Family Medicine Clerkship - Brainscape Flash Cards - Cases 11-15

Question 1

Case 11: Health maintenance visit for adult female

Answer 1

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

Question 2

Case 11: recommendations for mammo’s in low-risk women?

Answer 2

USPSTF: biennial (q2yrs) after age 50; ACS/AAFP/ACOG: q1-2 yrs 40-49 y/o, then annually 50+ y/o

Question 3

Case 11: Which women should be offered BRCA screening?

Answer 3

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

Question 4

Case 11: Cervical cancer screening guidelines

Answer 4

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

Question 5

Case 11: Osteoporosis screening guidelines

Answer 5

Women 65+ w/ DEXA Q ?2 yrs

Question 6

Case 11: bisphosphonates: indications, ADRs, drug examples & dosing schedule

Answer 6

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)

Question 7

Case 12: define strain

Answer 7

stretching or tearing injury of a ligament

Question 8

Case 12: define sprain

Answer 8

stretching or tearing injury of a muscle or tendon

Question 9

Case 12: Grading of Ankle Sprains

Answer 9

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

Question 10

Case 12: Ottawa Ankle rules

Answer 10

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

Question 11

Case 12: Ottawa Knee rules

Answer 11

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)

Question 12

Case 12: P-R-I-C-E Mnemonic for MSK injuries

Answer 12

Protect (splint, cast), Rest, Ice, Compression and Elevation

Question 13

Case 12: test for supraspinatus pathology?

Answer 13

Empty can test (remember against resistance!)

Question 14

Case 12: test for infraspinatus/teres minor pathology?

Answer 14

external rotation against resistance

Question 15

Case 12: test for subscapularis pathology?

Answer 15

internal rotation or lift-off test against resistance

Question 16

Case 12: test for subacromial impingement of supraspinatus tendon?

Answer 16

Hawkins impingement - pain w/ int rotation when arm is flexed 90° and elbow flexed 90°

Question 17

Case 12: test for ATFL tear?

Answer 17

ant. Drawer of foot

Question 18

Case 12: test for calcaneofibular tear?

Answer 18

inversion test: invert ankle w/ one hand while stabilizing lwr leg w/ other hand

Question 19

Case 13: review derm term cards

Answer 19

mmkay?

Question 20

Case 13: ABCDEE of skin lesions

Answer 20

[A]symmetry, [B]order irreg, [C]olor variegation, [D]iam >6mm, [E]levated, [E]volving (enlarged? thicker? bleeding?)

Question 21

Case 13: known groups at high risk for melanoma

Answer 21

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

Question 22

Case 13: Melanomas with a _______ depth < ___ mm have a low rate of met & high cure rate w/ excision

Answer 22

Breslow, 1 mm

Question 23

Case 13: Preventive advice for pts

Answer 23

SPF of 15+; avoid 10a-4p; sun-protective clothing & avoid artificial UV light

Question 24

Case 13: AK’s and HPV –> which type of skin cancer?

Answer 24

Basal Cell Carcinoma

Question 25

Case 13: review derm melanoma cards

Answer 25

mmkay?

Question 26

Case 13: name the 4 types of melanoma, which is most common? # 2?

Answer 26

1 = superficial spreading; #2 nodular; acral leniginous (asians and blacks); lentigo maligan (elderly, Hawai’i)

Question 27

Case 14: w/u for asx microscopic hematuria

Answer 27

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

Question 28

Case 14: how to diff 3 sources of hematuria

Answer 28

glomerular -> significant proteinuria, casts & dysmorphic RBCs; non-glom renal -> proteinuria but NO casts or dysmorphic RBCs; urologic -> no proteinuria, casts or dysmorphic cells

Question 29

Case 14: what is considered clinically significant hematuria?

Answer 29

3+ RBCs/hpf

Question 30

Case 14: eosinophils in the urine?

Answer 30

think interstitial nephritis d/t analgesic/drug rxn

Question 31

Case 14: premedication options to decr r/o nephropathy d/t dye?

Answer 31

N-acetylcysteine or bicarb

Question 32

Case 14: f/u schedule for dx’d benign micro hematuria?

Answer 32

f/u at 5, 12, 24 & 36 mos w/: BP check, urine cytology, UA

Question 33

Case 15: short-term tx options for hyperthyroidism/

Answer 33

methimazole or propylthiouracil (L/U difference!)

Question 34

Case 15: MoA of PTU (propylthiouracil) + ADRs

Answer 34

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

Question 35

Case 15: MoA of methimazole + ADRs

Answer 35

stops organification of iodine; ADR: containdicated in preg, otherwise first line

Question 36

Case 15: type of tremor seen in hyperthyroidism?

Answer 36

usually a fine, resting tremor

Question 37

Case 15: tx for thyroid storm

Answer 37

IV b blockers + PTU or methimazole

Question 38

Case 15: spotaneous remission?

Answer 38

esp. likely in adolescents; tx for 6 to 18 mos and re-check

Question 39

Case 15: dx of PRIMARY hypothyroidism?

Answer 39

low T4, high TSH –> provided nl p.e., no further w/u needed

Question 40

Case 15: w/u for suspected 2° hypothyroidism?

Answer 40

TRH challenge (r/o’s hypothalamic dysfxn) measure TSH s/p 30 mins;

Question 41

Case 15: health adult dose of Levoxyl? Geriatric?

Answer 41

1.7ug/kg or 1ug/kg for geriatric pts

Question 42

Case 15: which thyroid nodules require biospy?

Answer 42

non-functioning (ii.e. no T4 output) nodules that are >1cm