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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. When should invasive eletrophysiologic study should be considered?
Rotator Cuff problem
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Albumin; low molecular weight proteins
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

2. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
MSK - pulmonary - GI - or psychological
Giardia
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

3. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Excessive bleeding in amount - duration - or both at irregular intervals
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Giardia

4. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Common problem that resolves spontaneously and is most often seen in children and young adults
Polymenorrhea
Increase; 200 g/day
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

5. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Warts
Rotator Cuff problem
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

6. Difference between Pneumonia and Bronchitis
Hgb - Electrolytes - and TSH
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

7. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Warts
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

8. What is the caUse of benign positional vertigo?
DM - HTN - DVT - seizures - depression - or anxiety
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
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.

9. What the consequences of decreased cardiac output?
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

10. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
Impetigo
Less than 80 ml of blood
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

11. 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
Viral infection of the semicircular apparatus
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Molluscum contagiosum- pox virus
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

12. Tx of chronic or intermittent afibs
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Anticoag with warfarin to prevent thromboembolism
Other brainstem or cranial nerve findings

13. Define nephrotic range proteinuria
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
>3.5g of protein per 24hrs
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

14. 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
Common problem that resolves spontaneously and is most often seen in children and young adults
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Peptic ulcer disease or gastritis

15. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Hgb - Electrolytes - and TSH
Analgesic headache
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

16. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Less than 80 ml of blood
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Associated with hypotension

17. Define the patient population typically affected by orthostatic or postural proteinuria
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Supraspinatus and bicipital tendons
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
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

18. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
HIV and syphilis
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.
Coronary artery disease/ angina
Acute headache - ataxia - profuse nausea - and vomiting

19. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

20. History for Sinusitis

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21. At was quantity does urine dipstick test detect elevated protein?
100mg; means patient can be trace protein positive and not be detected
True
Pleurisy
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

22. 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
Colposcopy - Endocervical curettage - and directed cervical biopsy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

23. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Acute headache - ataxia - profuse nausea - and vomiting
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Viral infection of the semicircular apparatus

24. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Albumin; low molecular weight proteins
Subarachnoid hemorrhage
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

25. Prenatal visit schedule for low-risk pregnancies
Warts
Giardia
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
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

26. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Hypertension - CAD - valvular heart disease
Fever with frontal or maxillary tenderness
35 (exception for postmenopausal women who have recently been started on HRT)

27. What type of imaging is need for chronic sinusitis?
Molluscum contagiosum- pox virus
Scleroderma/polymyositis with secondary gastroesophageal reflux
CT
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

28. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Folliculitis
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
LH surge triggers ovulation
Peptic ulcer disease or gastritis

29. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Molluscum contagiosum- pox virus
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
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

30. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Temporal arteritis-biopsy of the temporal artery
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

31. What treatments are the cornerstone for treating cases of functional constipation?
These patients are associated with low renin states=less likely to respond to medication
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
HIV and syphilis

32. Describe the presentation of myocardial pain?
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
GERD
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

33. What are the indiciations for neuroimaging?
>3.5g of protein per 24hrs
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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

34. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
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
E. Coli O157:H7
LH surge triggers ovulation

35. What does orthostatic positional changes that bring on dizziness suggest?
100mg; means patient can be trace protein positive and not be detected
Pleurisy
Dehydration - anemia - cardiac causes
Rotator cuff tendonitis

36. How can GERD (or esophageal motility disorders) lead to chest pain?
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
DM - HTN - DVT - seizures - depression - or anxiety
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

37. What are signs of pulmonary congestion?
Loop diuretics (Check serum K+ levels before drug admin)
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Repeat Pap after infection treated

38. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Associated with hypotension
Viral infection of the semicircular apparatus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

39. What are the two common clinical presentations of acute diarrhea?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Peptic ulcer disease or gastritis

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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Viral infection of the semicircular apparatus

41. What does the classic ring worm lesion have?
A central clear area
Loop diuretics (Check serum K+ levels before drug admin)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

42. What is benign transient proteinuria?
Pain
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
Common problem that resolves spontaneously and is most often seen in children and young adults
Infectious esophagitis

43. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
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
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
Coag disorders

44. Name the skin lesion: honey colored crusts
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Folliculitis
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.
Impetigo

45. What is a markers of CNS vertigo?
Chest pain during pneumonia or PE
Other brainstem or cranial nerve findings
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
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

46. 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.
S. aureus- beta hemolytic streptococcus
Variability in the time for follicle development during the proliferative phase
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

47. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
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
Supraspinatus and bicipital tendons
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Non-cardiac causes of palpitations

48. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Candida albicans
Albumin; low molecular weight proteins
Irregular bleeding between cycles
Chest pain during pneumonia or PE

49. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Coronary artery disease/ angina
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

50. 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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Generalized Anxiety disorder and panic disorder

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