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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. 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
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Associated with hypotension
E. Coli O157:H7
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

2. Constipation: What are indications for lab testing?
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
CBC

3. What are the features of nephrotic syndrome?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Dehydration - anemia - cardiac causes

4. Complete the sentence: pericarditis can cause frictional rub and......
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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
HIV and syphilis

5. What diagnosis does the 'worse headache of my life' suggest?
Folliculitis
Subarachnoid hemorrhage
Coronary artery disease/ angina
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

6. Prenatal visit schedule for low-risk pregnancies
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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

7. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
A 24hr urine protein collection and urine creatinine clearance determination
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
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Peptic ulcer disease or gastritis

8. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Wolff-Parkinson-White syndrome
Viral gastroenteritis
Kids: Rotavirus Adults: Norwalk Virus
Variability in the time for follicle development during the proliferative phase

9. Describe the presentation of pneumonia
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
ACEi - ARBS - thiazide diuretics
HIV and syphilis
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

10. Name 4 factors that predispose an individual to develop pneumonia.
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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
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.
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

11. Describe the presentation tracheobronchitis
Candida albicans
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Polymenorrhea
Upper sternal area burning pain - associated with a productive cough

12. Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
Wolff-Parkinson-White syndrome
Slow progression of cervical cancer changes -Availability of effective early treatment
Cervical radiculopathy
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

13. PE 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
Scabies
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Infectious esophagitis

14. What are the three types of lice?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
35 (exception for postmenopausal women who have recently been started on HRT)
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

15. 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
True
Fever with frontal or maxillary tenderness
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Scabies

16. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Warts
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

17. Pneumothorax - sudden sharp chest pain - preceded by viral illness
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
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
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
Pleurisy

18. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Less abrupt onset and cessation of palpitations
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
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

19. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Medication or chemical esophagitis
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Anticoag with warfarin to prevent thromboembolism

20. Name the diagnosis of heartburn: dysphagia - assoc. with immunocompromised condition
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Infectious esophagitis
Varicella virus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

21. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
GERD
DM - HTN - DVT - seizures - depression - or anxiety
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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

22. What is the next best step if a patient has two or more positive dipstick tests?
Furucnle
A 24hr urine protein collection and urine creatinine clearance determination
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

23. When is a lumbar puncture contraindicated?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Bulk forming: Psyllium - Methycellulose - Polycarbophil
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

24. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
Menorrhagia
Giardia

25. Carcinoma in situ is generally referred to a gynecologist and requires ______
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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
Viral gastroenteritis
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

26. Vaccines that should be updated before planned pregnancy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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

27. What is the preload?
Rotator cuff tendonitis
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
High blood pressure - focal neurologic defecit - or papilledema
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

28. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Slow progression of cervical cancer changes -Availability of effective early treatment
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Analgesic headache

29. What are the features of glomerular nephritis
Coag disorders
Possibility of Ischemic colitis
RBC casts and old to moderate HTN
With a KOH wet mount preparation

30. History for Sinusitis

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31. What does orthostatic positional changes that bring on dizziness suggest?
Pleurisy
Dehydration - anemia - cardiac causes
Temporal arteritis-biopsy of the temporal artery
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

32. What is the goal of CHF treatment? What drugs should be used?
Nonulcer dyspepsia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
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
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.

33. What occurs after ovulation
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.
Generalized Anxiety disorder and panic disorder
100mg; means patient can be trace protein positive and not be detected
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

34. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Echocardiogram
Scleroderma/polymyositis with secondary gastroesophageal reflux

35. Define proteinuria
Paroxysmal atrial fibrillation or supraventricular tachycardia
Albumin; low molecular weight proteins
>150mg per 24hrs
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

36. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Chest pain during pneumonia or PE
Less than 80 ml of blood
Bence-Jones

37. What is the caUse of Meniere disease? What are the cardinal symptoms?
35 (exception for postmenopausal women who have recently been started on HRT)
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
>150mg per 24hrs

38. What does treatment for migrans include?
Furucnle
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
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

39. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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
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
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
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

40. SE Of Beta blockers?
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Tension headache
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Infectious esophagitis

41. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
CBC
Paroxysmal atrial fibrillation or supraventricular tachycardia
Echocardiogram
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

42. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
DM - HTN - DVT - seizures - depression - or anxiety
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
HIV and syphilis
When the patient has symptoms in association with exercise or who describe chest pain or pressure

43. Menometrorrhagia
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Excessive bleeding in amount - duration - or both at irregular intervals
True
Staphylococcal scalded skin syndrome

44. What type of imaging is need for chronic sinusitis?
CT
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Anticoag with warfarin to prevent thromboembolism
Cholelithiasis

45. Diagnosis of HTN
Colposcopy - Endocervical curettage - and directed cervical biopsy
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
True

46. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
These patients are associated with low renin states=less likely to respond to medication
Giardia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

47. What is the role of LH in the menstrual cycle
LH surge triggers ovulation
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
BB or CCB - catheter ablation of identified bypass tract
Acute headache - ataxia - profuse nausea - and vomiting

48. What medications can cause heart 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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

49. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
DM - HTN - DVT - seizures - depression - or anxiety
Temporal arteritis-biopsy of the temporal artery

50. History and PE for Pneumonia
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
S. Aureus
PE - MI - aortic dissection - pneumothorax

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