Family Med SG10

Question 1

Bacterial agent that causes septic glenohumeral arthritis or septic subacromial bursitis

Answer 1

Gram pos organisms, primarily staph (including MRSA) and to a lesser extent strep

Question 2

Treatment of tinea pedis

Answer 2

Tolnaftate (Tinactin) BID

Question 3

Pt with poor posture or rounded shoulders

Answer 3

impingement syndrome

Question 4

Atrophy of larger muscles of the shoulder like deltoid or pec versus atrophy of smaller shoulder muscles

Answer 4

Large means imobilization. Small means torn rotator cuff or nerve impingement

Question 5

Unilateral versus bilateral winging of the scapula

Answer 5

Unilateral is long thoracic nerve issue. Bilateral is weakness of the scapular stabilizers

Question 6

Things that can get impinged in impingement syndrome

Answer 6

Supraspinatous tendon, long head of the biceps muscle, subacromial bursa

Question 7

Rotator cuff tendonitis

Answer 7

Positive Apley scratch test

Question 8

Shoulder instability

Answer 8

Positive sulcus sign and ant/post translation tests

Question 9

Anterior shoulder pain with anterior tenderness to palpation

Answer 9

Biceps tendonitis. Also Speed’s and Yergason’s tests positive

Question 10

Shoulder dislocation

Answer 10

Apprehension and relocation testing is positive

Question 11

No imaging studies are recommended in the initial evaluation of rotator cuff pathology

Answer 11

right

Question 12

Rotator cuff tendonitis on Xray

Answer 12

Xray may be normal or demonstrate calcium depositis in the region of the rotator cuff attachment to the humerus (“calcific tendonitis”)

Question 13

Rotator cuff tears on Xrays

Answer 13

May be indirectly suggested by narrowing of subacromial space

Question 14

When is CT indicated for shoulder pathology?

Answer 14

Indicated in the setting of complicated fracture, suspected tumor, or when MRI is contraindicated. CT arthrogram for adhesive capsulitis

Question 15

Management of rotator cuff tendonitis and shoulder instability

Answer 15

Relative rest, PT, anti-inflamm as needed in topical or oral form, subacromial injection

Question 16

Primary causes of fatigue (as opposed to secondary)

Answer 16

Chronic fatigue syndrome, fibromyalgia

Question 17

What level of recommendation for referring women whose family history is assoc with increased risk of BRCA1 or 2 for genetic counseling?

Answer 17

Grade B rec

Question 18

Colorectal cancer RFs

Answer 18

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

Question 19

Unusual causes of iron def

Answer 19

Jejunal disease and celiac sprue. Corresponding hx is crampy abdominal pain

Question 20

Chronic fatigue syndrome

Answer 20

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

Question 21

Management of iron deficiency anemia

Answer 21

Ferrous sulfate 325 mg TID, docusate sodium PRN constipation, and colonoscopy if concern for GI cause

Question 22

Staging of colon cancer versus rectal cancer

Answer 22

Colon requires surgical removal and pathologic staging. Rectal can be staged by endorectal ultrasound

Question 23

CEA greater than what is assoc with worse prognosis for colon cancer?

Answer 23

Over 5

Question 24

Components of the patient-centered medical home

Answer 24

Personal physician. Physician-directed medical practice. Whole person orientation (all stages of life). Care is coordinated and/or integrated. Quality and safety

Question 25

Trichomonas

Answer 25

Vaginal discharge with odor or itching. May be asymptomatic. Dx by saline wet mount or rapid antigen testing.

Question 26

Testicular cacner race

Answer 26

Most common in African Americans

Question 27

Three main types of testicular tumors

Answer 27

Germ cell, non-germ cell, and extragonadal

Question 28

Germ cell tumors

Answer 28

95% of all primary testicular tumors. Types are seminoma (45%) or nonseminoma (50%)

Question 29

Non-germ cell tumor

Answer 29

Examples are Leydig asnd sertoli cell. 5% of all primary testicular tumors. Malignant in only about 10% of cases

Question 30

Extragonadal testicular tumor

Answer 30

Lymphoma, leukemia, melanoma are most common that metastasize to the testicle

Question 31

Risk factors for testicular cancer

Answer 31

Klinefelters (47XXY) and their first degree relatives. Down syndrome. Testicular feminizing syndrome. True hermaphrodites. Persistent Mullerian syndrome. Cutaneous ichthyosis; Family hx; Cryptorchidism; Environmental hazards (DES, Agent Orange, and solvents used to clean jets); testicular cancer in other testicle

Question 32

HEEADSSS

Answer 32

Home, education, eating, activities, drugs, sex, suicide, safety

Question 33

Cremasteric reflex in testicular torsion

Answer 33

Often, but not always, absent

Question 34

Blue dot sign on upper pole of testes

Answer 34

Pathognomonic for appendiceal torsion when tenderness is also present

Question 35

Prehn’s sign

Answer 35

Physical lifting of the testicle relieves the pain of epididymitis but not testicular torsion

Question 36

How many hours do you have to rescue the testicle after torsion?

Answer 36

4 to 12

Question 37

Peak ages for testicular torsion

Answer 37

First year of life and 14 yo

Question 38

Etiologies of testicular torsion

Answer 38

congenital (failure of anchoring of the gubernaculum), undescended testes, recent trauma