Family Med SG10 Flashcards
Bacterial agent that causes septic glenohumeral arthritis or septic subacromial bursitis
Gram pos organisms, primarily staph (including MRSA) and to a lesser extent strep
Treatment of tinea pedis
Tolnaftate (Tinactin) BID
Pt with poor posture or rounded shoulders
impingement syndrome
Atrophy of larger muscles of the shoulder like deltoid or pec versus atrophy of smaller shoulder muscles
Large means imobilization. Small means torn rotator cuff or nerve impingement
Unilateral versus bilateral winging of the scapula
Unilateral is long thoracic nerve issue. Bilateral is weakness of the scapular stabilizers
Things that can get impinged in impingement syndrome
Supraspinatous tendon, long head of the biceps muscle, subacromial bursa
Rotator cuff tendonitis
Positive Apley scratch test
Shoulder instability
Positive sulcus sign and ant/post translation tests
Anterior shoulder pain with anterior tenderness to palpation
Biceps tendonitis. Also Speed’s and Yergason’s tests positive
Shoulder dislocation
Apprehension and relocation testing is positive
No imaging studies are recommended in the initial evaluation of rotator cuff pathology
right
Rotator cuff tendonitis on Xray
Xray may be normal or demonstrate calcium depositis in the region of the rotator cuff attachment to the humerus (“calcific tendonitis”)
Rotator cuff tears on Xrays
May be indirectly suggested by narrowing of subacromial space
When is CT indicated for shoulder pathology?
Indicated in the setting of complicated fracture, suspected tumor, or when MRI is contraindicated. CT arthrogram for adhesive capsulitis
Management of rotator cuff tendonitis and shoulder instability
Relative rest, PT, anti-inflamm as needed in topical or oral form, subacromial injection
Primary causes of fatigue (as opposed to secondary)
Chronic fatigue syndrome, fibromyalgia
What level of recommendation for referring women whose family history is assoc with increased risk of BRCA1 or 2 for genetic counseling?
Grade B rec
Colorectal cancer RFs
Age over 50, FAP and HNPCC, personal hx of colorectal cancer or adenomas, first deg rel with colorectal cancer, first deg relative with adenomas dx before age 60, personal hx of ovarian, endometrial, or breast cancer, long standing UC or crohns, DM
Unusual causes of iron def
Jejunal disease and celiac sprue. Corresponding hx is crampy abdominal pain
Chronic fatigue syndrome
Unknown etiology. Fatigue lasting over 6 mos. Fatigue is unrelieved by rest but worse with exertion. CDC dx criteria: At least 6 mos of disabling fatigue. Four of the following: impaired memory/concentration, post-exertional malaise, tender lymphadenopathy, st, HA, myalgias, and arthralgias
Management of iron deficiency anemia
Ferrous sulfate 325 mg TID, docusate sodium PRN constipation, and colonoscopy if concern for GI cause
Staging of colon cancer versus rectal cancer
Colon requires surgical removal and pathologic staging. Rectal can be staged by endorectal ultrasound
CEA greater than what is assoc with worse prognosis for colon cancer?
Over 5
Components of the patient-centered medical home
Personal physician. Physician-directed medical practice. Whole person orientation (all stages of life). Care is coordinated and/or integrated. Quality and safety
