Family Med SG5

Question 1

Lichen planus

Answer 1

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

Question 2

Seborrheic keratoses

Answer 2

Usually elevated hyperpigmented lesions of the face and trunk. Stuck on appearance

Question 3

Maximal urinary flow rate

Answer 3

Test is optional. Over 15 mL/sec excludes clinically important bladder outlet obstruction

Question 4

Surgical excision of skin cancer

Answer 4

Most widely used for SCC. Well-defined small SCC lacking any high risk features should get a 4 mm margin aroud a 2cm lesion

Question 5

Mohs microscopic surgery is indicated for whom

Answer 5

Patients with any non-melanoma skin cancer over 2 cms or those around important structures

Question 6

Topical 5-FU for skin cancer treatment

Answer 6

Approved by the FDA for treatment of actinic keratoses. Not technically approved for CC but commonly used for it in patients who refuse surgery

Question 7

Radiation therapy for skin cancer

Answer 7

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

Question 8

Medical management for BPH

Answer 8

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

Question 9

When is surgical management of BPH indicated?

Answer 9

If risk for hydronephrosis or renal insuff or urinary retention, infection, etc.

Question 10

Treatment of tinea capitus

Answer 10

Oral therapy is required bc topical therapy does not penetrate the hair shaft. Use griseofulvin (oral antifungal)

Question 11

Treatment of tinea ungulum (onychomycosis)

Answer 11

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

Question 12

Treatment of tinea pedis, tinea magnum, tinea corporis, and tinea cruris

Answer 12

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

Question 13

Avg 1 year mortality after a hip fracture

Answer 13

Twenty five percent

Question 14

FRAX

Answer 14

Tool to help calculate risk of fracture

Question 15

DEXA

Answer 15

Looks at lumbar spine and hip density to determine if someone has osteoporosis

Question 16

What are the cut-offs for normal, osteopenia, and osteoporosis on DEXA

Answer 16

Zero to 1 is nl. -1 to -2.5 is osteopenia. Less than tht is osteoporosis

Question 17

Alternative cervical cancer screening guidelines

Answer 17

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

Question 18

Why are anovulatory cycles a risk factor for endometrial cancer?

Answer 18

Unopposed estrogen (estrogen without the progesterone)

Question 19

What are some little known minor risk factors for endometrial cancer?

Answer 19

Hypertension, DM, Hx of breast or colon cancer, Menstrual cycle irregularities, age

Question 20

Why is OCP use protective against endometrial cancer?

Answer 20

Incr progesterone

Question 21

Ddx for abnormal uterine bleeding in a post-menopausal woman

Answer 21

Cervical polyps, endometrial hyperplasia, endometrial cancer, proliferative endometrium, iatrogenic causes, systemic disorders, genital tract pathology

Question 22

Evaluation of cervical polyps as a source of abnormal uterine bleeding

Answer 22

Rule out via pelvic exam. More common in postpartum (the cervix just changed) and perimenopausal women (again, change)

Question 23

What is the chance that endometrial hyperplasia (simple) will progress to cancer?

Answer 23

Less than 5% for simple hyperplasia. For atypical complex hyperplasia, it is 30-45%