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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. What are the common causes for laryngitis?
BB or CCB - catheter ablation of identified bypass tract
Acute headache - ataxia - profuse nausea - and vomiting
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

2. How is constipation clinically defined?
Common problem that resolves spontaneously and is most often seen in children and young adults
Less than 3 stools per week
Infectious esophagitis
Pain

3. Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
Albumin; low molecular weight proteins
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus

4. What treatments are the cornerstone for treating cases of functional constipation?
Chest pain during pneumonia or PE
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
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber

5. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Giardia
Nonulcer dyspepsia

6. What are the two common clinical presentations of acute diarrhea?
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Hgb - Electrolytes - and TSH
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
DM - HTN - DVT - seizures - depression - or anxiety

7. What does treatment for migrans include?
Presence of proteinuria on at least two separate ocassion
Generalized Anxiety disorder and panic disorder
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
Influenza - Rhinovirus - Adenovirus - Parainfluenza

8. Name the diagnosis of heartburn: associated with signs of connective tissue disease - potential risk of stricture/ dysphagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
Scleroderma/polymyositis with secondary gastroesophageal reflux
CT
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

9. What are the primary glomerular diseases?
Fever with frontal or maxillary tenderness
Scabies
Viral gastroenteritis
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

10. What is benign transient proteinuria?
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Generalized Anxiety disorder and panic disorder
Common problem that resolves spontaneously and is most often seen in children and young adults
These patients are associated with low renin states=less likely to respond to medication

11. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Clarithromycin - amoxicillin - metronidazole PPI: cimetidine - ranitidine - famotidine - nazatidine
CBC
Associated with hypotension
These patients are associated with low renin states=less likely to respond to medication

12. What are the physical exam signs of CHF?
DM - HTN - DVT - seizures - depression - or anxiety
Thiazide (useful in patients without renal impairment) -SE: sex dysfxn - dyslipidemia - hyperglycemia - and elevation in uric acids
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
24 hour halter

13. Describe the presentation of pneumonia
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
Non-cardiac causes of palpitations
Furucnle

14. What should blood work include for suspected heart failure?
Polymenorrhea
A central clear area
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Anticoag with warfarin to prevent thromboembolism

15. patients with herpes zoster may experience what symptom before the rash appear?
Pain
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Rotator Cuff problem

16. What are the most common causes for the common cold?
1. Rhinovirus 2. Coronavirus 3. Others: Influenza - Parainfluenza - RSV - Adenovirus
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Warts
A central clear area

17. 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
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Rotator Cuff tendonitis
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
Warts

18. Name the diagnosis of heartburn: severe constant mid abdominal pain
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
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Pancreatitis
Upper sternal area burning pain - associated with a productive cough

19. A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
24 hour halter
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
DM - HTN - DVT - seizures - depression - or anxiety
Varicella virus

20. Diarrhea is defined as an ____ in stool weight to more than ____g per day
PVC or Premature atrial contraction (PAC)
Albumin; low molecular weight proteins
Increase; 200 g/day
Scleroderma/polymyositis with secondary gastroesophageal reflux

21. patients who present with an MI - unstable angina - or PE should be hospitalization of evaluation
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
Folliculitis
Candida albicans
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.

22. What places women at higher risk of getting cervical cancer?
Cluster headache
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
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

23. Things that need to be included in history of shoulder pain
Slow progression of cervical cancer changes -Availability of effective early treatment
Varicella virus
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
ACEi

24. Uterine bleeding between regular cycles
Intermenstrual bleeding
HPV
Orthopnea - paroxysmal nocturna dyspnea - rales - jugular venous distention - and edema
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

25. What are the three major risk factors for heart failure?
Hypertension - CAD - valvular heart disease
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Polymenorrhea
A 24hr urine protein collection and urine creatinine clearance determination

26. Clinical Manifestations of HTN
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Scabies
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin

27. Describe the presentation tracheobronchitis
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
Upper sternal area burning pain - associated with a productive cough
S. Aureus
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse

28. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Lightheadedness - dizziness - syncope
Varicella virus
Loop diuretics (Check serum K+ levels before drug admin)
Associated with hypotension

29. What medications can cause heart palpitations?
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue

30. What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
Hypertension - CAD - valvular heart disease
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
Squamocolumnar junction=most common site of cervical cancer
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

31. When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
Loop diuretics (Check serum K+ levels before drug admin)
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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
A central clear area

32. What is the role of FSH in one's menstrual cycle
Intermenstrual bleeding
PE - MI - aortic dissection - pneumothorax
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Pleurisy

33. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Loop diuretics (Check serum K+ levels before drug admin)
PVC or Premature atrial contraction (PAC)
Diuretics -BB -CCB -ACEi
Rotator Cuff tendonitis

34. PE for a patient getting an abnormal vaginal bleeding work up
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM

35. _____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
Bulk forming: Psyllium - Methycellulose - Polycarbophil
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

36. What test done in PE measures instability of shoulder?
Associated with hypotension
NSAIDs - combined with ice or heat - and brief periods of rest followed by PT (maintaining ROM - flexibility - strength) -Severe: Cortisone shot
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Less than 3 stools per week

37. Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation - scratching - or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored - dome shaped papules occurring on the face - trunk - axillae - and extremities i
Pediculus humanus capitis- head louse - P. humanus corporis- body louse - Phthirus pubis- pubic or crab louse
Anticoag with warfarin to prevent thromboembolism
Molluscum contagiosum- pox virus
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

38. What are the most common viral causes of diarrhea in kids and adults?
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
Kids: Rotavirus Adults: Norwalk Virus
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
These patients are associated with low renin states=less likely to respond to medication

39. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
CBC

40. Name the diagnosis of heartburn: chest pressure - nausea - diaphoresis - palpitations
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Coronary artery disease/ angina
Usually occurs in individuals over 50 to 60 yo -Involves tendons - bursae - and sometimes entire capusule

41. Name the skin lesion: honey colored crusts
Higher filling presure - pulmonary congestion - and decreasd cardiac return
Impetigo
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
Excessive bleeding in amount - duration - or both at irregular intervals

42. Describe the presentation of angina?
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Common problem that resolves spontaneously and is most often seen in children and young adults
S. Aureus
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

43. What are the signs of acute sinusitis?
RBC casts and old to moderate HTN
Fever with frontal or maxillary tenderness
24 hour halter
Polymenorrhea

44. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
HIV and syphilis
Possibility of Ischemic colitis
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain

45. What are the signs of cerebral hemorrhage?
E. Coli O157:H7
Acute headache - ataxia - profuse nausea - and vomiting
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
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

46. What is the preload?
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Bence-Jones
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
Molluscum contagiosum- pox virus

47. Name 4 factors that predispose an individual to develop pneumonia.
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Reserved for pats with hx of traumatic injury or persistent pain despite therapy
Cholelithiasis
1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport

48. What is the caUse of Meniere disease? What are the cardinal symptoms?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Generalized Anxiety disorder and panic disorder
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
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

49. What type of imaging is need for chronic sinusitis?
Increasing fluid (8 - 8oz glasses of water/day) -fiber
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
CT
1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct

50. When is a lumbar puncture contraindicated?
When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
Less than 3 stools per week
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
GERD

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