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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. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Albumin; low molecular weight proteins

2. Describe the history and PE of patient presenting with common cold
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Varicella virus

3. After treatment of dysplasia - women need Pap smears every...
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Warts
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

4. How is constipation clinically defined?
Less than 3 stools per week
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
True

5. Palpitations: Which patients warrant hospitalization - monitoring and aggressive eval?
Albumin; low molecular weight proteins
Pts with palpitations and dizziness - near syncope - or syncope
Serotypes 16 - 18 - 31 -52 -58
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

6. What HPV serotypes are most commonly associated with cervical cancer?
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Serotypes 16 - 18 - 31 -52 -58
Regular bleeding at intervals of more than 35 days
Bence-Jones

7. Irregular cycles with excessive flow - duration - or both
Staphylococcal scalded skin syndrome
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
Giardia
Menorrhagia

8. Chronic pain and shoulder stiffness with limited motion
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Adhesive capsulitis (frozen shoulder): most common in middle age women
DM - HTN - DVT - seizures - depression - or anxiety
Generalized Anxiety disorder and panic disorder

9. What is the role of FSH in one's menstrual cycle
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Temporal arteritis-biopsy of the temporal artery
Coronary artery disease/ angina
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

10. Name some medications that can cause proteinuria
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.
Influenza - Rhinovirus - Adenovirus - Parainfluenza
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
HPV testing -Pos=colposcopy -Neg=repeat pap smear

11. What should be considered in younger patients with menorrhagia
Coag disorders
Furucnle
Serotypes 16 - 18 - 31 -52 -58
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

12. When should invasive eletrophysiologic study should be considered?
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
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Albumin; low molecular weight proteins

13. Define the patient population typically affected by orthostatic or postural proteinuria
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
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
Pancreatitis
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

14. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Hgb - Electrolytes - and TSH
Acute headache - ataxia - profuse nausea - and vomiting
Diuretics -BB -CCB -ACEi
Increase; 200 g/day

15. Hyperthyroidism - pheochromocytoma - anemia - dehydration - hypovolemia are...
Diuretics -BB -CCB -ACEi
Varicella virus
Pts with palpitations and dizziness - near syncope - or syncope
Non-cardiac causes of palpitations

16. How does CHF present on X-ray?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
BB or CCB - catheter ablation of identified bypass tract
Generalized Anxiety disorder and panic disorder
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

17. What type of imaging is need for chronic sinusitis?
Coag disorders
CT
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
Excessive bleeding in amount - duration - or both at irregular intervals

18. What should preconception counseling include?
Variability in the time for follicle development during the proliferative phase
Excessive bleeding in amount - duration - or both at irregular intervals
Supraspinatus and bicipital tendons
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

19. What diagnosis does the 'worse headache of my life' suggest?
Subarachnoid hemorrhage
Acute headache - ataxia - profuse nausea - and vomiting
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Common problem that resolves spontaneously and is most often seen in children and young adults

20. 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
>150mg per 24hrs
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
Echocardiogram
True

21. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Pain
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Coronary artery disease/ angina

22. Name the diagnosis: live in the mouth - vaginal tract - and gut; produce budding spores - pseudohypahe (elongated cells) - or true hypae
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
>150mg per 24hrs
Candida albicans
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

23. What are symptoms are CHF?
High blood pressure - focal neurologic defecit - or papilledema
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Furucnle
Influenza - Rhinovirus - Adenovirus - Parainfluenza

24. Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum) - the hair and the nails
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

25. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Varicella virus
Anticoag with warfarin to prevent thromboembolism
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

26. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

27. What are the primary glomerular diseases?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
CBC

28. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Pain
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Common problem that resolves spontaneously and is most often seen in children and young adults

29. What are the signs of malignant hypertension?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
High blood pressure - focal neurologic defecit - or papilledema

30. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Viral gastroenteritis
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Wolff-Parkinson-White syndrome
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

31. Tx of chronic or intermittent afibs
Other brainstem or cranial nerve findings
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Anticoag with warfarin to prevent thromboembolism

32. What are the indiciations for neuroimaging?
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

33. What occurs after ovulation
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.
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
Higher filling presure - pulmonary congestion - and decreasd cardiac return
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

34. Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution - starting at the trunk and spreading to the
GERD
Varicella virus
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

35. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Increase; 200 g/day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
Squamocolumnar junction=most common site of cervical cancer
GERD

36. What is the next best step if a patient has two or more positive dipstick tests?
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
Cellulitis
A 24hr urine protein collection and urine creatinine clearance determination
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

37. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Scleroderma/polymyositis with secondary gastroesophageal reflux
CT
Pleurisy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

38. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
RBC casts and old to moderate HTN
CBC
Non-cardiac causes of palpitations
Bence-Jones

39. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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
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
Albumin; low molecular weight proteins
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

40. Describe the presentation of angina?
Repeat Pap after infection treated
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
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

41. What is considered normal blood loss during a menstrual cycle?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Less abrupt onset and cessation of palpitations
Less than 80 ml of blood

42. 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
Cellulitis
Serotypes 16 - 18 - 31 -52 -58
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Scabies

43. Shoulder pain with pain radiating to elbow
Fever with frontal or maxillary tenderness
Cervical radiculopathy
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

44. What is the Epley maneuver?
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.
>150mg per 24hrs
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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

45. Diagnostic Evaluation of Abnoraml vaginal bleeding
Cellulitis
Pts with palpitations and dizziness - near syncope - or syncope
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
Subarachnoid hemorrhage

46. What lab tests are recommended for newly diagnosed hypertensive patients?
24 hour halter
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

47. When does troponin rise following myocardial injury or infarction?
Wolff-Parkinson-White syndrome
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Cellulitis

48. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Chest pain during pneumonia or PE
Paroxysmal atrial fibrillation or supraventricular tachycardia

49. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Dehydration - anemia - cardiac causes
S. aureus- beta hemolytic streptococcus
Adhesive capsulitis (frozen shoulder): most common in middle age women
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

50. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
Increase; 200 g/day
Giardia
Less abrupt onset and cessation of palpitations

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