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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. How is constipation clinically defined?
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Slow progression of cervical cancer changes -Availability of effective early treatment
Less than 3 stools per week
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

2. Diagnostic Evaluation of Abnoraml vaginal bleeding
Warts
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
MSK - pulmonary - GI - or psychological
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

3. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

4. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator Cuff problem
Anticoag with warfarin to prevent thromboembolism
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

5. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
True
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Other brainstem or cranial nerve findings
Colposcopy - Endocervical curettage - and directed cervical biopsy

6. What are signs of pulmonary congestion?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Folliculitis
Other brainstem or cranial nerve findings
Scabies

7. MI - pericardial tamponade - PE - GI bleed - are...
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Associated with hypotension
HIV and syphilis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

8. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
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
Molluscum contagiosum- pox virus
GERD
Colposcopy - Endocervical curettage - and directed cervical biopsy

9. 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
Irregular bleeding between cycles
Cluster headache
Repeat Pap after infection treated
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

10. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Rotator cuff tendonitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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

11. What lab tests are recommended for newly diagnosed hypertensive patients?
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
Fever with frontal or maxillary tenderness

12. Name the diagnosis of heartburn: severe constant mid abdominal pain
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pancreatitis
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

13. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Menorrhagia
Cluster headache
Regular bleeding at intervals of more than 35 days

14. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Paroxysmal atrial fibrillation or supraventricular tachycardia
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Intermenstrual bleeding

15. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
ACEi
Rotator cuff tendonitis
True
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

16. Metrorrhagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Irregular bleeding between cycles

17. What is the caUse of benign positional vertigo?
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
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.
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
Molluscum contagiosum- pox virus

18. What does orthostatic positional changes that bring on dizziness suggest?
Pts with palpitations and dizziness - near syncope - or syncope
Less than 80 ml of blood
Dehydration - anemia - cardiac causes
Serotypes 16 - 18 - 31 -52 -58

19. Name the skin lesion: erythema - warmth - edema - pain - fever
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
Acute headache - ataxia - profuse nausea - and vomiting
Cellulitis
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

20. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Viral gastroenteritis
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Paroxysmal atrial fibrillation or supraventricular tachycardia

21. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
35 (exception for postmenopausal women who have recently been started on HRT)
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Rotator Cuff problem
Albumin; low molecular weight proteins

22. Cycle length variabilty is primarily due to what?
Possibility of Ischemic colitis
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Variability in the time for follicle development during the proliferative phase
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

23. What is the Barany maneuver?
Hgb - Electrolytes - and TSH
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
Acute headache - ataxia - profuse nausea - and vomiting

24. What is the peripheral caUse of vertigo?
Increase; 200 g/day
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

25. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
Viral infection of the semicircular apparatus
GERD
Folliculitis
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

26. Describe the presentation of pericardial pain
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
A 24hr urine protein collection and urine creatinine clearance determination

27. Pneumonia tx: suitable for healthy adults less than 60
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
With a KOH wet mount preparation
Furucnle

28. Diarrhea from custard filled pastries
Bence-Jones
S. Aureus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
DM - HTN - DVT - seizures - depression - or anxiety

29. Describe the presentation tracheobronchitis
Albumin; low molecular weight proteins
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Upper sternal area burning pain - associated with a productive cough
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

30. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Pain
Cervical radiculopathy

31. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pain

32. What is a markers of CNS vertigo?
HIV and syphilis
Regular bleeding at intervals of more than 35 days
Other brainstem or cranial nerve findings
Generalized Anxiety disorder and panic disorder

33. 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
ACEi - ARBS - thiazide diuretics
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Slow progression of cervical cancer changes -Availability of effective early treatment
Molluscum contagiosum- pox virus

34. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
S. aureus- beta hemolytic streptococcus

35. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Peptic ulcer disease or gastritis

36. What should blood work include for suspected heart failure?
Streptococci
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Giardia
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

37. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Pancreatitis

38. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Slow progression of cervical cancer changes -Availability of effective early treatment
Nonulcer dyspepsia
Upper sternal area burning pain - associated with a productive cough
Paroxysmal atrial fibrillation or supraventricular tachycardia

39. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
Menorrhagia
Generalized Anxiety disorder and panic disorder

40. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Fever with frontal or maxillary tenderness
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

41. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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
HPV
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

42. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Cholelithiasis
Hgb - Electrolytes - and TSH
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Kids: Rotavirus Adults: Norwalk Virus

43. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
GERD
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

44. Clinical Manifestations of HTN
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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.
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

45. When should a patient get a stress test?
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
When the patient has symptoms in association with exercise or who describe chest pain or pressure

46. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
CBC
Impetigo
These patients are associated with low renin states=less likely to respond to medication

47. 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
Serotypes 16 - 18 - 31 -52 -58
E. Coli O157:H7
Menorrhagia
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

48. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
ACEi - ARBS - thiazide diuretics
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.
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Tension headache

49. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Viral infection of the semicircular apparatus
Loop diuretics (Check serum K+ levels before drug admin)

50. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Candida albicans
Folliculitis
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
>150mg per 24hrs

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