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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. name the 4 emergent causes of chest pain
PE - MI - aortic dissection - pneumothorax
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Pleurisy
Hypertension - CAD - valvular heart disease

2. What are signs of pulmonary congestion?
Pancreatitis
Staphylococcal scalded skin syndrome
Pleurisy
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

3. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
S. aureus- beta hemolytic streptococcus
Warts

4. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Common problem that resolves spontaneously and is most often seen in children and young adults
Less than 3 stools per week
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.

5. How is constipation clinically defined?
Less than 3 stools per week
Increase; 200 g/day
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Bulk forming: Psyllium - Methycellulose - Polycarbophil

6. 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
Less than 80 ml of blood
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia

7. What lab tests are recommended for newly diagnosed hypertensive patients?
Peptic ulcer disease or gastritis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Less than 80 ml of blood
Associated with hypotension

8. What is the role of LH in the menstrual cycle
Staphylococcal scalded skin syndrome
LH surge triggers ovulation
CT
Bulk forming: Psyllium - Methycellulose - Polycarbophil

9. Name some medications that can cause proteinuria
Less than 3 stools per week
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
These patients are associated with low renin states=less likely to respond to medication
LH surge triggers ovulation

10. Who should have Xray testing for shoulder pain?
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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
Dehydration - anemia - cardiac causes

11. What places women at higher risk of getting cervical cancer?
With a KOH wet mount preparation
Rotator Cuff tendonitis
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
HIV and syphilis

12. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
Infectious esophagitis
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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

13. What are the features of glomerular nephritis
High blood pressure - focal neurologic defecit - or papilledema
Subarachnoid hemorrhage
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
RBC casts and old to moderate HTN

14. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
ACEi

15. What are the three types of lice?
Peptic ulcer disease or gastritis
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Pleurisy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse

16. What are the signs of acute sinusitis?
RBC casts and old to moderate HTN
Fever with frontal or maxillary tenderness
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
ACEi

17. Initial treatment for Rhinosinusitis
BB or CCB - catheter ablation of identified bypass tract
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

18. Name the skin lesion: honey colored crusts
Cellulitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Impetigo
Variability in the time for follicle development during the proliferative phase

19. 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
Less than 80 ml of blood
Wolff-Parkinson-White syndrome
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Scabies

20. Oligomenorrhea
RBC casts and old to moderate HTN
Regular bleeding at intervals of more than 35 days
Less abrupt onset and cessation of palpitations
Viral infection of the semicircular apparatus

21. Diagnosis of HTN
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Coag disorders
HPV
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

22. 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)
DM - HTN - DVT - seizures - depression - or anxiety
Common problem that resolves spontaneously and is most often seen in children and young adults
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

23. 1+ protein level on urine dipstick usually represents how much protein in the urine?
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.
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

24. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Diuretics -BB -CCB -ACEi
Slow progression of cervical cancer changes -Availability of effective early treatment

25. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
These patients are associated with low renin states=less likely to respond to medication
Associated with hypotension
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

26. Where does the development of abnormal cervical cells begin?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Squamocolumnar junction=most common site of cervical cancer
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Tension headache

27. What medications can cause heart palpitations?
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Rotator Cuff problem
Cholelithiasis

28. What are the consequences of diastolic dysfunction?
Pancreatitis
Higher filling presure - pulmonary congestion - and decreasd cardiac return
PVC or Premature atrial contraction (PAC)
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

29. What is considered normal blood loss during a menstrual cycle?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Less than 80 ml of blood
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. Uterine bleeding between regular cycles
Scabies
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Polymenorrhea
Intermenstrual bleeding

31. What is the caUse of benign positional vertigo?
Squamocolumnar junction=most common site of cervical cancer
Less abrupt onset and cessation of palpitations
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.
Cholelithiasis

32. What diagnosis does the 'worse headache of my life' suggest?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Subarachnoid hemorrhage
Rotator Cuff tendonitis
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

33. After treatment of dysplasia - women need Pap smears every...
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Wolff-Parkinson-White syndrome

34. What are the 2 psych disorders most commonly associated with palpitations?
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
Generalized Anxiety disorder and panic disorder
24 hour halter
Bulk forming: Psyllium - Methycellulose - Polycarbophil

35. What is the goal of CHF treatment? What drugs should be used?
Irregular bleeding between cycles
Cholelithiasis
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
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

36. Constipation: What are indications for lab testing?
Tension headache
Loop diuretics (Check serum K+ levels before drug admin)
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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

37. What is the caUse of Meniere disease? What are the cardinal symptoms?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

38. True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location - pulsatile quality - moderate to severe intensity - or aggravation by movement. They must also be associated with one of the foll
Streptococci
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Higher filling presure - pulmonary congestion - and decreasd cardiac return
True

39. Prenatal visit schedule for low-risk pregnancies
Dehydration - anemia - cardiac causes
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

40. Cycle length variabilty is primarily due to what?
Albumin; low molecular weight proteins
Variability in the time for follicle development during the proliferative phase
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

41. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza
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
Colposcopy - Endocervical curettage - and directed cervical biopsy

42. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
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
HPV

43. Name the skin lesion: erythema - warmth - edema - pain - fever
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Less than 3 stools per week
Cellulitis
Rotator Cuff problem

44. 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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
MSK - pulmonary - GI - or psychological
Common problem that resolves spontaneously and is most often seen in children and young adults
Cluster headache

45. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Polymenorrhea
Squamocolumnar junction=most common site of cervical cancer
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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

46. Treatment for supraventricular tachycardias
Scleroderma/polymyositis with secondary gastroesophageal reflux
BB or CCB - catheter ablation of identified bypass tract
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: 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

47. What is the preload?
PVC or Premature atrial contraction (PAC)
Cluster headache
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Serotypes 16 - 18 - 31 -52 -58

48. Describe the presentation tracheobronchitis
>150mg per 24hrs
Nonulcer dyspepsia
Upper sternal area burning pain - associated with a productive cough
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

49. What are the two common clinical presentations of acute diarrhea?
Bence-Jones
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
100mg; means patient can be trace protein positive and not be detected

50. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Loop diuretics (Check serum K+ levels before drug admin)
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

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