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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. Name the microorganism: impetigo - erysipelas - cellulitis - lymphangitis
Streptococci
DM - HTN - DVT - seizures - depression - or anxiety
Repeat Pap after infection treated
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

2. Name 4 factors that predispose an individual to develop pneumonia.
ACEi - ARBS - thiazide diuretics
CT
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

3. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Associated with hypotension
Rotator cuff tendonitis
Fever with frontal or maxillary tenderness
Colposcopy - Endocervical curettage - and directed cervical biopsy

4. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Cluster headache
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids

5. Patient presents with aching shoulder - which becomes acutely painful with overhead activity
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Rotator Cuff problem
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Increasing fluid (8 - 8oz glasses of water/day) -fiber

6. What is the peripheral caUse of vertigo?
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
True

7. Define proteinuria
Tension headache
>150mg per 24hrs
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

8. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Giardia
Folliculitis
Viral gastroenteritis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines

9. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Albumin; low molecular weight proteins
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)

10. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
24 hour halter
Analgesic headache
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
S. aureus- beta hemolytic streptococcus

11. Name the skin lesion: pustule in association with a hair follice
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Folliculitis
Albumin; low molecular weight proteins
Presence of proteinuria on at least two separate ocassion

12. Describe the presentation of pericardial pain
These patients are associated with low renin states=less likely to respond to medication
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
A tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem

13. Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Chest pain during pneumonia or PE
Slow progression of cervical cancer changes -Availability of effective early treatment
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

14. What treatments are the cornerstone for treating cases of functional constipation?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Influenza - Rhinovirus - Adenovirus - Parainfluenza
EGD
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

15. Name types of laxatives
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
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
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

16. Name the diagnosis of heartburn: upper abdominal/ epigastric pain - bloating - belching - flatulence - nausea
Nonulcer dyspepsia
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Less than 3 stools per week
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

17. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Kids: Rotavirus Adults: Norwalk Virus
PE - MI - aortic dissection - pneumothorax

18. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
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

19. Name the skin lesion: small tumors of the skin that obscure normal skin lines - have a mosaic surface pattern - and may have thrombosed vessels appeairng as black dots on the surface
Warts
Scabies
Rotator Cuff tendonitis
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes

20. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
A central clear area
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation

21. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Regular bleeding at intervals of more than 35 days
Furucnle
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

22. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
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
Substernal chest tightness or pressure - that radiates to the left arm - shoulders - or jaw. Patients may also describe: diaphoresis - SOB - nausea - vomiting
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool

23. Shoulder pain with pain radiating to elbow
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Albumin; low molecular weight proteins
Rotator Cuff problem
Cervical radiculopathy

24. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Echocardiogram
Acute headache - ataxia - profuse nausea - and vomiting
Pleurisy
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

25. What type of imaging is need for chronic sinusitis?
Cervical radiculopathy
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Repeat Pap after infection treated
CT

26. What is the next best step if a patient has two or more positive dipstick tests?
MSK - pulmonary - GI - or psychological
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
A 24hr urine protein collection and urine creatinine clearance determination
Fever with frontal or maxillary tenderness

27. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Warts
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
Tension headache
Bulk forming: Psyllium - Methycellulose - Polycarbophil

28. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Excessive bleeding in amount - duration - or both at irregular intervals
Acute headache - ataxia - profuse nausea - and vomiting
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart

29. Pain from inflammation or irritation is detected only by the parietal pleura - the parietal pleura is the source of...
Presence of proteinuria on at least two separate ocassion
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Chest pain during pneumonia or PE

30. Carcinoma in situ is generally referred to a gynecologist and requires ______
Scleroderma/polymyositis with secondary gastroesophageal reflux
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

31. What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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
ACEi - ARBS - thiazide diuretics

32. Isolated - extra pounding beats
PVC or Premature atrial contraction (PAC)
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
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
RBC casts and old to moderate HTN

33. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
>3.5g of protein per 24hrs
Less abrupt onset and cessation of palpitations
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

34. HIgh risk pregnant patients should be evaluated for ____ and ____
HIV and syphilis
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

35. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Less than 3 stools per week
Coronary artery disease/ angina
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
RBC casts and old to moderate HTN

36. When does troponin rise following myocardial injury or infarction?
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
LH surge triggers ovulation
Coronary artery disease/ angina

37. What type of diuretic is the most widely used for HTN? What are some SE of this drug?
Coronary artery disease/ angina
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
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

38. History for Acute bronchitis
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
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
BB or CCB - catheter ablation of identified bypass tract

39. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
BB or CCB - catheter ablation of identified bypass tract

40. A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
DM - HTN - DVT - seizures - depression - or anxiety
Scleroderma/polymyositis with secondary gastroesophageal reflux
Pancreatitis
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

41. What diagnosis does the 'worse headache of my life' suggest?
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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: 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
Subarachnoid hemorrhage

42. Natural history of cervical cancer
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
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.
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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

43. Pneumothorax - sudden sharp chest pain - preceded by viral illness
Hypertension - CAD - valvular heart disease
Menorrhagia
HPV
Pleurisy

44. 1+ protein level on urine dipstick usually represents how much protein in the urine?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
PVC or Premature atrial contraction (PAC)
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day

45. Treatment for supraventricular tachycardias
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
CT
BB or CCB - catheter ablation of identified bypass tract
GERD

46. What are the secondly causes of glomerular disease?
Giardia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Viral infection of the semicircular apparatus
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

47. Name the microorganism: folliculitis - cellulitis - furuncles (abscess/ boil) - bullous impetigo and staphylococcal scaleded skin syndrome
S. aureus- beta hemolytic streptococcus
Medication or chemical esophagitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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

48. 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
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Intermenstrual bleeding
Upper sternal area burning pain - associated with a productive cough

49. Mainstay treatment for soft tissue inflammation (Shoulder)
RBC casts and old to moderate HTN
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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

50. What are the physical exam signs of CHF?
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
S. Aureus
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
Molluscum contagiosum- pox virus

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