Family Medicine EOR (230 Topic Quick Cram) (Smarty PANCE)

What is the classic description of stable angina?

Predictable, exertional chest discomfort caused by fixed atherosclerotic coronary obstruction. Symptoms are brought on by physical or emotional stress, are relieved by rest or nitroglycerin, and typically last <20 minutes. There is no troponin elevation.

What is the classic description of unstable angina?

New-onset, worsening, or rest chest pain caused by transient myocardial ischemia without myocardial necrosis. It typically presents as crescendo angina, occurs at rest or with minimal exertion, lasts >20 minutes, and shows normal biomarkers (no troponin elevation).

What is the difference between unstable angina and STEMI?

Unstable angina (UA) and NSTEMI share similar symptoms; the key distinction is troponin elevation (normal in UA, elevated in NSTEMI/STEMI).

What is the gold standard diagnostic test for Coronary Artery Disease?

Coronary Angiography (Cardiac Catheterization)

What is the first-line pharmacologic treatment for chronic stable angina?

Beta-blockers (e.g., Metoprolol, Atenolol)

What is Prinzmetal's (Variant) Angina?

Coronary vasospasm causing transient ST elevations at rest (often early morning) - treat with Calcium Channel Blockers

What is the most common arrhythmia identified in clinical practice?

Atrial Fibrillation

What is the treatment for unstable Atrial Fibrillation?

Synchronized Cardioversion

What is the CHADS2-VASc score used for?

Determining stroke risk and need for anticoagulation in Atrial Fibrillation

What is the hallmark ECG finding in Atrial Flutter?

"Sawtooth" P waves at 250-350 bpm

What is the most common cause of Right-Sided Heart Failure?

Left-Sided Heart Failure

What are the classic physical signs of Left-Sided Heart Failure?

Dyspnea, Orthopnea, PND, Rales/Crackles, S3 Gallop

What is the most useful diagnostic test for Heart Failure?

Echocardiogram (to assess Ejection Fraction)

What physical exam finding is most specific for Right-Sided Heart Failure?

Elevated JVP (Jugular Venous Distention)

What is the first-line medication for Systolic Heart Failure (HFrEF) to reduce mortality?

ACE Inhibitors (or ARBs) + Beta Blockers

What is the classic presentation of Infective Endocarditis?

Fever + New Murmur

What are the classic peripheral stigmata of Endocarditis? Use mnemonic FROM JANE

Fever, Roth spots, Osler nodes (painful), Murmur, Janeway lesions (painless), Anemia, Nailbed hemorrhages, Emboli

What is the antibiotic prophylaxis for endocarditis before dental procedures?

Amoxicillin 2g (PO) 30-60 min before procedure

What is the LDL goal for patients with Coronary Artery Disease or Diabetes?

< 70 mg/dL (or at least 50% reduction with high-intensity statin)

What are the high-intensity statins?

Atorvastatin 40-80mg, Rosuvastatin 20-40mg

What clinical sign suggests severe Hypertriglyceridemia (>1000 mg/dL)?

Eruptive Xanthomas (and high risk of Pancreatitis)

What is the first-line treatment for Hypertriglyceridemia >500 mg/dL?

Fibrates (e.g., Fenofibrate, Gemfibrozil) to prevent pancreatitis

What is the blood pressure goal for most adults (JNC 8 / ACC/AHA)?

< 130/80 mmHg

What is the first-line antihypertensive for African American patients?

Thiazide Diuretics or Calcium Channel Blockers

What are the classic symptoms of Peripheral Vascular Disease (PAD)?

Intermittent Claudication (leg pain with walking, relieved by rest), diminished pulses, atrophic skin

What is the best initial screening test for PAD?

Ankle-Brachial Index (ABI) - <0.9 is diagnostic

What is the classic murmur of Aortic Stenosis?

Systolic crescendo-decrescendo at RUSB, radiating to carotids (Syncope, Angina, Dyspnea)

What is the classic murmur of Mitral Regurgitation?

Holosystolic "blowing" murmur at Apex, radiating to Axilla

What is the classic murmur of Mitral Valve Prolapse?

Mid-systolic click followed by late systolic murmur

What is Samter's Triad in Asthma?

Asthma, Nasal Polyps, Aspirin Sensitivity

What is the gold standard for diagnosing Asthma?

Spirometry showing reversible obstruction (FEV1 increases >12% with bronchodilator)

What is the most common cause of Acute Bronchitis?

Viral infection (Adenovirus, Rhinovirus, Influenza) - Antibiotics usually NOT indicated

What is the definition of Chronic Bronchitis?

Productive cough for >3 months in 2 consecutive years

What is the spirometry finding diagnostic for COPD?

FEV1/FVC ratio < 0.70 (irreversible obstruction)

What are the two main types of COPD presentations?

"Pink Puffer" (Emphysema - dyspnea, barrel chest) and "Blue Bloater" (Chronic Bronchitis - productive cough, cyanosis, edema)

What is the only intervention shown to prolong survival in COPD?

Supplemental Oxygen (if hypoxic) and Smoking Cessation

What is the most common type of Lung Cancer?

Adenocarcinoma (peripheral lesion, non-smokers)

Which lung cancer is associated with paraneoplastic syndromes like SIADH and Cushing's?

Small Cell Carcinoma (Central lesion)

What is the most common cause of Community Acquired Pneumonia?

Streptococcus pneumoniae (rust-colored sputum)

What organism causes "Walking Pneumonia" in young adults?

Mycoplasma pneumoniae (treat with Azithromycin or Doxycycline)

What is the CURB-65 score used for?

Admission criteria for Pneumonia (Confusion, Urea >7, RR >30, BP <90/60, Age >65)

What is the gold standard for diagnosing Obstructive Sleep Apnea?

Polysomnography (Sleep Study) - AHI > 5 events/hour

What is the first-line pharmacotherapy for Tobacco Dependence?

Varenicline (Chantix) or Nicotine Replacement Therapy

What is the PPD (Mantoux) size cutoff for a positive TB test in general population with no risk factors?

> 15 mm

What is the PPD cutoff for HIV positive or immunocompromised patients?

> 5 mm

What is the classic symptom of an Anal Fissure?

Severe tearing pain during defecation with bright red blood on tissue

What is the most common location for an Anal Fissure?

Posterior Midline

What physical exam signs suggest Appendicitis?

McBurney's point tenderness, Rovsing sign (LLQ palpation hurts RLQ), Psoas sign, Obturator sign

What is the imaging modality of choice for Appendicitis in adults vs. children/pregnant?

Adults: CT Abdomen/Pelvis; Children/Pregnant: Ultrasound or MRI

What are the classic symptoms of Small Bowel Obstruction?

Crampy abdominal pain, vomiting, obstipation (no gas/stool), abdominal distention

What is the characteristic abdominal X-ray finding in SBO?

Dilated loops of bowel with air-fluid levels and "step-ladder" pattern

What is Charcot's Triad for Acute Cholangitis?

Fever, RUQ Pain, Jaundice

What is Murphy's Sign?

Inspiratory arrest on RUQ palpation - indicative of Acute Cholecystitis

What is the first-line imaging for Cholecystitis?

RUQ Ultrasound (gallstones, wall thickening, pericholecystic fluid)

What are the classic physical stigmata of Cirrhosis?

Ascites, Caput medusae, Spider angiomas, Palmar erythema, Gynecomastia, Asterixis

What screening is required for patients with Cirrhosis?

Alpha-Fetoprotein (AFP) and Ultrasound every 6 months for Hepatocellular Carcinoma

What is the tumor marker for Colorectal Cancer?

CEA (Carcinoembryonic Antigen) - used for monitoring recurrence, not screening

What is the "Apple Core" lesion on Barium Enema suggestive of?

Colorectal Cancer

What is the most common cause of traveler's diarrhea?

Enterotoxigenic E. coli (ETEC)

What are the "Alarm Symptoms" in GERD?

Dysphagia, Odynophagia, Weight loss, Bleeding, Anemia (requires Endoscopy)

What is Barrett's Esophagus?

Metaplasia of squamous to columnar epithelium (precancerous for Adenocarcinoma)

What is the most common cause of Gastritis and Peptic Ulcer Disease?

Helicobacter pylori infection (and NSAID use)

What is the Triple Therapy for H. pylori?

Clarithromycin + Amoxicillin + PPI (CAP) for 14 days

What is the most common cause of Upper GI Bleed?

Peptic Ulcer Disease

What is the difference between Melena and Hematochezia?

Melena: Black tarry stool (Upper GI source); Hematochezia: Bright red blood (Lower GI source - or massive Upper)

What is the classic presentation of Giardiasis?

Frothy, greasy, foul-smelling diarrhea after camping/drinking stream water

What is the treatment for Giardia lamblia?

Metronidazole (Flagyl)

What is the difference between Internal and External Hemorrhoids?

Internal: Painless, bleed; External: Painful, itch, do not bleed unless thrombosed

What is the classic presentation of Hiatal Hernia?

Heartburn/GERD symptoms worsened by lying down

What are the two major types of Inflammatory Bowel Disease?

Crohn's Disease (Transmural, Skip lesions, Mouth to Anus) and Ulcerative Colitis (Mucosal, Continuous, Rectum/Colon only)

What antibodies are associated with Crohn's vs. UC?

Crohn's: ASCA positive; UC: p-ANCA positive

What are the Rome IV Criteria for IBS?

Recurrent abdominal pain related to defecation, change in stool frequency, or change in stool form

What is the classic presentation of Acute Pancreatitis?

Epigastric pain radiating to the back, nausea, vomiting

What lab value is most specific for Pancreatitis?

Lipase > 3x upper limit of normal

What is Ranson's Criteria?

Predicts mortality in Pancreatitis (Glucose >200, Age >55, LDH >350, AST >250, WBC >16k)

What serology indicates immunity to Hepatitis B from vaccination?

Positive Anti-HBs (Surface Antibody) ONLY; Negative Anti-HBc (Core Antibody)

What serology indicates active Hepatitis A infection?

IgM Anti-HAV

What is the most common bacterial cause of Acute Sinusitis?

Streptococcus pneumoniae (followed by H. influenzae and Moraxella)

When are antibiotics indicated for Acute Sinusitis?

Symptoms lasting >10 days or worsening after initial improvement ("double sickening")

What is the classic presentation of Allergic Rhinitis?

Sneezing, clear rhinorrhea, itchy eyes/nose, "allergic shiners", pale/boggy turbinates

What is the treatment for Aphthous Ulcers (Canker Sores)?

Topical steroids (Triamcinolone) or magic mouthwash (symptomatic relief); self-limiting

What is Blepharitis and how is it treated?

Chronic inflammation of eyelid margins (crusting/scaling); Treat with warm compresses and baby shampoo scrubs

What is a Cholesteatoma?

Keratinized mass in the middle ear caused by chronic negative pressure; presents with painless otorrhea and conductive hearing loss

How do you differentiate Viral vs. Bacterial Conjunctivitis?

Viral: Watery discharge, preauricular lymphadenopathy; Bacterial: Purulent discharge, "glued shut" eyes in morning

What is the classic sign of Allergic Conjunctivitis?

Bilateral itching, watery discharge, "cobblestoning" of tarsal conjunctiva

What is the hallmark of Corneal Abrasion on fluorescein stain?

Ice rink/linear uptake of dye; Treat with antibiotic ointment (Erythromycin/Ciprofloxacin)

What is the difference between Pterygium and Pinguecula?

Pterygium: Fleshy triangular growth that crosses onto the cornea; Pinguecula: Yellow nodule that does NOT cross onto cornea

What is the first-line treatment for Epistaxis (Nosebleed)?

Direct pressure (leaning forward) for 10-15 minutes; then topical vasoconstrictors (Oxymetazoline)

What is the classic triad of Acute Angle-Closure Glaucoma?

Severe eye pain, Halos around lights, Cloudy "steamy" cornea (Fixed mid-dilated pupil)

What is the difference between Hordeolum and Chalazion?

Hordeolum (Stye): Painful acute infection of eyelid gland; Chalazion: Painless chronic granuloma (hard nodule)

What is Hyphema?

Blood in the anterior chamber of the eye (usually trauma); requires ophthalmology consult and head elevation

What is the classic triad of Meniere's Disease?

Episodic Vertigo, Tinnitus, Sensorineural Hearing Loss (low frequency)

How is Meniere's Disease treated?

Salt restriction, Diuretics (HCTZ/Triamterene), Meclizine for acute attacks

What is the difference between Labyrinthitis and Vestibular Neuritis?

Labyrinthitis: Vertigo + Hearing Loss; Vestibular Neuritis: Vertigo only (No hearing loss)

What is the leading cause of permanent legal blindness in the elderly?

Macular Degeneration (affects central vision)

What is the difference between Dry and Wet Macular Degeneration?

Dry: Drusen bodies (slow progression); Wet: Neovascularization (rapid vision loss, treat with VEGF inhibitors)

What are Nasal Polyps in a child suggestive of?

Cystic Fibrosis (requires sweat chloride test)

What is the classic sign of Otitis Externa (Swimmer's Ear)?

Pain with traction on the pinna/tragus; Treat with Ciprofloxacin/Dexamethasone drops

What is the hallmark finding in Acute Otitis Media?

Bulging, immobile, erythematous tympanic membrane (Streptococcus pneumoniae most common)

What is the treatment for Otitis Media?

Amoxicillin (First-line); Augmentin if recent antibiotic use or resistant