CMC 3 Final

Question 1

What two notable hormones have a stimulatory effect on prolactin secretion?

Answer 1

TRH
Estrogen

Question 2

What effect does dopamine have on prolactin? What are some neurogenic mechanisms that inhibit dopamine secretion?

Answer 2

Question 3

What are 3 notable physiologic causes of hyperprolactinemia?

Answer 3

Question 4

How can primary hypothyroidism lead to hyperprolactinemia?

Answer 4

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

Question 5

What are 3 notable history findings and 4 physical exam findings in cholecystitis?

Answer 5

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

Question 6

When are attacks of biliary colic most common?

Answer 6

At night, possibly because the horizontal position of the gallbladder may allow for gallstones to enter the cystic duct

Question 7

What are 3 notable history findings and 3 physical exam findings in choledocholithiasis?

Answer 7

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)

Question 8

What are 3 notable history findings and 4 physical exam findings in cholangitis?

Answer 8

Hx
-Fever
-Jaundice
-Confusion

PE
-Fever
-Tachycardia
-Jaundice
-Rebound tenderness epigastric/RUQ

Question 9

What are 5 notable history findings, 4 physical exam findings, and a lab result that would indicate pancreatitis?

Answer 9

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)

Question 10

What are 3 notable history findings and 5 PE signs of appendicitis?

Answer 10

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

Question 11

What are 3 notable history findings in Peptic ulcer disease?

Answer 11

Hx
-Pain worsens after drinking/eating
-N/V
-NSAID use

*No focal PE findings

Question 12

What are 5 notable history findings and 3 PE findings indicative of ectopic pregnancy?

Answer 12

Hx
-Reproductive age
-Fever
-Vaginal bleeding
-Amenorrhea preceding vaginal bleeding
-Sexually active

PE
-Vaginal bleeding
-Cervical motion tenderness
-Adnexal mass/tenderness

Question 13

What are 4 notable history findings and 1 PE finding associated with renal colic due to nephrolithiasis?

Answer 13

Hx
-Renal colic peaks in early and late morning
-Dysuria
-Abnormal urinary frequency
-Triamterene & acetazolamine use

PE
-CVA tenderness

Question 14

What are 5 notable history findings and 3 notable PE findings in small bowel obstruction?

Answer 14

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

Question 15

What are 4 notable history findings and 3 PE findings in diverticulitis?

Answer 15

Hx
-Fever
-Constipation
-Diarrhea
-Dysuria

PE
-Fever/tachycardia
-LLQ tenderness
-Rebound tenderness (if perforated bowel)

Question 16

Which disease is associated with “bronze diabetics”?

Answer 16

Hemochromatosis

Question 17

Which disease is associated with Kayser-Flescher rings (golden-brown copper pigment in periphery of cornea), as well as ataxia and dysarthria?

Answer 17

Wilson’s disease

Question 18

What are 5 notable history findings and 2 PE findings indicative of primary biliary cholangitis?

Answer 18

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)

Question 19

What are 5 notable history findings and 3 PE findings indicative of primary sclerosing cholangitis?

Answer 19

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

Question 20

What are 3 notable history findings and 1 PE finding in patients with Non-alcoholic fatty liver disease (NASH/MASLD)?

Answer 20

Hx
-40’s or 50’s at time of dx
-Hx of obesity
-Hx of T2DM

PE
-Hepatomegaly, nodular edge if cirrhotic liver

Question 21

What are notable Hx and PE findings for chronic alcohol use?

Answer 21

Hx
- >2 drinks a day for women
- >3 drinks a day for men

PE
-Parotid palpation for enlargement

Question 22

Which forms of hepatitis are associated with:
-Ingestion of shellfish
-Travel to developing world
-Exposure to peopke with jaundice/day care centers

Answer 22

Hepatitis A

Question 23

Which forms of hepatitis are associated with tattoos or body piercings?

Answer 23

Hepatitis B or C

Question 24

Which types of hepatitis are associated with cramped living quarters?

Answer 24

Hepatitis A or E

Question 25

Which types of hepatitis are associated with sexual exposures?

Answer 25

Hepatitis B or C

Question 26

What is the indication and focused question for a renal ultrasound?

Answer 26

I- flank pain, unilateral ab pain, hematuria

FQ- Is there hydronephrosis?

Question 27

What are the indications and focused question for a gallbladder ultrasound?

Answer 27

I- RUQ pain, right scapula pain (referred)

FQ- Is there cholelithiasis? Cholecystitis?

Question 28

What are the indications and focused questions for an ultrasound in a suspected small bowel obstruction?

Answer 28

I- ab pain, distension, persistent vomiting

FQ- Is there bowel dilation? Signs of ischemia?

Question 29

Whare are the indications and focused questions for an ultrasound for free abdominal fluid?

Answer 29

I- trauma, ab swelling, hypotension w/ ectopic pregnancy

FQ- Is there free fluid (ascites, blood)? Big enough pocket for paracentesis?

Question 30

What should be done in cases of any kind of pathology (trauma, pregnancy) where there is free abominal fluid and hypotension?

Answer 30

Direct to OR

Question 31

Where does an S3 heart sound occur if at all? What is the pathology? What may it indicate?

Answer 31

• 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

Question 32

Where does an S4 heart sound occur if at all? What is the pathology? What may it indicate?

Answer 32

-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)

Question 33

An inspiratory wheeze (AKA stridor) would give what information about the location of respiratory distress?

Answer 33

EXtrathoracic

Upper airway obstruction (tracheal stenosis, foreign body or croup)

Question 34

An expiratory wheeze would give what information about the location of respiratory distress?

Answer 34

INtrathoracic

Asthma, COPD ,etc

Question 35

What are two notable physical exam signs in context of stridor, fever and dyspnea w/ cough that would denote potential impending respiratory collapse?

Answer 35

Intercostal retractions and lethargy