Family Med SG5 Flashcards
Lichen planus
Common in middle age; Primary lesion is a flat topped papule with an irreg border on the flexor surfaces of the wrists and legs immediately above the ankles. Lesions are usually multiple
Seborrheic keratoses
Usually elevated hyperpigmented lesions of the face and trunk. Stuck on appearance
Maximal urinary flow rate
Test is optional. Over 15 mL/sec excludes clinically important bladder outlet obstruction
Surgical excision of skin cancer
Most widely used for SCC. Well-defined small SCC lacking any high risk features should get a 4 mm margin aroud a 2cm lesion
Mohs microscopic surgery is indicated for whom
Patients with any non-melanoma skin cancer over 2 cms or those around important structures
Topical 5-FU for skin cancer treatment
Approved by the FDA for treatment of actinic keratoses. Not technically approved for CC but commonly used for it in patients who refuse surgery
Radiation therapy for skin cancer
Initial management for small well-defined primary SCCs, especially in older patients and those who are not surgical candidates. Contraindic on tumors located on the trunk or extremities because these are more prone to break down and ulcerate than skin on the head and neck
Medical management for BPH
Alpha blockers (decrease symptoms of LUTS); 5 alpha reductase inhib (finasteride and dutasteride) are more effective in men with larger prostates, requires long term treatment for over 1 yr; Some patients may need combo treatment of alpha antags and 5 alpha reductase inhib
When is surgical management of BPH indicated?
If risk for hydronephrosis or renal insuff or urinary retention, infection, etc.
Treatment of tinea capitus
Oral therapy is required bc topical therapy does not penetrate the hair shaft. Use griseofulvin (oral antifungal)
Treatment of tinea ungulum (onychomycosis)
Griseofulvin is approved, but longterm treatment is required. Terbinafine for 12 wk (toes) or 6 wk (fingers) is better. You can also use itraconazole as a pulse treatment
Treatment of tinea pedis, tinea magnum, tinea corporis, and tinea cruris
Treat with topical antifungals in the “azole” family or the “allylamine” fam (terbinafine and naftifine); infections should resolve within 2-4 weeks of topical treatment
Avg 1 year mortality after a hip fracture
Twenty five percent
FRAX
Tool to help calculate risk of fracture
DEXA
Looks at lumbar spine and hip density to determine if someone has osteoporosis
What are the cut-offs for normal, osteopenia, and osteoporosis on DEXA
Zero to 1 is nl. -1 to -2.5 is osteopenia. Less than tht is osteoporosis
Alternative cervical cancer screening guidelines
First PAP at age 21, biennial up to age 30 and for those over 30 yo with 3 consecutive normal paps, screening can be done every 3 years
Why are anovulatory cycles a risk factor for endometrial cancer?
Unopposed estrogen (estrogen without the progesterone)
What are some little known minor risk factors for endometrial cancer?
Hypertension, DM, Hx of breast or colon cancer, Menstrual cycle irregularities, age
Why is OCP use protective against endometrial cancer?
Incr progesterone
Ddx for abnormal uterine bleeding in a post-menopausal woman
Cervical polyps, endometrial hyperplasia, endometrial cancer, proliferative endometrium, iatrogenic causes, systemic disorders, genital tract pathology
Evaluation of cervical polyps as a source of abnormal uterine bleeding
Rule out via pelvic exam. More common in postpartum (the cervix just changed) and perimenopausal women (again, change)
What is the chance that endometrial hyperplasia (simple) will progress to cancer?
Less than 5% for simple hyperplasia. For atypical complex hyperplasia, it is 30-45%
