0 Family Medicine 25, 26, 27

Front 1

What muscles comprise the rotator cuff and what is the function of each?

Back 1

SITS
Supraspinatus: Shoulder abduction

Infraspinatus: Shoulder external rotation

Teres Minor: External rotation of shoulder

Subscapularis: Internal rotation of shoulder

Front 2

What are non-musculoskeletal causes of referred shoulder pain?

Back 2

MI
Lung Cancer
Cholecystitis
Ruptured Ectopic pregnancy

Front 3

Which musculoskeletal causes of shoulder pain require urgent management?

Why?

Back 3

Septic glenohumeral arthritis or septic subacromial bursitis

Delay in treatment may lead to tissue destruction, loss of function; extension of infection may lead to osteomyelitis, bacteremia, sepsis

Front 4

What are red flags for septic arthritis?
Causative organisms?

Back 4

Red flags: Local redness, swelling; systemic complaints: fever, chills, myalgias

Etiology: primarily staph (including MRSA); lesser extent strep

Predisposing facors: DM, EtOH, immunocompromised

Requires urgent evaluation with u/s or MRI, consult with ortho

Front 5

Loss of active AND passive ROM is more likely due to ______.

Back 5

Joint disease

Front 6

Loss of only active ROM is more likely due to ________.

Back 6

Muscle tissue pathology

Front 7

Tine pedia:
Definitive test
Treatment

Back 7

Scrape sample and expose to KOH

Tx: Tolnaftate (tinactin) bid

Front 8

Poor posture or rounded shoulder may indicate ________.

Back 8

Impingement syndrome

Front 9

Boney deformity in the area of the clavicle or acromioclavicular joint may indicate ________.

Back 9

Fractured clavicle or sprain of the AC joint

Front 10

Fullness of the anterior shoulder with a large dimple in posterior shoulder may indicate ________.

Back 10

Anterior dislocation

Front 11

Atrophy of large shoulder muscles like deltoid or pactoralis major may indicate _________.

Back 11

Immobilization or lack of use of joint

Front 12

Atrophy of smaller shoulder muscles like supraspinatous or infraspinatous may indicate ________.

Back 12

Torn rotator cuff or nerve impingement

Front 13

Which muscle is being tested:
Externally rotate with elbows at side

Back 13

Infraspinatous
Teres minor

Front 14

Which muscle is being tested:
Internally rotate with elbows at side

Back 14

Subscapularis

Front 15

Which muscle is being tested:
Empty can test

Back 15

Supraspinatous

Front 16

Where is the damage:
Unilateral scapular winging

Back 16

Long Thoracic Nerve

Front 17

Where is the damage:
Bilateral scapular winging

Back 17

Weakness in scapular stabilizers

Front 18

What is the Apley scratch test? What does it assess?

Back 18

Place hand over shoulder behind back and reach for opposite shoulder blade

If pain/decreased ROM-->rotator cuff tendonitis

If unable to raise arm above head: rotator cuff tear
If significant pain/decreased ROM-->impingement/bursitis

Front 19

What is a sulcus sigan and what does it indicate?

Back 19

With pt seated, apply downward traction on arm as it hangs by side; look for indentation to appear just below acromion process.

If present, there's inferior glenohumeral instability.

Front 20

A positive Apley's scratch test indicates _______.

Back 20

Rotator cuff tendonitis--possible to have preserved ROM and minimal pain with this diagnosis

Front 21

How does a rotator cuff tear differ from tendonitis in presentation?

Back 21

Partial/limited rotator cuff tear: Limited ROM with significant pain

Complete tear: Unable to raise arm above head; after a few weeks will result in muscle atrophy

Front 22

What tests rule out subacromial impingement or bursitis?

Back 22

Neer, Hawkins-Kennedy

Front 23

What tests/findings indicate shoulder instability?

Back 23

Positive sulcus sign
Positive anterior/posterior translation tests

Front 24

When is an x-ray indicated in rotator cuff injury?

Back 24

In acute setting, when fracture and/or dislocation are suspected

In chronic setting, when there's red glag for infection/tumor.

Front 25

What imaging modality is most commonly used for assessment of rotator cuff injury?

Back 25

MRI--note no imaging studies recommended in initial evaluation of rotator cuff pathology

Front 26

When is CT scan indicated in assessment of rotator cuff injury?

Back 26

In setting of complicated fracture, suspected tumor, or in situations where MRI is contraindicated

Front 27

Management of rotator cuff tendonitis and instability.

Back 27

Relative rest to limit further damage

Physical Therapy to improve ROM, increase muscle strength of shoulder stabilizers

Topical NSAIDs

Subacromial joint injection after trying above treatments first (usually involves mixture of local anesthetic and corticosteroid)

Front 28

How does fatigue differ from sleepiness?

Back 28

Fatigue: feeling of exhaustion or tiredness that is pervasive, NOT relieved by rest, and often worsened by exertion

Sleepiness: Feeling of tiredness that gives a pt tendency to fall asleep, often relieved by either rest or exertion

Front 29

What are causes of primary fatigue?

Back 29

Chronic fatigue syndrome
Fibromyalgia

Front 30

Secondary vs Physiologic causes of fatigue.

Back 30

Secondary: side f/x of meds, DM, hypo/hyperthy, anemia, acute infection, CV disease, malignancy, chronic conditions such as RA, malignancy, pregnancy, electrolyte imbalances

Physiologic causes:
Acute decrease in sleep
Alternating shift work
Inadequate or poor quality of sleep due to primary sleep disorder (restless leg syndrome, sleep apnea), lifestyle issues (inc'd physical exertion), medical causes (sleep interrupted by nocturia/pain)

Front 31

What are the USPSTF A, B, C, D, I recommendations?

Back 31

A: Preventive intervention strongly recommended
B: Recommended
C: Balance of benefits and harms too close to make recommendation
D: Recommends against use of intervention
I: Evidence insufficient for recommending for or against intervention

Front 32

What are the USPSTF recommendations for breast cancer screening?

Back 32

Mammogram with or without clinical breast exam every 2 years for women 50+ (Grade B recommendation)

Refer women with strong family history for BRCA genetic counseling

Front 33

What are the USPSTF recommendation for cervical cancer screening?

Back 33

Screen women who have been sexually active and have a cervix (Grade A)

Front 34

What are the USPSTF recommendations for colorectal cancer screening?

Back 34

Fecal occult testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 and continuing until age 75 (Grade A)

If life expectancy under 10 years, unlikely benefit to screening

Front 35

What are the USPSTF recommendations for PSA screening? Category?

Back 35

PSA testing NOT recommended for prostate cancer. PSA screening has minimal or no survival advantage.

Grade I recommendation

Front 36

Which cancer screenings have a Category D recommendation?

Back 36

Pancreatic cancer screening
Testicular cancer screening

Front 37

What are the USPSTF recommendations for total body skin exam?

Back 37

Category I

Front 38

What are the patient barriers to screening?

Back 38

Lack of awareness
Denial of vulnerability
Lack of insurance
Not having received a screening recommendation
Fear of pain with a procedure
Fear of finding bad results

Front 39

What is the second most common cause of cancer-related death in the US?

Back 39

Colorectal cancer

Front 40

What diseases increase risk for colorectal cancer?

Back 40

Personal h/o ovarian, endometrial, breast cancer

Personal h/o long-standing ulcerative colitis or Crohn's colitis

h/o DM

Front 41

What is the SPIKES strategy for delivering bad news?

Back 41

Set up interview (private room, sit face to face with patient)
Perception (before you tell, ask what pts knows)
Invitation (ask how pt would like to explain information about diagnosis)
Knowledge (give knowledge and information)
Emotions/Empathy (identify emotion patient is feeling and identify reason for it)
Strategy/Summary: lay out plan for what will happen next

Front 42

What is chronic fatigue syndrome?
Criteria for diagnosis?

Back 42

Syndrome that causes disabling levels of fatigue lasting more than 6 months

Fatigue is characterized as being unrelieved by rest and worsened with exertion

6+ months disabling fatigue not explained by any other medical cause

Plus 4 of these: impaired memory/concentration, post-exertional malaise, tender LAD, sore throat, HA, myalgias, arthralgias

Note that this is a diagnosis of exclusion.

Front 43

What lab tests should be ordered to evaluate fatigue?

Back 43

CBC
Iron studies if blood loss suspected
ESR fi signs of CT disease or chronic infection
Glucose
TSH


DO NOT ORDER EBV TITER

Front 44

Medical management of iron deficiency anemia in adult male.

Back 44

Ferrous sulfate 325 mg TID
Docusate sodium 100 mg bid PRN constipation
Colonoscopy if concerned for GI cause

Front 45

Who should be screened for rubella susceptibility?

Back 45

All females of childbearing age

Front 46

Who should be screened for gonorrhea/chlamydia?

Back 46

Women under 25 and others at inc'd risk

Front 47

What are the symptoms and diagnostic tests for chlamydia?

Back 47

Dysuria
Penile/vaginal discharge
Dyspareunia
Abdominal or testicular pain
Breakthrough bleeding
May be asymptomatic

Dx: Nucleic acid amplification of urine, endocervical sample, or urethral sample

SAME GOES FOR GONORRHEA

Front 48

What are the symptoms and diagnostic tests for trichomonas?

Back 48

Vaginal discharge with odor or itching

May be asyx

Dx via saline wet mount, rapid antigen testing, trichomonas culture

Front 49

What are the three main types of testicular tumors? Which is the most common?

Back 49

Germ cell tumor (95% of primary testicular tumors; classified as either seminoma, (45%) or nonseminoma (50%))

Non-germ cell (Leydig cell, Sertoli cell tumors)

Extragonadal (lymphoma, leukemia, and melanoma are most common malignancies that mets to testicle)

Front 50

What are the risk factors for testicular cancer?

Back 50

KLINEFELTER'S (47XXY) have higher incidence of testicular cancer; as do those with Down syndrome, testic feminization, true hermaphrodites

FMH
Cryptorchidism
Exposure to DES, agent orange, solvents used to clean jets

h/o prior testicular cancer

Front 51

What interview topics should be addressed in an adolescent interview?

Back 51

HEEADSS
Home
Education/Employment
Eating
Activities
Drugs
Sexuality
Suicide/Depression
Safety/Violence

Front 52

What is testicular lie?
What is a normal lie?

Back 52

Position of testicle within scrotum (high vs low)--left testicle normally sits slightly lower than right

Front 53

What is the cremasteric reflex?
What is its diagnostic utility?

Back 53

Light stroking of superior medial thigh results in brisk ipsilateral testicular retraction

Should be attempted after inspection and before palpation

If reflex is present, may r/o torsion (reflex is usually absent with torsion)

Front 54

What is the blue dot sign?
What is its diagnostic utility?

Back 54

Small bluish discolorartion visualized through skin of upper pole of testis--pathognomonic for appendiceal torsion

Front 55

What is Prehn's sign?
What is its diagnostic utility?

Back 55

Physical lifting of testicles relieves pain of epididymitis but not that caused by testicular torsion?

Front 56

What are the signs and symptoms of acute epididymitis?

Back 56

Relatively rare, but can cause serious illness

Severe swelling, exquisite pain in involved side (isolated to edpidymis)
Often accompanied by high fever, rigors, irritative voiding symptoms

Front 57

What are the signs and symptoms of a hydrocele?

Back 57

Painless scrotal fluid collection; may complain of slowly growing mass that causes pulling or dragging sensation

Generally asyx unless a/w infection/trauma

Front 58

What are the signs and symptoms of a varicocele?

Back 58

Collection of dilated and tortuous veins in plexus surrounding spermatic cord

Most commonly on left side (85-95%)

Front 59

This hernia develops as a result of persistent process vaginalis.

Back 59

Indirect hernia

Front 60

This hernia develops as a result of weakness in the transversalis fascia.

Back 60

Direct hernia

Front 61

Color Doppler Ultransonography vs Radionuclide Scintigraphy:
What can these both assess?
Difference?

Back 61

Color Doppler U/S:
If torsion present, intratestic blood flow is decd or absent
Faster, more readily available

Radionuclide scintigraphy:
If torsion present, dec'd radiotracer in ischemic testis
100% sensitivity, may help prevent unnecessary surgery when color Doppler u/s shows equivocal flow

Front 62

Medical management of testicular torsion.

Back 62

Immediate surgery within 6 hours after onset of pain

Delay can lead to loss of testis, which may lead to impaired fertility

Viability of testis is 90% at 6 hours
50% at >12 hours
10% at >24 hours