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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. What are the signs of acute sinusitis?
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
Fever with frontal or maxillary tenderness
Candida albicans
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

2. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Chest pain during pneumonia or PE
Folliculitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

3. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
S. aureus- beta hemolytic streptococcus
Bence-Jones
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Intermenstrual bleeding

4. 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
LH surge triggers ovulation
Viral gastroenteritis
Slow progression of cervical cancer changes -Availability of effective early treatment

5. Diarrhea from custard filled pastries
S. Aureus
Impetigo
Acute headache - ataxia - profuse nausea - and vomiting
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

6. Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
Cervical radiculopathy
HPV
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

7. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
Repeat Pap after infection treated
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
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
35 (exception for postmenopausal women who have recently been started on HRT)

8. What are the consequences of diastolic dysfunction?
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

9. What are symptoms are CHF?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
>3.5g of protein per 24hrs
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus

10. What is the caUse of acute larbyrinthitis or vestibular neuronitis?
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
Acute headache - ataxia - profuse nausea - and vomiting
Fever with frontal or maxillary tenderness
Viral infection of the semicircular apparatus

11. name the 4 emergent causes of chest pain
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
Varicella virus
PE - MI - aortic dissection - pneumothorax
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

12. Describe the presentation of pericardial pain
Regular bleeding at intervals of more than 35 days
Associated with hypotension
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
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing

13. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
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
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Hypertension - CAD - valvular heart disease

14. Define nephrotic range proteinuria
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
>3.5g of protein per 24hrs

15. What are the common causes for laryngitis?
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
Wolff-Parkinson-White syndrome
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Pleurisy

16. What are the physical exam signs of CHF?
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded - stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided
Furucnle

17. What should blood work include for suspected heart failure?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot

18. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Scleroderma/polymyositis with secondary gastroesophageal reflux
S. aureus- beta hemolytic streptococcus
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile

19. What is considered normal blood loss during a menstrual cycle?
Less than 80 ml of blood
Generalized Anxiety disorder and panic disorder
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Scleroderma/polymyositis with secondary gastroesophageal reflux

20. What is the mechanism of action for stimulant agents in treating constipation?
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
Dehydration - anemia - cardiac causes
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

21. Discomfort with abducting the arm past 90 degress
Slow progression of cervical cancer changes -Availability of effective early treatment
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
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.
Rotator Cuff tendonitis

22. What are the 2 psych disorders most commonly associated with palpitations?
Slow progression of cervical cancer changes -Availability of effective early treatment
Coronary artery disease/ angina
Generalized Anxiety disorder and panic disorder
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF

23. What are the features of glomerular nephritis
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
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Temporal arteritis-biopsy of the temporal artery
RBC casts and old to moderate HTN

24. 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
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.
Bence-Jones
Scleroderma/polymyositis with secondary gastroesophageal reflux

25. Isolated - extra pounding beats
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Staphylococcal scalded skin syndrome
PVC or Premature atrial contraction (PAC)
Viral gastroenteritis

26. Predictors of cardiac etiology
Regular bleeding at intervals of more than 35 days
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

27. Describes what occurs during squamous metaplasia of the cervix.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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.
Wolff-Parkinson-White syndrome
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

28. What are the three major risk factors for heart failure?
Menorrhagia
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Hypertension - CAD - valvular heart disease
Anticoag with warfarin to prevent thromboembolism

29. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Coronary artery disease/ angina
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Loop diuretics (Check serum K+ levels before drug admin)

30. What is the role of FSH in one's menstrual cycle
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Infectious esophagitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

31. Define proteinuria
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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.
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
>150mg per 24hrs

32. What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Staphylococcal scalded skin syndrome
E. Coli O157:H7
CBC

33. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Adhesive capsulitis (frozen shoulder): most common in middle age women
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
Albumin; low molecular weight proteins

34. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
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
Folliculitis
MSK - pulmonary - GI - or psychological

35. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Pain
Generalized Anxiety disorder and panic disorder
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

36. Treatment for supraventricular tachycardias
Warts
BB or CCB - catheter ablation of identified bypass tract
Cholelithiasis
Paroxysmal atrial fibrillation or supraventricular tachycardia

37. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
Paroxysmal atrial fibrillation or supraventricular tachycardia
S. aureus- beta hemolytic streptococcus
Lightheadedness - dizziness - syncope
Loop diuretics (Check serum K+ levels before drug admin)

38. Diarrhea is defined as an ____ in stool weight to more than ____g per day
Impetigo
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Increase; 200 g/day
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

39. What are the features of nephrotic 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
Furucnle
Anticoag with warfarin to prevent thromboembolism
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria

40. Lab testing for heart palpitation
Coag disorders
Hgb - Electrolytes - and TSH
These patients are associated with low renin states=less likely to respond to medication
Scabies

41. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Pleurisy
Cervical radiculopathy
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

42. Name the diagnosis of heartburn: gnawing epigastric pain - nausea - vomiting - bloating
Pancreatitis
Peptic ulcer disease or gastritis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Coag disorders

43. Describe the presentation of pneumonia
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
When the patient has symptoms in association with exercise or who describe chest pain or pressure
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB

44. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Cluster headache
With a KOH wet mount preparation

45. What are the primary glomerular diseases?
Colposcopy - Endocervical curettage - and directed cervical biopsy
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

46. What should preconception counseling include?
CBC
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
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
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

47. Chronic pain and shoulder stiffness with limited motion
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
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Adhesive capsulitis (frozen shoulder): most common in middle age women
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

48. Why don't ACEi work well for the elderly and African Americans when treating HTN?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
These patients are associated with low renin states=less likely to respond to medication
Excessive bleeding in amount - duration - or both at irregular intervals

49. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
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
Rotator Cuff tendonitis
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Medication or chemical esophagitis

50. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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.
Diuretics -BB -CCB -ACEi
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Increase; 200 g/day

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