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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. Tx of chronic or intermittent afibs
LH surge triggers ovulation
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
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Anticoag with warfarin to prevent thromboembolism

2. Define proteinuria
>150mg per 24hrs
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
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
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

3. Chronic pain and shoulder stiffness with limited motion
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Associated with hypotension
Adhesive capsulitis (frozen shoulder): most common in middle age women
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin

4. What should blood work include for suspected heart failure?
BB or CCB - catheter ablation of identified bypass tract
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Lightheadedness - dizziness - syncope
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

5. What is the peripheral caUse of vertigo?
Cholelithiasis
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
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Medication or chemical esophagitis

6. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Polymenorrhea
Increase; 200 g/day
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

7. 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
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
Cluster headache
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

8. Mainstay treatment for soft tissue inflammation (Shoulder)
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.
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Folliculitis

9. Name the diagnosis of heartburn: regurgitation - dysphagia
Fever with frontal or maxillary tenderness
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
Serotypes 16 - 18 - 31 -52 -58
GERD

10. What is the difference between a Holter monitor or an event monitor?
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
Intermenstrual bleeding
Peptic ulcer disease or gastritis
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

11. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Subarachnoid hemorrhage
Staphylococcal scalded skin syndrome
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Diuretics -BB -CCB -ACEi

12. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

13. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

14. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
ACEi
Staphylococcal scalded skin syndrome
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

15. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Dehydration - anemia - cardiac causes
High blood pressure - focal neurologic defecit - or papilledema
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

16. Pneumothorax - sudden sharp chest pain - preceded by viral illness
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Pleurisy
Infectious esophagitis
A central clear area

17. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Lightheadedness - dizziness - syncope
Supraspinatus and bicipital tendons
Medication or chemical esophagitis
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

18. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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
MSK - pulmonary - GI - or psychological
Intermenstrual bleeding
Furucnle

19. Name some medications that can cause proteinuria
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Diuretics -BB -CCB -ACEi
Coag disorders
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

20. What drugs do you use to treat H.pylori + PUD?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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.
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

21. What are the symptoms of palpitations?
E. Coli O157:H7
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Lightheadedness - dizziness - syncope
Anticoag with warfarin to prevent thromboembolism

22. What are the 2 psych disorders most commonly associated with palpitations?
True
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Generalized Anxiety disorder and panic disorder
Acute headache - ataxia - profuse nausea - and vomiting

23. Uterine bleeding between regular cycles
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Intermenstrual bleeding
Hypertension - CAD - valvular heart disease
Increasing fluid (8 - 8oz glasses of water/day) -fiber

24. Name types of laxatives
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Pts with palpitations and dizziness - near syncope - or syncope
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

25. Name 4 factors that predispose an individual to develop pneumonia.
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Serotypes 16 - 18 - 31 -52 -58
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
>3.5g of protein per 24hrs

26. Complete the sentence: pericarditis can cause frictional rub and......
Adhesive capsulitis (frozen shoulder): most common in middle age women
Subarachnoid hemorrhage
Cholelithiasis
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

27. What is the standard tool used for diagnosis of GERD?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
EGD
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block

28. Define nephrotic range proteinuria
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
>3.5g of protein per 24hrs
S. Aureus
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

29. Vaccines that should be updated before planned pregnancy
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Chest pain during pneumonia or PE
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Cluster headache

30. Name the skin lesion: honey colored crusts
Impetigo
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Serotypes 16 - 18 - 31 -52 -58

31. What is the goal of CHF treatment? What drugs should be used?
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Influenza - Rhinovirus - Adenovirus - Parainfluenza
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

32. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Streptococci
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas

33. What is the next best step if a patient has two or more positive dipstick tests?
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
A 24hr urine protein collection and urine creatinine clearance determination
Squamocolumnar junction=most common site of cervical cancer

34. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Scleroderma/polymyositis with secondary gastroesophageal reflux
Cholelithiasis
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting

35. Describe the presentation of myocardial pain?
HIV and syphilis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

36. What is benign transient proteinuria?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Common problem that resolves spontaneously and is most often seen in children and young adults
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

37. 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.
Polymenorrhea
Streptococci
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
Supraspinatus and bicipital tendons

38. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Anticoag with warfarin to prevent thromboembolism
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
LH surge triggers ovulation
Excessive bleeding in amount - duration - or both at irregular intervals

39. What does treatment for migrans include?
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
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Cervical radiculopathy
Menorrhagia

40. Menometrorrhagia
RBC casts and old to moderate HTN
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Excessive bleeding in amount - duration - or both at irregular intervals

41. When does troponin rise following myocardial injury or infarction?
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Anticoag with warfarin to prevent thromboembolism

42. How can GERD (or esophageal motility disorders) lead to chest pain?
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Viral gastroenteritis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

43. Define the patient population typically affected by orthostatic or postural proteinuria
Kids: Rotavirus Adults: Norwalk Virus
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
Pain
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

44. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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

45. Difference between Pneumonia and Bronchitis
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
Cervical radiculopathy
Less than 3 stools per week
Common problem that resolves spontaneously and is most often seen in children and young adults

46. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Rotator cuff tendonitis
Paroxysmal atrial fibrillation or supraventricular tachycardia
CT
HPV

47. What are the signs of acute sinusitis?
DM - HTN - DVT - seizures - depression - or anxiety
Fever with frontal or maxillary tenderness
Echocardiogram
RBC casts and old to moderate HTN

48. Prenatal visit schedule for low-risk pregnancies
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

49. How to NSAIDs contribute to gastritis and ulcer formation?
Associated with hypotension
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow - secretion of mucus - and bicarbonate. Without these protective factors - acid-induced inflammation and ulcers my result.
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

50. What is an acoustic neuroma?
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

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