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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. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Excessive bleeding in amount - duration - or both at irregular intervals
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Less than 3 stools per week

2. Treatment for supraventricular tachycardias
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
BB or CCB - catheter ablation of identified bypass tract
Acute headache - ataxia - profuse nausea - and vomiting
Chest pain during pneumonia or PE

3. Chronic pain and shoulder stiffness with limited motion
100mg; means patient can be trace protein positive and not be detected
Diuretics -BB -CCB -ACEi
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Adhesive capsulitis (frozen shoulder): most common in middle age women

4. What medications can cause heart palpitations?
Excessive bleeding in amount - duration - or both at irregular intervals
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

5. Four muscles of rotator cuff
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

6. When should invasive eletrophysiologic study should be considered?
E. Coli O157:H7
Cervical radiculopathy
Scleroderma/polymyositis with secondary gastroesophageal reflux
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

7. What is the role of LH in the menstrual cycle
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
LH surge triggers ovulation

8. Name the diagnosis of heartburn: severe constant mid abdominal pain
Cellulitis
Pancreatitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
GERD

9. What is the next best step if a patient has two or more positive dipstick tests?
A 24hr urine protein collection and urine creatinine clearance determination
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Coronary artery disease/ angina
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

10. What are the three major risk factors for heart failure?
True
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
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
Hypertension - CAD - valvular heart disease

11. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

12. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Dehydration - anemia - cardiac causes
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed

13. Define nephrotic range proteinuria
Viral gastroenteritis
>3.5g of protein per 24hrs
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
Less than 80 ml of blood

14. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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
Pts with palpitations and dizziness - near syncope - or syncope
CT

15. Diagnostic Evaluation of Abnoraml vaginal bleeding
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Coronary artery disease/ angina
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
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

16. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
HPV
LH surge triggers ovulation
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Possibility of Ischemic colitis

17. What are the two common clinical presentations of acute diarrhea?
A 24hr urine protein collection and urine creatinine clearance determination
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
CT
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

18. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
24 hour halter

19. How does CHF present on X-ray?
DM - HTN - DVT - seizures - depression - or anxiety
Repeat Pap after infection treated
Less abrupt onset and cessation of palpitations
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

20. 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
With a KOH wet mount preparation
MSK - pulmonary - GI - or psychological
Nonulcer dyspepsia

21. Name the skin lesion: pustule in association with a hair follice
Folliculitis
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Increasing fluid (8 - 8oz glasses of water/day) -fiber

22. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
PE - MI - aortic dissection - pneumothorax

23. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Pts with palpitations and dizziness - near syncope - or syncope
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Folliculitis

24. Diarrhea is defined as an ____ in stool weight to more than ____g per day
With a KOH wet mount preparation
Increase; 200 g/day
Irregular bleeding between cycles
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

25. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Adhesive capsulitis (frozen shoulder): most common in middle age women
Tension headache
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

26. 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
CT
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
Warts
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

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

28. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Furucnle
Scleroderma/polymyositis with secondary gastroesophageal reflux
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

29. Cycle length variabilty is primarily due to what?
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.
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
Analgesic headache
Variability in the time for follicle development during the proliferative phase

30. Discomfort with abducting the arm past 90 degress
Cholelithiasis
Rotator Cuff tendonitis
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

31. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Viral gastroenteritis
Coag disorders
Coronary artery disease/ angina
Upper sternal area burning pain - associated with a productive cough

32. Oligomenorrhea
Regular bleeding at intervals of more than 35 days
A central clear area
Rotator cuff tendonitis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis

33. 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
MSK - pulmonary - GI - or psychological
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
100mg; means patient can be trace protein positive and not be detected

34. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
These patients are associated with low renin states=less likely to respond to medication
CT
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

35. What is the preload?
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

36. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Wolff-Parkinson-White syndrome

37. When should a patient get a stress test?
When the patient has symptoms in association with exercise or who describe chest pain or pressure
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Molluscum contagiosum- pox virus

38. What places women at higher risk of getting cervical cancer?
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
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
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

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
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
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

40. 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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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
Cluster headache

41. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Upper sternal area burning pain - associated with a productive cough
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

42. Pneumothorax - sudden sharp chest pain - preceded by viral illness
CBC
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Pleurisy
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

43. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Tension headache
DM - HTN - DVT - seizures - depression - or anxiety
Hypertension - CAD - valvular heart disease
Paroxysmal atrial fibrillation or supraventricular tachycardia

44. Shoulder pain with pain radiating to elbow
Cervical radiculopathy
When the patient has symptoms in association with exercise or who describe chest pain or pressure
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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.

45. ______ infections cause approximately 95% of bronchitis cases in healthy adults.
>3.5g of protein per 24hrs
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
Peptic ulcer disease or gastritis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

46. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
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
MSK - pulmonary - GI - or psychological
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Rotator Cuff problem

47. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Varicella virus

48. History for Sinusitis

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49. Carcinoma in situ is generally referred to a gynecologist and requires ______
Medication or chemical esophagitis
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

50. What treatments are the cornerstone for treating cases of functional constipation?
S. aureus- beta hemolytic streptococcus
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

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