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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. Name the type of headache: severe - unilateral - localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation - rhinorrhea - ptosis - miosis - nasal congestion - and eyelid edema; attacks occur every
Cluster headache
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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

2. How are fungal infections diagnosed?
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
With a KOH wet mount preparation
>150mg per 24hrs
Enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus - vertigo - hearing loss

3. Shoulder pain with pain radiating to elbow
Paroxysmal atrial fibrillation or supraventricular tachycardia
Dermatophytes - i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
Cervical radiculopathy
These patients are associated with low renin states=less likely to respond to medication

4. What are the common causes for laryngitis?
Rotator Cuff tendonitis
Streptococci
Influenza - Rhinovirus - Adenovirus - Parainfluenza
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions

5. What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
Colposcopy - Endocervical curettage - and directed cervical biopsy
Viral -Non viral causes: Chemical irritation - Mycoplasma - and Chlamydia
With a KOH wet mount preparation
Tension headache

6. What is the leading caUse of parasitic diarrhea that presents as foul - greasy - bulky stools with associated weight loss or neuropathy?
Giardia
Cellulitis
HPV testing -Pos=colposcopy -Neg=repeat pap smear
When the patient has symptoms in association with exercise or who describe chest pain or pressure

7. What is the mechanism of action for stimulant agents in treating constipation?
Lightheadedness - dizziness - syncope
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.
Molluscum contagiosum- pox virus
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)

8. What are the features of nephrotic syndrome?
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
>3.5g of protein per 24hrs
With a KOH wet mount preparation
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

9. Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
Furucnle
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med
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
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

10. What are the signs of cerebral hemorrhage?
Acute headache - ataxia - profuse nausea - and vomiting
Erythromycin - Macrolide (i.e. azithromycin) - Doxycyline
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

11. Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
Paroxysmal atrial fibrillation or supraventricular tachycardia
Cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
Irregular bleeding between cycles
Possibility of Ischemic colitis

12. Whats the diagnosis: Watery stools accompanied by a low-grade fever - headache - nausea or vomiting - and achiness
Pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
Echocardiogram
Viral gastroenteritis
True

13. How to NSAIDs contribute to gastritis and ulcer formation?
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.
Kids: Rotavirus Adults: Norwalk Virus
Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
CBC

14. Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
Apprehension test: abducting the arm to 90 degrees - rotating it externally - and then applying anterior traction to the humerus
Medication or chemical esophagitis
Consider AB:1st line: Amoxicillin - Cefuroxime Penicillin allergy: clarithromycin - azithromycin - trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid - levofloxacin - gatifloxcin

15. Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
Loop diuretics (Check serum K+ levels before drug admin)
EGD
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

16. Although urine dipstick test binds to albumin what - other important protein can it fail to detect?
Hgb - Electrolytes - and TSH
Higher filling presure - pulmonary congestion - and decreasd cardiac return
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.
Bence-Jones

17. What places women at higher risk of getting cervical cancer?
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
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
Non-cardiac causes of palpitations

18. What should be considered in younger patients with menorrhagia
Common problem that resolves spontaneously and is most often seen in children and young adults
Coag disorders
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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

19. What imaging is used to assess cardiac anatomy in patients with heart palpitations?
Echocardiogram
Pain
Cholelithiasis
The luteal or secretory phase begins - the corpus luteum develops - and pregesterone levels increase

20. What are the medications used to treat labyrinthitis - vestibular neuronitis - and BPV?
Squamocolumnar junction=most common site of cervical cancer
4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
Varicella virus

21. Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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
Bradycardia - fatigue - insomnia - sex dysfxn - and adverse effects on the lipid profile
HPV testing -Pos=colposcopy -Neg=repeat pap smear
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

22. Difference between Pneumonia and 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
100mg; means patient can be trace protein positive and not be detected
Less abrupt onset and cessation of palpitations
Possibility of Ischemic colitis

23. Name the diagnosis of heartburn: dysphagia - assoc. with ingestion
Medication or chemical esophagitis
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
Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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

24. What is the caUse of benign positional vertigo?
Intermenstrual bleeding
Serotypes 16 - 18 - 31 -52 -58
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.
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

25. Why don't ACEi work well for the elderly and African Americans when treating HTN?
These patients are associated with low renin states=less likely to respond to medication
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
Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
Fever with frontal or maxillary tenderness

26. 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
Massive proteinuria and edema - hypoalbuminemia - hyperlipidemia - lipiduria
Pancreatitis
Menorrhagia

27. Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
Tension headache
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
Polymenorrhea
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

28. What are the four classes of medications that are most commonly used for 1st line agents in HTN?
Streptococci
ACEi - ARBS - thiazide diuretics
Ischemic heart disease - stroke - peripheral vascular disease - renal insufficiency - retinopathy characterized by exudates and hemorrhages - and - in severe HTN - papilledema
Diuretics -BB -CCB -ACEi

29. What should blood work include for suspected heart failure?
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Scleroderma/polymyositis with secondary gastroesophageal reflux
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Increase; 200 g/day

30. MI - pericardial tamponade - PE - GI bleed - are...
HPV
Diuretics -BB -CCB -ACEi
Associated with hypotension
Pleurisy

31. Diarrhea from custard filled pastries
Cellulitis
Rotator cuff tendonitis
Meclizine - dimenhydrinate - antiemetics - and benzodiazepines
S. Aureus

32. Name some medications that can cause proteinuria
Irregular bleeding between cycles
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides
ACEi - ARBS - thiazide diuretics

33. Things that need to be included in history of shoulder pain
Polymenorrhea
Less abrupt onset and cessation of palpitations
Age - dominant hand - medications - PMHx - type of work - and activity level - Pain-acute or chronic - Associated trauma (swelling - rendness - laxity - catching - decrease ROM)
Higher filling presure - pulmonary congestion - and decreasd cardiac return

34. Natural history of cervical cancer
Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
Warts
Inflammation - stimulation - or destruction of the hair cells of the eighth cranial nerve
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

35. What HPV serotypes are most commonly associated with cervical cancer?
Kids: Rotavirus Adults: Norwalk Virus
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
Serotypes 16 - 18 - 31 -52 -58
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

36. What is the Epley 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
Cholelithiasis
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

37. Metrorrhagia
Squamocolumnar junction=most common site of cervical cancer
Irregular bleeding between cycles
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
HPV testing -Pos=colposcopy -Neg=repeat pap smear

38. The degenerative process that results in bursitis - tendonitis - and shoulder impingement often begins in the _____ or ____ tendons - which have a poor blood supply and are often under stress.
Supraspinatus and bicipital tendons
Loop diuretics (Check serum K+ levels before drug admin)
SITS: Supraspinatus - Infraspinatus - Teres Minor - Subscapularis
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

39. Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
Cellulitis
Bulk forming: Psyllium - Methycellulose - Polycarbophil
Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
Menorrhagia

40. What medications can cause heart palpitations?
Warts
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
Echocardiogram
Theophylline - Digoxin - B agonists - OTC stimulants (pseudophedrine) - antiarrhthymic med

41. How is constipation clinically defined?
Loop diuretics (Check serum K+ levels before drug admin)
In syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
Less than 3 stools per week
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

42. What is afterload?
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure
Nonulcer dyspepsia
Hypertension - CAD - valvular heart disease
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

43. Predictors of cardiac etiology
Male - report irregular heartbeat Sx duration >5min - hx of heart disease
Menorrhagia
Pancreatitis
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

44. What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
A 24hr urine protein collection and urine creatinine clearance determination
ACEi
100mg; means patient can be trace protein positive and not be detected
ACEi - penicillin - cephalosporin - cyclosporine - NSAIDs - heavy metals - aminoglycosides - sulfonamides

45. When does the American Cancer Society recommend obtaining Pap smear in low-risk women
Cluster headache
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
Nonulcer dyspepsia
Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal

46. Diagnostic Evaluation of Abnoraml vaginal bleeding
Candida albicans
Irregular bleeding between cycles
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
Lifestyle modification: Salt restriction - weight reduction - regular aerobic exercise

47. Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
CBC - UA - electrolytes - BUN - creatinine - albumin - TSH-BNP: elevated in CHF
Dyspnea - orthopnea - paroxysmal nocturnal dyspnea - nocturia - edema - weight gain - fatigue - chest pain - abdominal pain - anorexia - mental status changes
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
Premature ventricular contractions (PVCs) or premature atrial contractions (PACs)

48. Vaccines that should be updated before planned pregnancy
Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
>150mg per 24hrs
24 hour halter
Streptococci

49. What should preconception counseling include?
S. Aureus
1. Watery - noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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
Repeat Pap after infection treated

50. 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
Menorrhagia
Colposcopy - Endocervical curettage - and directed cervical biopsy
The resistance against which the heart contracts and is clinically reflected by systolic blood pressure

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