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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. Describe the presentation of myocardial pain?
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
ACEi
Subarachnoid hemorrhage
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. Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
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

3. At was quantity does urine dipstick test detect elevated protein?
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
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
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
100mg; means patient can be trace protein positive and not be detected

4. 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.
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Furucnle

5. What are the consequences of diastolic dysfunction?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
EGD
Kids: Rotavirus Adults: Norwalk Virus
Higher filling presure - pulmonary congestion - and decreasd cardiac return

6. MI - pericardial tamponade - PE - GI bleed - are...
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Rotator cuff tendonitis
Associated with hypotension
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

7. What medications can cause heart palpitations?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

8. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Less than 80 ml of blood
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 should preconception counseling include?
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
Slow progression of cervical cancer changes -Availability of effective early treatment
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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

10. Diagnostic Evaluation of Abnoraml vaginal bleeding
Peptic ulcer disease or gastritis
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
Impetigo
Repeat Pap after infection treated

11. What is the Barany maneuver?
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
Echocardiogram
Repeat Pap after infection treated
Non-cardiac causes of palpitations

12. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Staphylococcal scalded skin syndrome
Albumin; low molecular weight proteins
Irregular bleeding between cycles

13. Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
Analgesic headache
Temporal arteritis-biopsy of the temporal artery
Possibility of Ischemic colitis
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

14. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

15. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Scleroderma/polymyositis with secondary gastroesophageal reflux
Coronary artery disease/ angina
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
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

16. Describe the Hx 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
Less than 3 stools per week
LH surge triggers ovulation
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

17. What is the role of FSH in one's menstrual cycle
Generalized Anxiety disorder and panic disorder
Echocardiogram
Rotator Cuff tendonitis
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium

18. What are the features of glomerular nephritis
Acute headache - ataxia - profuse nausea - and vomiting
DM - HTN - DVT - seizures - depression - or anxiety
S. aureus- beta hemolytic streptococcus
RBC casts and old to moderate HTN

19. Menometrorrhagia
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Excessive bleeding in amount - duration - or both at irregular intervals
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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

20. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
HIV and syphilis
Wolff-Parkinson-White syndrome
Candida albicans
Coronary artery disease/ angina

21. Diagnosis of HTN
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Intermenstrual bleeding
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Generalized Anxiety disorder and panic disorder

22. What are the three types of lice?
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
EGD
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
Bence-Jones

23. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Increase; 200 g/day
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Serotypes 16 - 18 - 31 -52 -58

24. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Streptococci
Non-cardiac causes of palpitations
CBC

25. Pain in shoulder when throwing - swimming - or serving a tennis ball
Rotator cuff tendonitis
Supraspinatus and bicipital tendons
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

26. What places women at higher risk of getting cervical cancer?
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

27. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Excessive bleeding in amount - duration - or both at irregular intervals
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Viral gastroenteritis

28. Pneumonia tx: suitable for healthy adults older than 60
Folliculitis
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine

29. Clinical Manifestations of HTN
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Upper sternal area burning pain - associated with a productive cough

30. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Paroxysmal atrial fibrillation or supraventricular tachycardia
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Loop diuretics (Check serum K+ levels before drug admin)
Cervical radiculopathy

31. What is benign transient proteinuria?
Medication or chemical esophagitis
Common problem that resolves spontaneously and is most often seen in children and young adults
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
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema

32. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
>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
Scleroderma/polymyositis with secondary gastroesophageal reflux
ACEi - ARBS - thiazide diuretics

33. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
Folliculitis
DM - HTN - DVT - seizures - depression - or anxiety
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
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually

34. What is the goal of CHF treatment? What drugs should be used?
Folliculitis
HPV
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
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

35. What are the most common causes for the common cold?
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
These patients are associated with low renin states=less likely to respond to medication
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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

36. Things that need to be included in history of shoulder pain
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
35 (exception for postmenopausal women who have recently been started on HRT)
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)

37. Lab testing for heart palpitation
Staphylococcal scalded skin syndrome
Hgb - Electrolytes - and TSH
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.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

38. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Intermenstrual bleeding
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

39. Initial treatment for Rhinosinusitis
Generalized Anxiety disorder and panic disorder
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
HPV
E. Coli O157:H7

40. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Viral infection of the semicircular apparatus
Furucnle
Candida albicans
PE - MI - aortic dissection - pneumothorax

41. When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
ACEi
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

42. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

43. Vaccines that should be updated before planned pregnancy
Molluscum contagiosum- pox virus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
BB or CCB - catheter ablation of identified bypass tract

44. In regards to a Pap smear - What should be done if a patient has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
Repeat Pap after infection treated
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
Wolff-Parkinson-White syndrome
Furucnle

45. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
PVC or Premature atrial contraction (PAC)
Slow progression of cervical cancer changes -Availability of effective early treatment
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

46. What diagnosis does the 'worse headache of my life' suggest?
Less than 80 ml of blood
Subarachnoid hemorrhage
Repeat Pap after infection treated
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema

47. Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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
Associated with hypotension
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Reserved for pats with hx of traumatic injury or persistent pain despite therapy

48. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Presence of proteinuria on at least two separate ocassion
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Furucnle
Medication or chemical esophagitis

49. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
Echocardiogram
Serotypes 16 - 18 - 31 -52 -58
Colposcopy - Endocervical curettage - and directed cervical biopsy

50. An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Cellulitis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
Peptic ulcer disease or gastritis

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