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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. What is the standard tool used for diagnosis of GERD?
EGD
LH surge triggers ovulation
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

2. Name 4 factors that predispose an individual to develop pneumonia.
Rotator Cuff problem
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.
Supraspinatus and bicipital tendons
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

3. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Cholelithiasis
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

4. What are the signs of cerebral hemorrhage?
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
Viral infection of the semicircular apparatus
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Acute headache - ataxia - profuse nausea - and vomiting

5. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Generalized Anxiety disorder and panic disorder
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
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
Viral infection of the semicircular apparatus

6. Oligomenorrhea
Polymenorrhea
Squamocolumnar junction=most common site of cervical cancer
Regular bleeding at intervals of more than 35 days
Cholelithiasis

7. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Dehydration - anemia - cardiac causes
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Slow progression of cervical cancer changes -Availability of effective early treatment

8. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
A 24hr urine protein collection and urine creatinine clearance determination
24 hour halter
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

9. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Associated with hypotension

10. When should invasive eletrophysiologic study should be considered?
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
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Lightheadedness - dizziness - syncope

11. What are signs of pulmonary congestion?
Tension headache
Dehydration - anemia - cardiac causes
Regular bleeding at intervals of more than 35 days
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

12. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Intermenstrual bleeding
Fever with frontal or maxillary tenderness
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

13. What are the three types of lice?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Infectious esophagitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

14. What is a markers of CNS vertigo?
Slow progression of cervical cancer changes -Availability of effective early treatment
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Other brainstem or cranial nerve findings
Menorrhagia

15. What is the difference between a Holter monitor or an event monitor?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

16. Define 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
24 hour halter
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
>150mg per 24hrs

17. 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
CBC
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
S. Aureus

18. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
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
Scleroderma/polymyositis with secondary gastroesophageal reflux
Anticoag with warfarin to prevent thromboembolism

19. What is the caUse of Meniere disease? What are the cardinal symptoms?
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
>3.5g of protein per 24hrs

20. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
Nonulcer dyspepsia
Viral infection of the semicircular apparatus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

21. What is the peripheral caUse of vertigo?
Scleroderma/polymyositis with secondary gastroesophageal reflux
Viral gastroenteritis
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

22. How do you know if heart palpitations are due to stimulant or medication use?
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Less abrupt onset and cessation of palpitations
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

23. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Cluster headache
MSK - pulmonary - GI - or psychological
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

24. 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.
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
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Supraspinatus and bicipital tendons

25. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
DM - HTN - DVT - seizures - depression - or anxiety
E. Coli O157:H7
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Possibility of Ischemic colitis

26. When should a patient get a stress test?
Tension headache
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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

27. What test done in PE measures instability of shoulder?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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
CT
Diuretics -BB -CCB -ACEi

28. History for Acute bronchitis
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
EGD
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Anticoag with warfarin to prevent thromboembolism

29. What treatments are the cornerstone for treating cases of functional constipation?
Non-cardiac causes of palpitations
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Adhesive capsulitis (frozen shoulder): most common in middle age women
Increasing fluid (8 - 8oz glasses of water/day) -fiber

30. What the consequences of decreased cardiac output?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
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
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
With a KOH wet mount preparation

31. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
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
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

32. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Pancreatitis
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Paroxysmal atrial fibrillation or supraventricular tachycardia
35 (exception for postmenopausal women who have recently been started on HRT)

33. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
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
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
S. aureus- beta hemolytic streptococcus

34. Things that need to be included in history of shoulder pain
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Dehydration - anemia - cardiac causes

35. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
RBC casts and old to moderate HTN
Cluster headache
Pts with palpitations and dizziness - near syncope - or syncope
Coag disorders

36. name the 4 emergent causes of chest pain
Irregular bleeding between cycles
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Anticoag with warfarin to prevent thromboembolism
PE - MI - aortic dissection - pneumothorax

37. Describe the presentation of pneumonia
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
Rotator Cuff problem
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Colposcopy - Endocervical curettage - and directed cervical biopsy

38. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Non-cardiac causes of palpitations
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Cholelithiasis

39. 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)
Generalized Anxiety disorder and panic disorder
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Viral infection of the semicircular apparatus

40. 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
Serotypes 16 - 18 - 31 -52 -58
ACEi
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

41. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Cluster headache
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

42. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Varicella virus
Acute headache - ataxia - profuse nausea - and vomiting

43. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
True
High blood pressure - focal neurologic defecit - or papilledema
A 24hr urine protein collection and urine creatinine clearance determination

44. What is the preload?
Peptic ulcer disease or gastritis
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Candida albicans
Scabies

45. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Rotator Cuff problem
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
Loop diuretics (Check serum K+ levels before drug admin)
CT

46. 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
E. Coli O157:H7
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
DM - HTN - DVT - seizures - depression - or anxiety
Scleroderma/polymyositis with secondary gastroesophageal reflux

47. Pneumonia tx: suitable for healthy adults less than 60
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Bence-Jones
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

48. Uterine bleeding between regular cycles
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
Intermenstrual bleeding
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

49. Describes what occurs during squamous metaplasia of the cervix.
Varicella virus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Scabies

50. What does treatment for migrans include?
ACEi - ARBS - thiazide diuretics
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
True
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

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