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Family Medicine Shelf

Subjects : health-sciences, family-medicine

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1. What is the mechanism of action for stimulant agents in treating constipation?
Serotypes 16 - 18 - 31 -52 -58
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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.

2. 1+ protein level on urine dipstick usually represents how much protein in the urine?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Varicella virus
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)

3. Four muscles of rotator cuff
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
When the patient has symptoms in association with exercise or who describe chest pain or pressure
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve

4. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
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
Giardia
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Infectious esophagitis

5. Why don't ACEi work well for the elderly and African Americans when treating HTN?
Less than 3 stools per week
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
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
These patients are associated with low renin states=less likely to respond to medication

6. What are the primary glomerular diseases?
Productive cough and URI symptoms (runny nose - scratchy throat - nasal congestion) - low grade fever - fatigue
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Polymenorrhea

7. Discomfort with abducting the arm past 90 degress
Rotator Cuff tendonitis
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
35 (exception for postmenopausal women who have recently been started on HRT)
Focal glomerular sclerosis - membranous glomerular nephripathy - IgA nephropathy

8. What is the role of FSH in one's menstrual cycle
Fluoroquinolone with good activity again Pneumococcus (levofloxacin) - Macrolide - 2nd generation cephalosporin
Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

9. What is considered normal blood loss during a menstrual cycle?
Excessive bleeding in amount - duration - or both at irregular intervals
>150mg per 24hrs
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Less than 80 ml of blood

10. After treatment of dysplasia - women need Pap smears every...
Higher filling presure - pulmonary congestion - and decreasd cardiac return
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Folliculitis
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.

11. 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 - ARBS - thiazide diuretics
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Serotypes 16 - 18 - 31 -52 -58

12. Prenatal visit schedule for low-risk pregnancies
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
Non-cardiac causes of palpitations

13. Carcinoma in situ is generally referred to a gynecologist and requires ______
Occurs in overlying chest wall - and aggravated by breathing and coughing - sudden - sharp - unilateral - pleuritic - associated with SOB
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
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
Upper sternal area burning pain - associated with a productive cough

14. Natural history of cervical cancer
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
Rotator Cuff problem
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma

15. How does systolic vs. diastolic heart failure present on the echocardiogram?
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
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Viral infection of the semicircular apparatus
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

16. What are the signs of acute sinusitis?
Fever with frontal or maxillary tenderness
Less abrupt onset and cessation of palpitations
Pancreatitis
Rotator Cuff tendonitis

17. 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
Varicella virus
DM - HTN - DVT - seizures - depression - or anxiety
Scabies

18. Describe the presentation of pericardial pain
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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
Polymenorrhea
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

19. How to NSAIDs contribute to gastritis and ulcer formation?
Hypertension - CAD - valvular heart disease
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.
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
Hgb - Electrolytes - and TSH

20. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
HPV
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin
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
Squamocolumnar junction=most common site of cervical cancer

21. Irregular cycles with excessive flow - duration - or both
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear
Excessive bleeding in amount - duration - or both at irregular intervals
Menorrhagia

22. What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
Scabies
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
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

23. What medications can cause heart palpitations?
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
Excessive bleeding in amount - duration - or both at irregular intervals
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
100mg; means patient can be trace protein positive and not be detected

24. Name the type of headache: The patient chronically uses analgesic or antimigraine drugs - esp. those with caffeine
Analgesic headache
Chest pain during pneumonia or PE
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
Possibility of Ischemic colitis

25. Pain in shoulder when throwing - swimming - or serving a tennis ball
Echocardiogram
Rotator cuff tendonitis
4 mo for 1yr - then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp

26. Tx of chronic or intermittent afibs
Anticoag with warfarin to prevent thromboembolism
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
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
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

27. What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
Paroxysmal atrial fibrillation or supraventricular tachycardia
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
Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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

28. At was quantity does urine dipstick test detect elevated protein?
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
100mg; means patient can be trace protein positive and not be detected
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

29. Diarrhea from custard filled pastries
Non-cardiac causes of palpitations
S. Aureus
HPV
Aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume

30. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
E. Coli O157:H7
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
CT
Giardia

31. 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
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.
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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

32. History and PE for Pneumonia
Rotator Cuff tendonitis
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
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
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

33. What is the standard tool used for diagnosis of GERD?
EGD
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Possibility of Ischemic colitis
Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus

34. What is a markers of CNS vertigo?
Varicella virus
>3.5g of protein per 24hrs
Other brainstem or cranial nerve findings
Possibility of Ischemic colitis

35. What is the Epley maneuver?
Possibility of Ischemic colitis
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.
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
S. Aureus

36. Vaccines that should be updated before planned pregnancy
HIV and syphilis
Temporal arteritis-biopsy of the temporal artery
Analgesic headache
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses

37. Treatment for supraventricular tachycardias
CT
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Excessive bleeding in amount - duration - or both at irregular intervals
BB or CCB - catheter ablation of identified bypass tract

38. What are the common causes for laryngitis?
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
Influenza - Rhinovirus - Adenovirus - Parainfluenza

39. Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
35 (exception for postmenopausal women who have recently been started on HRT)
Temporal arteritis-biopsy of the temporal artery
Persistent - sharp - severe - relieved by sitting up; aggravated by breathing - laying back - coughing
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

40. What are the indiciations for neuroimaging?
Infectious esophagitis
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
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
ACEi - ARBS - thiazide diuretics

41. Where does the development of abnormal cervical cells begin?
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Paroxysmal atrial fibrillation or supraventricular tachycardia
Pain
Squamocolumnar junction=most common site of cervical cancer

42. What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
Possibility of Ischemic colitis
CBC
S. Aureus
Viral gastroenteritis

43. What are the two common clinical presentations of acute diarrhea?
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
Colposcopy - Endocervical curettage - and directed cervical biopsy
These patients are associated with low renin states=less likely to respond to medication

44. What are the signs of malignant hypertension?
High blood pressure - focal neurologic defecit - or papilledema
Polymenorrhea
Vital signs - orthostatic blood pressure (indicating acute bleeding) and pulse - signs of pregnancy - systemic disease - and sterile speculum and bimanual exam)
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

45. What diagnosis does the 'worse headache of my life' suggest?
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
Subarachnoid hemorrhage
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
LH surge triggers ovulation

46. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
FSH released by the pitu stimulates a primary ovarian follicle to release estrogen - which stops menses and stimulates the endometrium
Tension headache
High blood pressure - focal neurologic defecit - or papilledema
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

47. Define nephrotic range proteinuria
>3.5g of protein per 24hrs
Pain
Increasing fluid (8 - 8oz glasses of water/day) -fiber
Excessive bleeding in amount - duration - or both at irregular intervals

48. What does orthostatic positional changes that bring on dizziness suggest?
Persistent purulent discharge - facial pain exacerbated by leaning forward - maxillary tooth ache - 'double sickening'=relapse
Dehydration - anemia - cardiac causes
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
EGD

49. Describe the presentation of angina?
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
Rotator Cuff tendonitis
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
Fasting serum glucose - K+ - serum creatinine - UA - lipid profile - serum Ca2+ - uric acid

50. What are symptoms are CHF?
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss
Reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
EGD

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