CMC 3 Final Flashcards
What two notable hormones have a stimulatory effect on prolactin secretion?
TRH
Estrogen
What effect does dopamine have on prolactin? What are some neurogenic mechanisms that inhibit dopamine secretion?
What are 3 notable physiologic causes of hyperprolactinemia?
How can primary hypothyroidism lead to hyperprolactinemia?
Loss of the ability to produce thyroid hormone in the thyroid gland will serve as negative feedback to the hypothalamus to secrete more TRH, which will elevate levels of TSH and prolactin
What are 3 notable history findings and 4 physical exam findings in cholecystitis?
Hx
-Fever
-Pain worsening after eating/drinking (esp. fatty foods)
- Biliary colic, which can be epigastric/RUQ and radiate to the shoulder
PE
-Fever
-Tachycardia
-RUQ tenderness
-Murphy’s sign
When are attacks of biliary colic most common?
At night, possibly because the horizontal position of the gallbladder may allow for gallstones to enter the cystic duct
What are 3 notable history findings and 3 physical exam findings in choledocholithiasis?
Hx
-Pain worsens after eating/drinking
-Biliary colic, which can be epigastric/RUQ and radiate to the shoulder
-Jaundice
PE
-Jaundice
-RUQ/epigastric tenderness
-Palpable gallbladder (Courvoisier’s sign)
What are 3 notable history findings and 4 physical exam findings in cholangitis?
Hx
-Fever
-Jaundice
-Confusion
PE
-Fever
-Tachycardia
-Jaundice
-Rebound tenderness epigastric/RUQ
What are 5 notable history findings, 4 physical exam findings, and a lab result that would indicate pancreatitis?
Hx
-Pain worsens after eating/drinking (esp. fatty food)
-Pain radiates to chest or mid back
-Clay-colored stools
-Regular alcohol use
-Azathioprine, sulfonamides or valproic acid use
PE
-Jaundice
-Cullen sign (ecchymosis & edema around umbilicus)
-Grey Turner sign (ecchymosis of flank)
-Epigastric/LUQ tenderness
Labs
-Elevation of serum lipase or amylase (often 3x limit of normal)
What are 3 notable history findings and 5 PE signs of appendicitis?
Hx
-Migration of pain from periumbilical to RLQ
-Fever
-Anorexia, N/V
PE
-Fever/tachycardia
-McBurney’s point tenderness
-Rosving’s sign
-Rebound tenderness RLQ
-Psoas sign
What are 3 notable history findings in Peptic ulcer disease?
Hx
-Pain worsens after drinking/eating
-N/V
-NSAID use
*No focal PE findings
What are 5 notable history findings and 3 PE findings indicative of ectopic pregnancy?
Hx
-Reproductive age
-Fever
-Vaginal bleeding
-Amenorrhea preceding vaginal bleeding
-Sexually active
PE
-Vaginal bleeding
-Cervical motion tenderness
-Adnexal mass/tenderness
What are 4 notable history findings and 1 PE finding associated with renal colic due to nephrolithiasis?
Hx
-Renal colic peaks in early and late morning
-Dysuria
-Abnormal urinary frequency
-Triamterene & acetazolamine use
PE
-CVA tenderness
What are 5 notable history findings and 3 notable PE findings in small bowel obstruction?
Hx
-Colic
-Pain which decreases after vomiting
-Constipation
-Hx of abdominal surgery
Melena or hematemesis
PE
-Visisble peristalsis
-Hyperactive or absent bowel sounds
-Abdominal distension
What are 4 notable history findings and 3 PE findings in diverticulitis?
Hx
-Fever
-Constipation
-Diarrhea
-Dysuria
PE
-Fever/tachycardia
-LLQ tenderness
-Rebound tenderness (if perforated bowel)
Which disease is associated with “bronze diabetics”?
Hemochromatosis
Which disease is associated with Kayser-Flescher rings (golden-brown copper pigment in periphery of cornea), as well as ataxia and dysarthria?
Wilson’s disease
What are 5 notable history findings and 2 PE findings indicative of primary biliary cholangitis?
Hx
-Light stool color
-Steatorrhea
-History of autoimmune disease (CREST syndrome)
-90-95% female presentation
-Patient in 40’s-50’s
PE
-Xanthelasma
-Tendon xanthomata (check forearm extensors)
What are 5 notable history findings and 3 PE findings indicative of primary sclerosing cholangitis?
Hx
-More common in men (1.7:1 ratio)
-Light stool color
-Steatorrhea
-Hx of IBD
-Hx of bile duct cancer
PE
-Xanthelasma
-Tendon xanthomata
What are 3 notable history findings and 1 PE finding in patients with Non-alcoholic fatty liver disease (NASH/MASLD)?
Hx
-40’s or 50’s at time of dx
-Hx of obesity
-Hx of T2DM
PE
-Hepatomegaly, nodular edge if cirrhotic liver
What are notable Hx and PE findings for chronic alcohol use?
Hx
- >2 drinks a day for women
- >3 drinks a day for men
PE
-Parotid palpation for enlargement
Which forms of hepatitis are associated with:
-Ingestion of shellfish
-Travel to developing world
-Exposure to peopke with jaundice/day care centers
Hepatitis A
Which forms of hepatitis are associated with tattoos or body piercings?
Hepatitis B or C
Which types of hepatitis are associated with cramped living quarters?
Hepatitis A or E
Which types of hepatitis are associated with sexual exposures?
Hepatitis B or C
What is the indication and focused question for a renal ultrasound?
I- flank pain, unilateral ab pain, hematuria
FQ- Is there hydronephrosis?
What are the indications and focused question for a gallbladder ultrasound?
I- RUQ pain, right scapula pain (referred)
FQ- Is there cholelithiasis? Cholecystitis?
What are the indications and focused questions for an ultrasound in a suspected small bowel obstruction?
I- ab pain, distension, persistent vomiting
FQ- Is there bowel dilation? Signs of ischemia?
Whare are the indications and focused questions for an ultrasound for free abdominal fluid?
I- trauma, ab swelling, hypotension w/ ectopic pregnancy
FQ- Is there free fluid (ascites, blood)? Big enough pocket for paracentesis?
What should be done in cases of any kind of pathology (trauma, pregnancy) where there is free abominal fluid and hypotension?
Direct to OR
Where does an S3 heart sound occur if at all? What is the pathology? What may it indicate?
- It occurs just after S2 (AKA “ventricular gallop”)
-It is the sound of blood striking an overly compliant LV during beginning of diastole
-It is often a sign of systolic HF, but can be a normal finding in many situations
Where does an S4 heart sound occur if at all? What is the pathology? What may it indicate?
-It occurs just before S (AKA “atrial gallop”)
-It is produced by blood striking a noncompliant LV wall during atrial contraction at end of diastole
-It is often a sign of diastolic heart failure (unlike an S3 this is RARELY a normal finding)
An inspiratory wheeze (AKA stridor) would give what information about the location of respiratory distress?
EXtrathoracic
Upper airway obstruction (tracheal stenosis, foreign body or croup)
An expiratory wheeze would give what information about the location of respiratory distress?
INtrathoracic
Asthma, COPD ,etc
What are two notable physical exam signs in context of stridor, fever and dyspnea w/ cough that would denote potential impending respiratory collapse?
Intercostal retractions and lethargy
