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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. History for Sinusitis

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2. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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
S. aureus- beta hemolytic streptococcus
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Non-cardiac causes of palpitations

3. At was quantity does urine dipstick test detect elevated protein?
A 24hr urine protein collection and urine creatinine clearance determination
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
100mg; means patient can be trace protein positive and not be detected
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

4. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
PE - MI - aortic dissection - pneumothorax
PVC or Premature atrial contraction (PAC)
GERD
Streptococci

5. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures
MSK - pulmonary - GI - or psychological
Increase; 200 g/day
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

6. What is the next best step if a patient has two or more positive dipstick tests?
GERD
Regular bleeding at intervals of more than 35 days
Subarachnoid hemorrhage
A 24hr urine protein collection and urine creatinine clearance determination

7. What are the common causes for laryngitis?
Viral infection of the semicircular apparatus
S. aureus- beta hemolytic streptococcus
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Increase; 200 g/day

8. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Fever with frontal or maxillary tenderness
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Infectious esophagitis

9. When should a patient get a stress test?
Regular bleeding at intervals of more than 35 days
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Hgb - Electrolytes - and TSH
When the patient has symptoms in association with exercise or who describe chest pain or pressure

10. 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
Less than 3 stools per week
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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

11. Natural history of cervical cancer
Variability in the time for follicle development during the proliferative phase
CBC
Streptococci
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

12. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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.
Paroxysmal atrial fibrillation or supraventricular tachycardia

13. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
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
Chest pain during pneumonia or PE
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
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

14. What does treatment for migrans include?
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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
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
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

15. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Menorrhagia
Pts with palpitations and dizziness - near syncope - or syncope
Infectious esophagitis

16. History and PE for Pneumonia
HPV
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
PVC or Premature atrial contraction (PAC)
Lightheadedness - dizziness - syncope

17. Four muscles of rotator cuff
Varicella virus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

18. Name the skin lesion: honey colored crusts
Adhesive capsulitis (frozen shoulder): most common in middle age women
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Impetigo
Dehydration - anemia - cardiac causes

19. Diarrhea from custard filled pastries
Nonulcer dyspepsia
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
S. Aureus
Staphylococcal scalded skin syndrome

20. 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)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
S. Aureus
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

21. What the consequences of decreased cardiac output?
Excessive bleeding in amount - duration - or both at irregular intervals
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

22. What are the signs of malignant hypertension?
Excessive bleeding in amount - duration - or both at irregular intervals
Paroxysmal atrial fibrillation or supraventricular tachycardia
Squamocolumnar junction=most common site of cervical cancer
High blood pressure - focal neurologic defecit - or papilledema

23. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Candida albicans
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Warts

24. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
HPV testing -Pos=colposcopy -Neg=repeat pap smear

25. 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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Streptococci
With a KOH wet mount preparation

26. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
A central clear area
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

27. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Staphylococcal scalded skin syndrome
ACEi - ARBS - thiazide diuretics
Loop diuretics (Check serum K+ levels before drug admin)
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

28. What is the role of FSH in one's menstrual cycle
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
Less than 3 stools per week
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

29. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Hgb - Electrolytes - and TSH
Menorrhagia
Staphylococcal scalded skin syndrome
ACEi - ARBS - thiazide diuretics

30. What does the classic ring worm lesion have?
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.
A central clear area
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

31. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Scleroderma/polymyositis with secondary gastroesophageal reflux
EGD
Anticoag with warfarin to prevent thromboembolism
Medication or chemical esophagitis

32. 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
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
E. Coli O157:H7

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Presence of proteinuria on at least two separate ocassion
Diuretics -BB -CCB -ACEi
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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.

34. Name some medications that can cause proteinuria
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Menorrhagia
ACEi

35. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Diuretics -BB -CCB -ACEi
Giardia
S. Aureus
True

36. 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
Hypertension - CAD - valvular heart disease
Molluscum contagiosum- pox virus
Less than 3 stools per week
24 hour halter

37. What is an acoustic neuroma?
Lightheadedness - dizziness - syncope
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Viral infection of the semicircular apparatus
Influenza - Rhinovirus - Adenovirus - Parainfluenza

38. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
A 24hr urine protein collection and urine creatinine clearance determination
HPV

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.
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Supraspinatus and bicipital tendons
Scabies

40. What does orthostatic positional changes that bring on dizziness suggest?
Dehydration - anemia - cardiac causes
These patients are associated with low renin states=less likely to respond to medication
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Loop diuretics (Check serum K+ levels before drug admin)

41. What should be considered in younger patients with menorrhagia
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
CT
Coag disorders

42. patients with herpes zoster may experience what symptom before the rash appear?
Fever with frontal or maxillary tenderness
Pain
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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.

43. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Molluscum contagiosum- pox virus
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
24 hour halter
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

44. What occurs after ovulation
Varicella virus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

45. Name 4 factors that predispose an individual to develop pneumonia.
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Temporal arteritis-biopsy of the temporal artery

46. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Cellulitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Bence-Jones
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

47. What is the mechanism of action for stimulant agents in treating constipation?
Echocardiogram
Dehydration - anemia - cardiac causes
Temporal arteritis-biopsy of the temporal artery
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

48. name the 4 emergent causes of chest pain
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
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
PE - MI - aortic dissection - pneumothorax
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

49. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Albumin; low molecular weight proteins
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.

50. How does systolic vs. diastolic heart failure present on the echocardiogram?
Nonulcer dyspepsia
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
24 hour halter
Common problem that resolves spontaneously and is most often seen in children and young adults

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