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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. In addition to cardiac disease - chest pain could be attributed to 4 other causes. Name them
CBC
MSK - pulmonary - GI - or psychological
Nonulcer dyspepsia
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

2. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Staphylococcal scalded skin syndrome
DM - HTN - DVT - seizures - depression - or anxiety
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
Nonulcer dyspepsia

3. HIgh risk pregnant patients should be evaluated for ____ and ____
DM - HTN - DVT - seizures - depression - or anxiety
HIV and syphilis
A central clear area
Common problem that resolves spontaneously and is most often seen in children and young adults

4. name the 4 emergent causes of chest pain
ACEi
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
PE - MI - aortic dissection - pneumothorax
HPV testing -Pos=colposcopy -Neg=repeat pap smear

5. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
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.
S. aureus- beta hemolytic streptococcus
Non-cardiac causes of palpitations
Acute headache - ataxia - profuse nausea - and vomiting

6. Describe the Hx for a patient getting an abnormal vaginal bleeding work-up
Coag disorders
100mg; means patient can be trace protein positive and not be detected
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

7. Carcinoma in situ is generally referred to a gynecologist and requires ______
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
Impetigo
A 24hr urine protein collection and urine creatinine clearance determination
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

8. Four muscles of rotator cuff
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
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

9. What is the mechanism of action for stimulant agents in treating constipation?
Tension headache
MSK - pulmonary - GI - or psychological
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Furucnle

10. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
PE - MI - aortic dissection - pneumothorax
Supraspinatus and bicipital tendons
Nonulcer dyspepsia
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

11. When does troponin rise following myocardial injury or infarction?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
MSK - pulmonary - GI - or psychological
Colposcopy - Endocervical curettage - and directed cervical biopsy
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline

12. What treatments are the cornerstone for treating cases of functional constipation?
Candida albicans
Possibility of Ischemic colitis
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.
Increasing fluid (8 - 8oz glasses of water/day) -fiber

13. When should a patient get a stress test?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Pancreatitis
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

14. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Viral gastroenteritis
Lightheadedness - dizziness - syncope
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
Increase; 200 g/day

15. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Infectious esophagitis
PE - MI - aortic dissection - pneumothorax
Bence-Jones
Paroxysmal atrial fibrillation or supraventricular tachycardia

16. Who should have Xray testing for shoulder pain?
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Less abrupt onset and cessation of palpitations
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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

17. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
Pain
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
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

18. Natural history of cervical cancer
A 24hr urine protein collection and urine creatinine clearance determination
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

19. What occurs after ovulation
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Pancreatitis

20. Describe the presentation of pneumonia
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Pleurisy
Cholelithiasis

21. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
CBC
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

22. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
Associated with hypotension
CT
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

23. 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
Dehydration - anemia - cardiac causes
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
Streptococci

24. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
Infectious esophagitis
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
Acute headache - ataxia - profuse nausea - and vomiting
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

25. Pain in shoulder when throwing - swimming - or serving a tennis ball
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Rotator cuff tendonitis
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
MSK - pulmonary - GI - or psychological

26. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Repeat Pap after infection treated
Coag disorders
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Albumin; low molecular weight proteins

27. Chronic pain and shoulder stiffness with limited motion
RBC casts and old to moderate HTN
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
Paroxysmal atrial fibrillation or supraventricular tachycardia

28. What is the caUse of benign positional vertigo?
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.
Menorrhagia
Less than 3 stools per week
True

29. What HPV serotypes are most commonly associated with cervical cancer?
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Serotypes 16 - 18 - 31 -52 -58
Irregular bleeding between cycles
>150mg per 24hrs

30. Describe the presentation of angina?
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
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase
Common problem that resolves spontaneously and is most often seen in children and young adults

31. What is an acoustic neuroma?
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
Regular bleeding at intervals of more than 35 days
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

32. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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.
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Irregular bleeding between cycles

33. Isolated - extra pounding beats
Slow progression of cervical cancer changes -Availability of effective early treatment
High blood pressure - focal neurologic defecit - or papilledema
PVC or Premature atrial contraction (PAC)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

34. Cycle length variabilty is primarily due to what?
Variability in the time for follicle development during the proliferative phase
Diuretics -BB -CCB -ACEi
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
A central clear area

35. Name the diagnosis of heartburn: severe constant mid abdominal pain
Pancreatitis
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
DM - HTN - DVT - seizures - depression - or anxiety
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

36. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
Cervical radiculopathy
Repeat Pap after infection treated
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

37. Name the diagnosis of heartburn: colicky right upper quadrant pain - with meals - radiation to scapular regions
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Bence-Jones
S. Aureus
Cholelithiasis

38. Constipation: What are indications for lab testing?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
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
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)

39. What are the three types of lice?
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
DM - HTN - DVT - seizures - depression - or anxiety
Kids: Rotavirus Adults: Norwalk Virus

40. Things that need to be included in history of shoulder pain
24 hour halter
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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
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

41. When is a lumbar puncture contraindicated?
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Slow progression of cervical cancer changes -Availability of effective early treatment
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Echocardiogram

42. Shoulder pain with pain radiating to elbow
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Staphylococcal scalded skin syndrome
Cervical radiculopathy
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

43. 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
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
Adhesive capsulitis (frozen shoulder): most common in middle age women
True
Polymenorrhea

44. What lab tests are recommended for newly diagnosed hypertensive patients?
Cholelithiasis
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid
Male - report irregular heartbeat Sx duration >5min - hx of heart disease

45. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Supraspinatus and bicipital tendons
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cervical radiculopathy

46. 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
Temporal arteritis-biopsy of the temporal artery
EGD
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

47. What are the signs of malignant hypertension?
Coronary artery disease/ angina
Bence-Jones
Rotator Cuff problem
High blood pressure - focal neurologic defecit - or papilledema

48. Name the skin lesion: erythema - warmth - edema - pain - fever
Cellulitis
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
Acute headache - ataxia - profuse nausea - and vomiting
High blood pressure - focal neurologic defecit - or papilledema

49. What drugs do you use to treat H.pylori + PUD?
Infectious esophagitis
Chest pain during pneumonia or PE
Acute headache - ataxia - profuse nausea - and vomiting
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

50. Initial treatment for Rhinosinusitis
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
True

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