Family Medicine Clerkship - Brainscape Flash Cards - Cases 11-15
Case 11: Health maintenance visit for adult female
screening for: CVD (BP @ 18 y/o, lipids @ 45 y/o), breast CA, cervical CA, osteoporosis and domestic violence; also CRC, depression, addiction & immunizations as w/ men
Case 11: recommendations for mammo’s in low-risk women?
USPSTF: biennial (q2yrs) after age 50; ACS/AAFP/ACOG: q1-2 yrs 40-49 y/o, then annually 50+ y/o
Case 11: Which women should be offered BRCA screening?
Those at high risk defined as: i) two 1st degrees w/ br ca at least one @ < 50 y/o; OR ii) three 1st or 2nd degrees w/ breast ca dx’d @ any age; OR iii) breast+ovarian in 1st or 2nd degrees; OR iv) on 1st-degree w/ bilat; OR v) 2+ 1st/2nd degrees w/ ovarian; OR vi) h/o male relative w/ br ca
Case 11: Cervical cancer screening guidelines
In those w/o h/o prior abnl pap or other risk factors: pap q3yr 21-65 y/o OR pap + HPV screen q5yr 30-65 y/o
Case 11: Osteoporosis screening guidelines
Women 65+ w/ DEXA Q ?2 yrs
Case 11: bisphosphonates: indications, ADRs, drug examples & dosing schedule
indicated for prevention and tx; ADRs include esophagitis, gastritis and diff. swallowing, so stay standing 30 mins s/p dose; alendronate (daily or weekly), risedronate (daily or weekly), ibandronate (daily, weekly or MONTHLY), zoledronic acid (Q2 YEARS for tx, Q YEAR for prevent)
Case 12: define strain
stretching or tearing injury of a ligament
Case 12: define sprain
stretching or tearing injury of a muscle or tendon
Case 12: Grading of Ankle Sprains
Grade 1: stretching of ATFL (anterotalofibular ligament), no instability or fxn loss; Grade 2: partial tear of ATFL and stretching of CFL (calcanefibular ligament), more severe pain/swell/bruise, mild/mod instability, lost ROM and signif pain w/ weight bearing; Grade 3: complete tear of ATFL and CFL w/ partial tearing of PTFL, signif instability, decr ROM and inability to bear weight
Case 12: Ottawa Ankle rules
X-ray ankle when: pt unable to bear wt immediately or now OR bony tenderness of posterior edge or tip of distal 6 cm of either med or lat malleolus; X-ray FOOT if: bony tenderness over medial midfoot (navicular bone) OR lateral midfoot (base of 5th metatarsal) or unable to bear wt
Case 12: Ottawa Knee rules
Order knee xray in pts w/ knee injury when: i) >55 y/o; OR ii) isolated patella tenderness; OR iii) tenderness of fibular head; OR iv) inabiity to flex 90°; OR v) inability to bear weight for four steps immediately and in exam room (regardless of limping)
Case 12: P-R-I-C-E Mnemonic for MSK injuries
Protect (splint, cast), Rest, Ice, Compression and Elevation
Case 12: test for supraspinatus pathology?
Empty can test (remember against resistance!)
Case 12: test for infraspinatus/teres minor pathology?
external rotation against resistance
Case 12: test for subscapularis pathology?
internal rotation or lift-off test against resistance
Case 12: test for subacromial impingement of supraspinatus tendon?
Hawkins impingement - pain w/ int rotation when arm is flexed 90° and elbow flexed 90°
Case 12: test for ATFL tear?
ant. Drawer of foot
Case 12: test for calcaneofibular tear?
inversion test: invert ankle w/ one hand while stabilizing lwr leg w/ other hand
Case 13: review derm term cards
mmkay?
Case 13: ABCDEE of skin lesions
[A]symmetry, [B]order irreg, [C]olor variegation, [D]iam >6mm, [E]levated, [E]volving (enlarged? thicker? bleeding?)
Case 13: known groups at high risk for melanoma
fair-skinned ♀ & ♂ > 65 y/o; those w/ > 50 nevi; also consider FMHx of skin ca, h/o ↑ sun exposure, red or blond hair, burns easily, toxic exposure hx (arsenic, creosote or radium) and immunosuppression
Case 13: Melanomas with a _______ depth < ___ mm have a low rate of met & high cure rate w/ excision
Breslow, 1 mm
Case 13: Preventive advice for pts
SPF of 15+; avoid 10a-4p; sun-protective clothing & avoid artificial UV light
Case 13: AK’s and HPV –> which type of skin cancer?
Basal Cell Carcinoma
Case 13: review derm melanoma cards
mmkay?
Case 13: name the 4 types of melanoma, which is most common? # 2?
1 = superficial spreading; #2 nodular; acral leniginous (asians and blacks); lentigo maligan (elderly, Hawai’i)
Case 14: w/u for asx microscopic hematuria
1) repeat UA w/ microscopic verification of dipstick, if + then #2) image upper (CT or IVP) and lower (cystoscopy) urinary tract AND send urine for culture and cytology AND order BUN/Cr AND Check BP; #3 if any abnormalities found, refer to uro
Case 14: how to diff 3 sources of hematuria
glomerular -> significant proteinuria, casts & dysmorphic RBCs; non-glom renal -> proteinuria but NO casts or dysmorphic RBCs; urologic -> no proteinuria, casts or dysmorphic cells
Case 14: what is considered clinically significant hematuria?
3+ RBCs/hpf
Case 14: eosinophils in the urine?
think interstitial nephritis d/t analgesic/drug rxn
Case 14: premedication options to decr r/o nephropathy d/t dye?
N-acetylcysteine or bicarb
Case 14: f/u schedule for dx’d benign micro hematuria?
f/u at 5, 12, 24 & 36 mos w/: BP check, urine cytology, UA
Case 15: short-term tx options for hyperthyroidism/
methimazole or propylthiouracil (L/U difference!)
Case 15: MoA of PTU (propylthiouracil) + ADRs
stops organification of iodine and periph conversion of T4 to T3; ADRs: BLACK BOX hepatotoxicity but used in preg women b/c less teratogenic than methimazole
Case 15: MoA of methimazole + ADRs
stops organification of iodine; ADR: containdicated in preg, otherwise first line
Case 15: type of tremor seen in hyperthyroidism?
usually a fine, resting tremor
Case 15: tx for thyroid storm
IV b blockers + PTU or methimazole
Case 15: spotaneous remission?
esp. likely in adolescents; tx for 6 to 18 mos and re-check
Case 15: dx of PRIMARY hypothyroidism?
low T4, high TSH –> provided nl p.e., no further w/u needed
Case 15: w/u for suspected 2° hypothyroidism?
TRH challenge (r/o’s hypothalamic dysfxn) measure TSH s/p 30 mins;
Case 15: health adult dose of Levoxyl? Geriatric?
1.7ug/kg or 1ug/kg for geriatric pts
Case 15: which thyroid nodules require biospy?
non-functioning (ii.e. no T4 output) nodules that are >1cm
