-Parkinson-White syndrome

50. What are the indiciations for neuroimaging?
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Less than 80 ml of blood
S. Aureus
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

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