Clinical Medicine Flashcards
Deleted old SU questions. Added some pictures and more CM questions from slides (32 cards)
On neck inspection, where do you most commonly see a thyroglossal duct cyst?
Midline, above 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)
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)
Concerning findings: new nipple retraction, unilateral discharge
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)
What anatomical landmark lies just superior to the thyroid isthmus?
Hyoid Bone
Thyroid Cartilage (most prominent)
Cricoid Cartilage
Thyroid Isthmus
In Cushing’s syndrome, 24h free cortisol will be ___ times the normal amount
In Cushing’s syndrome, 24h free cortisol will be 3 times the normal amount
List 3 things that can cause decreased cortisol binding globulin
What is the effect on free cortisol?
- Genetic deficiency
- Nephrotic syndrome
- Androgens
- > increased free cortisol
- In these cases, measure total cortisol instead*
List 2 things that can cause increased cortisol binding globulin
What is the effect on free cortisol?
- OCPs (estrogen)
- Increases CBG production
- Hyperthyroid
What findings on a breast exam would be concerning for Paget’s disease of the breast?
Rash and ulceration of the nipple
Malignant
Note: Paget’s disease of the breast is not related to Paget’s disease of the bone ¯_(ツ)_/¯
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.
List 4 findings from the visual breast exam that would be concerning for malignancy
- Abnormal contours (lumps)
- Nipple retratction
- Dimpling
- Orange peel skin (Peu d’orange)→ inflammatory carcinoma
A - Urine or saliva
Describe the low dose dexamethasone suppression test
- Give 1mg dexamethasone at 12am
- Measure serum cortisol at 8am
- Should be LOW in normal states
- Cortisol at 8am will be elevated in Cushing’s
A 58 year old patient presents with itching, burning, and a scaly rash on the nipple.
What is the most likely diagnosis?
Paget’s disease of the breast
What is the circled structure?
Esophagus
A 27 year old women presents with a 1cmx1cm mass in the right breast. The mass is mobile, rubbery, and nontender with no overlying skin changes
What is the most likely diagnosis?
Fibroadenoma
What are the 4 positions for inspection during a breast exam
- Arms at sides
- Arms over head
- Hands on hips
- Leaning forward
Different positions to show possible dimpling/different countours. Hands on hips activates pectoralis muscle.
When should you do a breast exam?
When the chief complaint is related to the breast! Breast exams ARE NOT recommended for screening.
- breast pain
- mass
- nipple discharge
Where should you examine the lymph nodes during a breast exam?
- Axillary
- Supraclavicular
- Infraclavicular
