Clinical Medicine Flashcards
What is the single item question to screen for alcohol use disorder?
How many times in the past year have you had X or more drinks in a day?
X = 5 for men
X = 4 for women
On neck inspection, where do you most commonly see a thyroglossal duct cyst?
Midline, at the level of the thyroid gland
Usually assoicated with the hyoid bone too (moves with tongue extension)
Do thyroidal neck masses usually move with swallowing?
Yes
(fixed masses are likely not thyroid)
Describe the presenting characteristics of a breast fibroadenoma (5)
- Firm
- Round
- Mobile
- Nontender
- Age <35 years old
Fibroadenoma = benign
List 3 non-endocrine signs of a thyroid mass
Dysphonia, dysphagia, dyspnea
(Usually develop in this order)
The DSM-5 defines substance use disorder as the presene of at least ___/11 criteria
The DSM-5 defines substance use disorder as the presene of at least 2 /11 criteria
Impaired control:
(1) taking more or for longer than intended
(2) unsuccessful efforts to stop or cut down use
(3) spending a great deal of time obtaining, using, or recovering from use
(4) craving for substance
Social impairment:
(5) failure to fulfill major obligations due to use
(6) continued use despite problems caused or exacerbated by use
(7) important activities given up or reduced because of substance use
Risky use:
(8) recurrent use in hazardous situations
(9) continued use despite physical or psychological problems caused or exacerbated by substance use
Pharmacologic dependence:
(10) tolerance to effects of the substance
(11) withdrawal symptoms when not using or using less
List 3 possible causes of bloody nipple discharge
What other nipple findings would make you concerned for a malignant etiology?
- Nipple trauma
- Intraductal papilloma (benign)
- Carcinoma (malignant)
- Nipple retraction
List 3 possible causes of breast erythema and warmth
- Inflammatory breast cancer*
- Abscess
- Mastitis
*malignant
What is Modigliani syndrome?
Patients who have pronounced neck lordosis may look like they have a goiter
What is the single best time of day to measure cortisol in a case of cortisol excess?
12 am (midnight)
(8am in cortisol deficiency)
What is the single best time of day to measure cortisol in a case of cortisol deficiency?
8 am
(12am for cortisol excess)
How is Brief Intervention (BI) different from other substance abuse therapies?
Based on a harm reduction paradigm
- Emphasizes reduction in use rather than abstinence-only
- Goal is to reduce the risk of negative consequenes of drug use
State recommendation clearly, but work with pt to establish goals rather than telling them what to do
The 11 criteria for substance use disorder are clustered into 4 groups
What are the groups?
- Impaired control
- Social impairment
- Risky use
- Pharmacologic dependence
2/11 criteria required for diagnosis of substance use disorder
Impaired control:
(1) taking more or for longer than intended
(2) unsuccessful efforts to stop or cut down use
(3) spending a great deal of time obtaining, using, or recovering from use
(4) craving for substance
Social impairment:
(5) failure to fulfill major obligations due to use
(6) continued use despite problems caused or exacerbated by use
(7) important activities given up or reduced because of substance use
Risky use:
(8) recurrent use in hazardous situations
(9) continued use despite physical or psychological problems caused or exacerbated by substance use
Pharmacologic dependence:
(10) tolerance to effects of the substance
(11) withdrawal symptoms when not using or using less
What anatomical landmark lies just superior to the thyroid isthmus?
Cricoid cartilage
What are the CAGE questions to screen for an alcohol use disorder?
- Have you ever felt the need to Cut down on drinking?
- Have you ever been Annoyed by criticism of drinking?
- Have you ever had Guilty feelings about drinking?
- Have you ever taken a morning Eye opener?
Response of ≥ 2 is considered a positive screen
Which nerve is most likely to be injured during thyroid surgery?
Left recurrent laryngeal nerve
Supplies all intrinsic muscles of the larynx except the cricothyroid m.
A - Urine or saliva
What is the circled structure?
Esophagus
