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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. 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
24 hour halter
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Paroxysmal atrial fibrillation or supraventricular tachycardia

2. What does the classic ring worm lesion have?
Impetigo
Less than 3 stools per week
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
A central clear area

3. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Albumin; low molecular weight proteins
EGD

4. 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. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Pts with palpitations and dizziness - near syncope - or syncope
Supraspinatus and bicipital tendons
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

5. What are the most common viral causes of diarrhea in kids and adults?
>150mg per 24hrs
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Kids: Rotavirus Adults: Norwalk Virus

6. 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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
E. Coli O157:H7
LH surge triggers ovulation
Folliculitis

7. What places women at higher risk of getting cervical cancer?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
DM - HTN - DVT - seizures - depression - or anxiety
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

8. 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
Bence-Jones
Adhesive capsulitis (frozen shoulder): most common in middle age women
Loop diuretics (Check serum K+ levels before drug admin)

9. What is the Barany maneuver?
>150mg per 24hrs
PE - MI - aortic dissection - pneumothorax
S. aureus- beta hemolytic streptococcus
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

10. What does treatment for migrans include?
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
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
Nonulcer dyspepsia
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

11. What test done in PE measures instability of shoulder?
Cluster headache
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Cellulitis

12. What is the peripheral caUse of vertigo?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Adhesive capsulitis (frozen shoulder): most common in middle age women
High blood pressure - focal neurologic defecit - or papilledema
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

13. Describe the history and PE of patient presenting with common cold
Infectious esophagitis
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
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

14. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Rotator Cuff tendonitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Analgesic headache
Non-cardiac causes of palpitations

15. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Non-cardiac causes of palpitations
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
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.

16. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Pain
Fever with frontal or maxillary tenderness
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

17. patients with herpes zoster may experience what symptom before the rash appear?
Pain
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
A central clear area
PE - MI - aortic dissection - pneumothorax

18. MI - pericardial tamponade - PE - GI bleed - are...
Associated with hypotension
Peptic ulcer disease or gastritis
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

19. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
PE - MI - aortic dissection - pneumothorax
Repeat Pap after infection treated
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Squamocolumnar junction=most common site of cervical cancer

20. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Intermenstrual bleeding
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Folliculitis

21. What are signs of pulmonary congestion?
HPV
Supraspinatus and bicipital tendons
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

22. What are symptoms are CHF?
Fever with frontal or maxillary tenderness
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

23. How does systolic vs. diastolic heart failure present on the echocardiogram?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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. What HPV serotypes are most commonly associated with cervical cancer?
Serotypes 16 - 18 - 31 -52 -58
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
A central clear area
Generalized Anxiety disorder and panic disorder

25. History and PE for Pneumonia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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
Irregular bleeding between cycles
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.

26. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Paroxysmal atrial fibrillation or supraventricular tachycardia
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

27. What are the features of glomerular nephritis
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
Bence-Jones
RBC casts and old to moderate HTN
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

28. What are the features of nephrotic syndrome?
Candida albicans
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
GERD
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

29. Describe the presentation of pneumonia
RBC casts and old to moderate HTN
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
Intermenstrual bleeding
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

30. What are the signs of acute sinusitis?
35 (exception for postmenopausal women who have recently been started on HRT)
Fever with frontal or maxillary tenderness
Furucnle
Medication or chemical esophagitis

31. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
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
Nonulcer dyspepsia
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Candida albicans

32. Diarrhea from custard filled pastries
Analgesic headache
S. Aureus
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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.

33. What are the 2 psych disorders most commonly associated with palpitations?
Generalized Anxiety disorder and panic disorder
Infectious esophagitis
Warts
Presence of proteinuria on at least two separate ocassion

34. HIgh risk pregnant patients should be evaluated for ____ and ____
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
HIV and syphilis
Cluster headache
Fever with frontal or maxillary tenderness

35. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Other brainstem or cranial nerve findings
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Staphylococcal scalded skin syndrome
Loop diuretics (Check serum K+ levels before drug admin)

36. How do you define persistent protein uria?
Cervical radiculopathy
CT
Molluscum contagiosum- pox virus
Presence of proteinuria on at least two separate ocassion

37. How can GERD (or esophageal motility disorders) lead to chest pain?
Less than 3 stools per week
Candida albicans
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

38. 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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Non-cardiac causes of palpitations
Less than 80 ml of blood

39. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
S. aureus- beta hemolytic streptococcus
HIV and syphilis
Cellulitis

40. What are the consequences of diastolic dysfunction?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Supraspinatus and bicipital tendons
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return

41. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
A central clear area
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

42. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Cervical radiculopathy
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

43. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Bence-Jones

44. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
24 hour halter

45. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Scleroderma/polymyositis with secondary gastroesophageal reflux
Furucnle
Tension headache
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

46. 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
Warts
Generalized Anxiety disorder and panic disorder
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

47. 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
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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

48. Treatment for supraventricular tachycardias
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
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Streptococci
BB or CCB - catheter ablation of identified bypass tract

49. Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched - the mites can migrate to other areas such as the finger webs - wr
Variability in the time for follicle development during the proliferative phase
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
Scabies
Rotator Cuff problem

50. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Analgesic headache
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Furucnle

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