Family Med SG3

Question 1

What is the PHQ2?

Answer 1

Depresion screening scale. In the past month, have you ever felt down, depressed, or hopeless? Have you had little interest or pleasure in doing things?

Question 2

Lachman’s test

Answer 2

Assesses stability of the ACL. Stabilize the femur and try to pull the tibia anteriorly

Question 3

Valgus stress test

Answer 3

Forcing the knee into valgus (knock knee). This test the MCL

Question 4

Varus stress test

Answer 4

Tests the LCL

Question 5

McMurray test

Answer 5

Assess the medial and lateral menisci. (McMurray=Menisci MMM)

Question 6

3 most helpful findings in predicting carpal tunnel syndrome

Answer 6

Hand symptom diagrams, hypalgesia (decreased sens to pain), weak thumb abduction strength testing

Question 7

Patellofemoral pain syndrome

Answer 7

Anterior knee pain secondary to overuse. “Theater sign”= mild to moderate pain after prolonged sitting. More common in women than men

Question 8

IT band tendonitis

Answer 8

Lateral knee pain secondary to overuse. Pain aggravated with activity

Question 9

ACL sprain

Answer 9

Secondary to non-contact decelerating forces. Moderate to severe joint effusion. Swelling within 2 hours of “pop”

Question 10

MCL sprain

Answer 10

Medial joint line pain. Secondary to misstep or collision. Immediate onset of pain/swelling after trauma

Question 11

LCL sprain

Answer 11

Lateral joint line pain. Varus stress trauma. Immediate onset of lateral knee pain. Less common than MCL sprain

Question 12

Meniscal tear

Answer 12

Pain in the medial or lateral joint line. Secondary to twisting injury. Mild effusion. Can occur with chronic degenerative process.

Question 13

Negative birefrigent crystals versus positive

Answer 13

Negative in gout, and pos in pseudogout (p=p)

Question 14

Treatments for osteoarthritis with an A rating from the USPSTF

Answer 14

Water or land-based exercises, NSAIDs and acetominophen, intraarticular steroid injections

Question 15

Treatments for OA with a B raiting from USPSTF

Answer 15

glucosamine (does not decr pain or slow progression), chondroitin (does not decrease pain), acupuncture, S-adenosylmethionine (SAM-e) is as effective as NSAIDs for pain, tramadol, hyaluronic acid

Question 16

Arthroscopic debridement for OA

Answer 16

Has not been proven to help pain or functioning

Question 17

Treatment for CTS

Answer 17

Initially, nocturnal wrist splint for 1 mo

Question 18

When do you stop mammos? Colonoscopies? Cervical cancer?

Answer 18

Age 74 for mammos and age 75 for colonoscopies and age 65 for cervical cancer

Question 19

Difference between risk/hazardous drinking, alcohol abuse, and alcohol dependence

Answer 19

Hazardous drinking is when the alc use just exceeds the number that we say is acceptable. Alc abuse is when it interferes with life/safety/legal issues/interpersonal problems. Alc dependence is more physical (tolerance, withdrawal, significan time spent with alc, use continued despite physical and psych problems)

Question 20

There are higher rates of relapse in alcoholics who are what?

Answer 20

Men, younger age (probably because they are more likely to be single), few social supports, drank more prior to treatmen, and have poor compliance with drug therapy.

Question 21

How do you use the modified CAGE?

Answer 21

Positive answers to two or more require more intensive evaluation

Question 22

A positive answer to “Have you ever had a drinking problem?” plus evidence of alc consumption in the last 24 hours

Answer 22

Provides over 90% sensitivity and spec as a screening tool to identify an alcohol problem

Question 23

How much do men and women need to drink for it to be considered a problem?

Answer 23

Men is over 14 drinks/week, with over 4 on a single occasion. Women is over 7 drinks/week, with over 3 on single occasion

Question 24

Grey Turner’s sign

Answer 24

Bruising of the flank. Can be a sign of pancreatitis

Question 25

Cullen’s sign

Answer 25

Bruising of the periumbilical region. Can be a sign of pancreatitis

Question 26

Untreated symptomatic gallstones/biliary colic has a 70% risk of progressin over 2 years to complicatons like what?

Answer 26

cholangitis, pancreatitis, cholecystitis, choledocholithiasis, gall stone ileus, mirizzi syndrome

Question 27

Mirizzi syndrome

Answer 27

Gallstone compression of the hepatic duct

Question 28

Symptomatic gallstones should have a surgical eval within what amount of time?

Answer 28

The month

Question 29

Ursodiol

Answer 29

Actigal; Indicated for atypical sx of biliary colic with visible stones. Used more diagnostically for a 3 month trial. If sx resolve, then gallstones were the culprit and sbsequent therapy can be planned

Question 30

Interventions that work for patients with risk/hazardous drinking behavior

Answer 30

Brief (15 min) intervention by the family doc; Referral for motivational enhancement training; Referral for CBT; Participation in AA

Question 31

What is the cut off between macule/patch, papule/plaque?

Answer 31

1 cm

Question 32

If you see a rash with palms and soles distribution, what things should you think of?

Answer 32

Erythema multiforme, secondary syphilis, eczema

Question 33

What types of things cause annular lesions?

Answer 33

Drug eruptions, secondary syphilils, SLE

Question 34

What is the cutoff diameter that would make you concerned about SCC of the skin?

Answer 34

Over 2 cm in diameter

Question 35

What is the cutoff diameter that would make you concerned about a nevus?

Answer 35

Over 6 cm in diameter

Question 36

Skin cancer screening?

Answer 36

Insufficient evidence for full body skin exam

Question 37

What diameter is concerning for melanoma?

Answer 37

6mm diameter

Question 38

Tinea pedis

Answer 38

AKA athlete’s foot; Diagnosis is made clinically but can be aided by microscopy

Question 39

Sun exposure increases your risk for which skin lesions?

Answer 39

SCC, actinic keratosis, basal cell carcinoma, melanoma

Question 40

International prostate symptom score

Answer 40

Just know it exists. Series of questions

Question 41

Symmetrically firm and enlarged prostate

Answer 41

BPH

Question 42

Firm nodular, asymmetric or indurated prostate

Answer 42

Raises suspicion for prostate cancer

Question 43

Squamous cell carcinoma

Answer 43

Scaly, tend to grow thicker than actinic keratoses, pink macule can progressed to a red raised thing, heaped up edges are fleshy rather than clear, if over 2 cm, regarded to be hgh risk for recurrence and mets

Question 44

Basal cell carcinoma

Answer 44

Plaque-like or nodular with waxy or translucent appearant; usually no itching or change in skin color; slow growing and invades the tissues but rarely metastasizes

Question 45

How common are SCC and BCC?

Answer 45

SCC makes up 20% of all skin cancer, whereas BCC makes up 60% of all skin cancer

Question 46

Melanoma

Answer 46

Dark brown or black lesions, be suspicious of any lesion that is growing or bleeds with minor trauma; Only 1% of skin cancer but account for over 60% of skin cancer deaths; median age at dx is 53 yo;

Question 47

Risk factors for melanoma versus non-melanoma skin cancer

Answer 47

Non-melanoma is percent of lifetime sun exposure obtained before 18 yo, whereas melanoma is the number of intense sun exposure episodes. Melanoma in first deg relative is risk factor, but FH is not RF in non-melanoma. Males are much more likely than females to get SCC or BCC but the prev is about equal in melanoma (m>f slight). Outdoor work for nonmelanoma and indoor work for melanoma.

Question 48

Familial atypical mole-melanoma syndrome

Answer 48

Puts you at risk for melanoma

Question 49

Actinic keratosis

Answer 49

Scaly keratotic patches