Family Medicine Rotation Dr Cook/bewley

Front 1

1)Risks of ectopic pregnancy are:
2)What are the most helpful investigatory tests for it?

Back 1

1)Tubal ligation, DES-diethylstillbesterol, tubal pathology, prior ectopic pregnancy.
2)HCG>6500 -> transabd ultrasound next to detect

Front 2

1)Define endometriosis.
2)S&S
3)gold standard test

Back 2

1)Endometrial glands and stroma outside the uterine cavity.
2)May pelvic pain, dyspareunia, infertility, dysmenorrhea, pain on defecation or urination, constip., hematuria, diarrhea
3)laparoscopy

Front 3

1)Define Zollinger-Ellison syndrome (an uncommon cause of Peptic Ulcer Disease, PUD)

Back 3

1)Tumor of the small intestine or pancreas that secrete excessive amounts of gastrin hormone->overproduction of stomach acid

Front 4

1)What are the main factors of Peptic Ulcer Disease?
2)What is an uncommon cause of PUD?

Back 4

1)Helicobacter pylori infection and NSAIDs use.
2)Zollinger-Ellison syndrome.

Front 5

1)A pharmacological diagnostic test for GERD:

Back 5

1)PPI therapy and positive response to it. NB: pnt w/out endoscopic findings can still have significant symptoms.

Front 6

1)Tnx of H.pylori

Back 6

1)Only when H.pylori test is positive: PPI BID (bis in die, lat. twice daily), amox (substitute with metronidazole if pennic.allergies) and clarithromycin. ONLY WHEN TEST IS DOCUMENTED

Front 7

1)Clinical tests for peritonitis- inflammation of peritoneum, a thin membrane lining abdominal cavity and organs.

Back 7

1)Pain produced, when pnt is asked to cough. Pain produced on exhalation and inhalation. Clinical test strongly suggests ... when pain in all three instances is reproduced.

Front 8

1)CT scan will help differentiate following causes of abdominal pain:

Back 8

1)Appendicitis, diverticulitis, pancreatitis, renal calculi

Front 9

1)Presentation of renal calculi vs pyelonephritis.

Back 9

1)flank pain radiating to groin vs non-radiating flank pain.

Front 10

1)When does pain precede vomiting?

Back 10

1)In appendicitis.

Front 11

1)Name diagnostic tests for pancreatitis.

Back 11

1)Serum lipase and amylase. Contrast CT scan.

Front 12

What test has a 100% specificity and a 97% sensitivity for diverticulitis? It is also the best imaging study for appendicitis.

Back 12

Helical CT scan with rectal contrast. Transabdominal ultrasound is the next best study.

Front 13

Pain awakens the pnt at night and radiates to right scapula. It is often associated with nausea and vomiting. What is it?

Back 13

Biliary pain (biliary colic)

Front 14

1)What is Charcot's triad? 2)And what is it for? 3)what diagnostic study is the best?

Back 14

1)pain, fever, jaundice 2)acute cholangitis (potentially lethal if not treated urgently) 3)ERCP, Endoscopic Retrograde Colangeopancreatography (ultrasound doesn't work at all)

Front 15

What does cholescintigraphy do?

Back 15

It studies a gallbladder ejection fraction to diagnose a gallbladder dysfunction, yet not highly predictive.

Front 16

What is an imaging study of choice for pancreatitis?

Back 16

A CT scan

Front 17

What is the most common (up to 70%) cause of bowel obstruction?

Back 17

Adhesions from a prior surgery

Front 18

Clinical signs of bowel obstruction are:

Back 18

increased!!! bowel sounds, distention, previous abdominal surgery, >50yo, vomiting

Front 19

What is the initial imaging study for bowel obstruction?

Back 19

X-ray, b/c can show air-fluid level, distention. Even if it is negative, suspicion remains high. Then go with CT or ultrasound.

Front 20

Poorly localize epigastric or periumbilical pain, guarding, rigidity, rebound tenderness (Rovsing-referred rebound tenderness) is a likely sign of what?

Back 20

appendicitis

Front 21

Elevated WBC and CRP (C-reactive protein) may be suggestive of but not rule out if negative...?

Back 21

appendicitis

Front 22

What is the best imaging study of appendicitis?

Back 22

A helical CT with 3% diatrizoate rectal contrast.

Front 23

Gradual onset of pain in LLQ is suggestive of what?

Back 23

Diverticulitis. If adjacent to the bladder it may cause increased urinary frequency or urgency.

Front 24

What is IBS (irritable bowel syndrome)?

Back 24

A functional disorder characterized by chronic abdominal pain, defecation or change in the frequency or appearance of stool. Spontaneously resolves in 50% pnts.

Front 25

An in-utero exposure to DES (diethylstilbesterol) may affect a woman in what way?

Back 25

Predispose to Ectopic Pregnancy later.

Front 26

1)Hemochromatosis definition.
2)Hemosiderosis
3)What is the best test for them?

Back 26

1)iron overload. A treatable disease. Liver, heart and endocrine glands are affected the most.
2)Multiple transfusions. 1) and 2) are used synonymously.
3)Transferrin saturation

Front 27

What are most common liver dxs?

Back 27

Nonalcoholic fatty liver disease (NAFLD), alcoholic hepatitis, viral hepatitis

Front 28

1)What pathway is measured by International Normalized Ratio?
2)By aPTT activated Partial Thromboplastin Time?
3)What does PT measure?

Back 28

1)Extrinsic (INR=PTtest/PTnorm)
2)Intrinsic
3)II, V, VII, X and fibrinogen

Front 29

Rx to treat medium or large gastroesophageal varices:

Back 29

non-selective beta blockers: propranolol or nadolol (titrate to 50-60 beats/min at rest), if not tolerated->band ligation

Front 30

Spontaneous Bacterial Peritonitis -great risk in pnt's with ascites. Treatment and prophylaxis with?

Back 30

Treatment- IV cephalosporins (D-Ala-Ala attachment and inhibition of proteoglycan crosslinking). Prophylaxis with fluoroquinolones (inhibit DNA gyrase that facilitates DNA unwinding for replication and transcription)

Front 31

1)Sprue

Back 31

1)Carbohydrate malabsorption in sm intestine, a mucosal disorder.

Front 32

What are the primary causes of PUD (Peptic Ulcer Disease)?

Back 32

Helicobacter pylori and NSAIDs. Zollinger-Ellison syndrome (tumors of sm intestine or pancrease) is a much rarer cause of the disease.

Front 33

Name a primary diagnostic approach to treating GERD by a primary care physician.

Back 33

PPI not endoscopy

Front 34

What test can confirm H. pylori eradication and why?

Back 34

Stool antigen test, b/c it is Antigen Based not antibody (Ab stays present after eradication)

Front 35

What are the 'ingredients' of an H. pylori triple therapy?

Back 35

A PPI, a penicillin based antibiotic (eg amoixicillin. Allergic? -> metronidazole (Flagyl) is used to treat protozoa and anaerobic bacteria), and a macrolide (eg clarithromycin). 14 days -more effective

Front 36

In presence of slow chronic bleeding what is the most appropriate first step in diagnostic studies?

Back 36

EGD- esophagogastroduadenoscopy. Also used in suspected UGI bleed. If EGD is negative-> colonoscopy is the next step.

Front 37

Hematochezia definition

Back 37

non massive grossly evident bleeding

Front 38

In evaluation of bleeding how significant is a non tender abdominal examination?

Back 38

Very significant. Sever diverticular and vascular bleeds are non-tender, non-painful. Pay attention to systolic <115, HR=>100/min. Together with non-tender finding->80% risk of bleed. Urgent colonoscopy

Front 39

Octreotide (Sandostatin)

Back 39

inhibits growth hormone, glucagon and insulin potently. Treatment of thymic neoplasms and ESOPHAGEAL VARICES.

Front 40

What is an infectious organism suggested in consumption of undercooked poultry or employment in poultry industry?

Back 40

Campylobacter jejuni ->(Guilliam Barre syndrome possible)

Front 41

What's an infectious organism suggested with recent abics use?

Back 41

Clostridium difficile (drum stick shaped, anaerobic spore-forming rod). Pseudo membranous colitis.

Front 42

Community outbreak of gastroenteritis in winter or on cruise ships

Back 42

Norovirus (single-stranded RNA, non-enveloped, calcivirus)

Front 43

Daycare attendance or employment

Back 43

Shigella, Giardia, Cryptosporidium

Front 44

Seafood caused gastroenteritis or septicemia of open wounds

Back 44

Vibrio (gram neg, curved rod found in salt water)

Front 45

Hemolytic Uremic Syndrome or renal failure due to community acquired food borne transmission

Back 45

E coli O157-H7

Front 46

Community acquired foodborne transmission due to?

Back 46

Yersinia, Salmonella, Campylobacter, E.coli O157-H7, enteric viruses (person to person too)

Front 47

Receptive anal intercourse, oral-anal sex (anilingus) is risky for contraction of?

Back 47

Giardia and/or Clostridium histolyticum

Front 48

Shiga toxin producing E coli are afebrile versus (see other side of card)

Back 48

Salmonella, Campylobacter and Shigella are febrile. All with bloody diarrhea and abd pain

Front 49

Rx for noninflammatory diarrhea:

Back 49

Bismuth subsalicylates (Pepto-Bismol or Kaopectate) and loperamide (Immodium)

Front 50

What does sed rate help reveal?

Back 50

Inflammatory activity is suggested with this test running positive (red cell falls a certain distance in a tube, the greater the distance, the greater the inflammatory response of the pnt's immune system is)

Front 51

How do they test for lactoferrin, a neutrophil product (eg. for C. difficile colitis diarrhea)?

Back 51

Latex agglutination test