Family Medicine End of Rotation Exam
Acute pharyngitis pathophysiology - ANS-sore throat
Commonly viral but need to distinguish from Group A beta hemolytic streptococcus
Viral causes are self limited- supportive treatment
Acute sinusitis pathophysiology - ANS-inflammation of osteomeatal complex, differentiates
between allergic or viral
Acute sinusitis risk factors - ANS-Cigarette smoke
Nasal foreign body
Trauma
Acute sinusitis treatment - ANS-NSAIDs for pain
Saline washes/steam
Oral/nasal decongestants
Intranasal corticosteroids
Antibiotics used if 10-14 days of symptoms present, or more significant symptoms such as fever,
facial pain, or swelling
acute vs chronic urticaria - ANS-acute lasts a few minutes to hours and is commonly caused by
food or drugs.
chronic lasts more than 6 weeks, is idiopathic, and lesions wax and wane.
Agoraphobia Characteristics - ANS-1. Intense anxiety about being in a situation where an
incapacitating event occurs and no help would be available. Usually situations that would be
extremely embarrassing or humiliating
2. An example would be fear of having a panic attack while riding a bus.
3. Most patients have coexisting panic disorders
Alcohol abuse signs and symptoms - ANS-1. Current intoxication may result in slurred speech,
ataxia, flushing, erratic behavior, loss of inhibition, and euphoria
2. Chronic abuse may manifest as acne rosacea, palmar erythema, hepatomegaly, dupuytren
contracture (fixed flexion of one or more fingers), testicular atrophy, and gynecomastia in males
3. Labs that indicate abuse are elevated GGT, AST, ALT, LDH, MCV and decreased BUN, LDL
and RBC volume
4. withdrawal may result in tremors/shakes and start 16-18 hours after last drink, may also have
abnormal perceptions, vomiting, seizures, hallucinations, and delirium
Allergic Rhinitis etiology - ANS-Common in people with other atopic disease:
Atopic Triad: allergic rhinitis, asthma, atopic dermatitis (eczema)
,Allergic Rhinitis pathophysiology - ANS-IgE mediated reactivity to airborne allergies
Allergic Rhinitis signs and symptoms - ANS-Allergic Shiners
Dennie lines
Rhinorrhea
watery/itchy eyes
sneezing
nasal congestion
dry cough
pale, boggy, blue mucosa
horizontal nasal crease (from allergic salute)
Allergic Rhinitis treatment - ANS-**Intranasal Glucocorticoid
Oral antihistamines
Cromolyn sodium
Nasal saline
Immunotherapy (last resort)
Angina at rest, new onset of angina symptoms, or an increasing pattern of pain in previously
stable patients.
Also is predictable when angina is less responsive to NTG, last longer, and occurs at rest or wih
less exertion than previous episodes of angina. - ANS-Unstable angina
Angle-closure glaucoma physical exam findings - ANS-OPHTHALMIC EMERGENCY
Circumlimbal injection
Steamy cornea
Fixed mid-dilated pupil
Decreased visual acuity
Tearing
Anterior chamber narrowed
Acutely elevated IOP
Increased cup-to-disk ratio
Angle-closure glaucoma signs and symptoms - ANS-OPHTHALMIC EMERGENCY
Complete closure of the angle
**Pain and vision loss**
Nausea
Vomiting
Diaphoresis
Angle-closure glaucoma treatment - ANS-OPHTHALMIC EMERGENCY
Immediate referral
Begin IV carbonic anhydrase inhibitor (Diamox/acetazolamide)
,Topical beta blocker
Osmotic diuretic (mannitol)
**Do NOT administer mydriatics**
Anorexia Nervosa characteristics - ANS-1. patients have distorted body image
2. an intense fear of becoming fat, even though they are underweight
3. self imposed starvation despite normal appetite for food
4. patients are usually < 85% of expected weight for their height
5. losing weight is seen as achievement of self control, but gaining weight is viewed as a lack of
discipline
6. Patients deny seriousness of their low body weight
7. Patients may exercise excessively and have food related obsessions (food hording, etc)
8. peak onset is during early adolescence
Anorexia treatment - ANS-1. first goal is to restore nutritional state (may need hospitalization)
2. behavioral therapy and supervised weight gain programs
3. some antidepressants (amitriptyline, paroxetine, mirtazapine) may be used but play a small
role in treatment. (DO NOT use bupropion - can lower seizure threshold for malnourished)
Anti-tuberculosis class-specific side effects - ANS-INH: hepatitis, peripheral neuropathy
(co-administer B6)
RIF: hepatitis, flue syndrome, orange body fluid (urine, tears etc)
EMB: optic neuritis (red-green vision loss)
Antibiotic prophylaxis recommendations to prevent endocarditis??
DOC? - ANS-Recommended before invasive dental work or surgical procedures in the following
patients:
1. Prosthetic valves
2. Previous infective endocarditis
3. some congenital heart conditions
4. some acquired valve disorders
5. hypertrophic cardiomyopathy
6. cardiac transplants with valvulopathy
**DOC= amoxicillin
Aortic Regurgitation:
1. Murmur location
2. Radiation
3. Intensity
4. Pitch/quality
5. Aids to hearing
6. Associated findings
7. Timing - ANS-1. 2nd - 4th LICS
, 2. To apex and right sternal border
3. Grades 1-3
4. High pitch; blowing
5. Patient sitting and leaning forward; full exhalation
6. Mid-systolic or Austin flint murmur suggests large flow; arterial pulses large and bounding
7. systolic (soft) and diastolic crescendo
Aortic Stenosis:
1. Murmur location
2. Radiation
3. Intensity
4. Pitch/quality
5. Aids to hearing
6. Timing - ANS-1. 2nd RICS
2. Neck and left sternal border (LSB)
3. Often loud with a thrill (grade 4-6)
4. Medium pitch; harsh
5. Patient sitting, leaning forward
6. Midsystolic
Aphthous ulcers etiology - ANS-unclear. possible involvement of herpes 6 virus
Asthma step 1 treatment (preferred) - ANS-SABA prn
Asthma step 2 treatment (preferred) - ANS-SABA prn
Low dose ICS
Asthma step 3 treatment (preferred) - ANS-SABA prn
low dose ICS + LABA
OR
Med ICS
Asthma step 4 treatment (preferred) - ANS-SABA prn
Med ICS + LABA
Asthma step 5 treatment (preferred) - ANS-SABA prn
High ICS + LABA
Asthma step 6 treatment (preferred) - ANS-SABA prn
High ICS + LABA + Oral corticosteroids
Atrial fibrillation general characteristics - ANS-most common chronic arrhythmia increasing
incidence and prevalence with age
Acute pharyngitis pathophysiology - ANS-sore throat
Commonly viral but need to distinguish from Group A beta hemolytic streptococcus
Viral causes are self limited- supportive treatment
Acute sinusitis pathophysiology - ANS-inflammation of osteomeatal complex, differentiates
between allergic or viral
Acute sinusitis risk factors - ANS-Cigarette smoke
Nasal foreign body
Trauma
Acute sinusitis treatment - ANS-NSAIDs for pain
Saline washes/steam
Oral/nasal decongestants
Intranasal corticosteroids
Antibiotics used if 10-14 days of symptoms present, or more significant symptoms such as fever,
facial pain, or swelling
acute vs chronic urticaria - ANS-acute lasts a few minutes to hours and is commonly caused by
food or drugs.
chronic lasts more than 6 weeks, is idiopathic, and lesions wax and wane.
Agoraphobia Characteristics - ANS-1. Intense anxiety about being in a situation where an
incapacitating event occurs and no help would be available. Usually situations that would be
extremely embarrassing or humiliating
2. An example would be fear of having a panic attack while riding a bus.
3. Most patients have coexisting panic disorders
Alcohol abuse signs and symptoms - ANS-1. Current intoxication may result in slurred speech,
ataxia, flushing, erratic behavior, loss of inhibition, and euphoria
2. Chronic abuse may manifest as acne rosacea, palmar erythema, hepatomegaly, dupuytren
contracture (fixed flexion of one or more fingers), testicular atrophy, and gynecomastia in males
3. Labs that indicate abuse are elevated GGT, AST, ALT, LDH, MCV and decreased BUN, LDL
and RBC volume
4. withdrawal may result in tremors/shakes and start 16-18 hours after last drink, may also have
abnormal perceptions, vomiting, seizures, hallucinations, and delirium
Allergic Rhinitis etiology - ANS-Common in people with other atopic disease:
Atopic Triad: allergic rhinitis, asthma, atopic dermatitis (eczema)
,Allergic Rhinitis pathophysiology - ANS-IgE mediated reactivity to airborne allergies
Allergic Rhinitis signs and symptoms - ANS-Allergic Shiners
Dennie lines
Rhinorrhea
watery/itchy eyes
sneezing
nasal congestion
dry cough
pale, boggy, blue mucosa
horizontal nasal crease (from allergic salute)
Allergic Rhinitis treatment - ANS-**Intranasal Glucocorticoid
Oral antihistamines
Cromolyn sodium
Nasal saline
Immunotherapy (last resort)
Angina at rest, new onset of angina symptoms, or an increasing pattern of pain in previously
stable patients.
Also is predictable when angina is less responsive to NTG, last longer, and occurs at rest or wih
less exertion than previous episodes of angina. - ANS-Unstable angina
Angle-closure glaucoma physical exam findings - ANS-OPHTHALMIC EMERGENCY
Circumlimbal injection
Steamy cornea
Fixed mid-dilated pupil
Decreased visual acuity
Tearing
Anterior chamber narrowed
Acutely elevated IOP
Increased cup-to-disk ratio
Angle-closure glaucoma signs and symptoms - ANS-OPHTHALMIC EMERGENCY
Complete closure of the angle
**Pain and vision loss**
Nausea
Vomiting
Diaphoresis
Angle-closure glaucoma treatment - ANS-OPHTHALMIC EMERGENCY
Immediate referral
Begin IV carbonic anhydrase inhibitor (Diamox/acetazolamide)
,Topical beta blocker
Osmotic diuretic (mannitol)
**Do NOT administer mydriatics**
Anorexia Nervosa characteristics - ANS-1. patients have distorted body image
2. an intense fear of becoming fat, even though they are underweight
3. self imposed starvation despite normal appetite for food
4. patients are usually < 85% of expected weight for their height
5. losing weight is seen as achievement of self control, but gaining weight is viewed as a lack of
discipline
6. Patients deny seriousness of their low body weight
7. Patients may exercise excessively and have food related obsessions (food hording, etc)
8. peak onset is during early adolescence
Anorexia treatment - ANS-1. first goal is to restore nutritional state (may need hospitalization)
2. behavioral therapy and supervised weight gain programs
3. some antidepressants (amitriptyline, paroxetine, mirtazapine) may be used but play a small
role in treatment. (DO NOT use bupropion - can lower seizure threshold for malnourished)
Anti-tuberculosis class-specific side effects - ANS-INH: hepatitis, peripheral neuropathy
(co-administer B6)
RIF: hepatitis, flue syndrome, orange body fluid (urine, tears etc)
EMB: optic neuritis (red-green vision loss)
Antibiotic prophylaxis recommendations to prevent endocarditis??
DOC? - ANS-Recommended before invasive dental work or surgical procedures in the following
patients:
1. Prosthetic valves
2. Previous infective endocarditis
3. some congenital heart conditions
4. some acquired valve disorders
5. hypertrophic cardiomyopathy
6. cardiac transplants with valvulopathy
**DOC= amoxicillin
Aortic Regurgitation:
1. Murmur location
2. Radiation
3. Intensity
4. Pitch/quality
5. Aids to hearing
6. Associated findings
7. Timing - ANS-1. 2nd - 4th LICS
, 2. To apex and right sternal border
3. Grades 1-3
4. High pitch; blowing
5. Patient sitting and leaning forward; full exhalation
6. Mid-systolic or Austin flint murmur suggests large flow; arterial pulses large and bounding
7. systolic (soft) and diastolic crescendo
Aortic Stenosis:
1. Murmur location
2. Radiation
3. Intensity
4. Pitch/quality
5. Aids to hearing
6. Timing - ANS-1. 2nd RICS
2. Neck and left sternal border (LSB)
3. Often loud with a thrill (grade 4-6)
4. Medium pitch; harsh
5. Patient sitting, leaning forward
6. Midsystolic
Aphthous ulcers etiology - ANS-unclear. possible involvement of herpes 6 virus
Asthma step 1 treatment (preferred) - ANS-SABA prn
Asthma step 2 treatment (preferred) - ANS-SABA prn
Low dose ICS
Asthma step 3 treatment (preferred) - ANS-SABA prn
low dose ICS + LABA
OR
Med ICS
Asthma step 4 treatment (preferred) - ANS-SABA prn
Med ICS + LABA
Asthma step 5 treatment (preferred) - ANS-SABA prn
High ICS + LABA
Asthma step 6 treatment (preferred) - ANS-SABA prn
High ICS + LABA + Oral corticosteroids
Atrial fibrillation general characteristics - ANS-most common chronic arrhythmia increasing
incidence and prevalence with age
