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1
Q

Diabetes labs

A

Hba1c > 6.5%
Fasting glucose 126
2 hour glucose 200
Random glucose 200

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2
Q

Type 2 D.M.

A

Post puberty presentation
⬇️insulin sensitivity
acanthosis nigricans
Obesity

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3
Q

Type 1 D.M.

A

“Immune mediated B cell destruction”
presents childhood
Permanent insulin dependence
Diabetic ketoacidosis

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4
Q

Diabetic ketoacidosis DKA

A

glucose > 200
Metabolic acidosis (pH< 7.3, HCO3 <15)
Ketosis (ketones in blood)

Kussmaul (deep) inspirations using accessory muscles

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5
Q

Metabolic syndrome

A 
3 of the following:
1 abdominal obesity 40 35
2 BP > 130/85
3 fasting glucose > 100
4 HDL < 40 50
5 LDL > 150
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6
Q

Associated with metabolic syndrome

A

Obstructive sleep apnea
Polycystic ovarian syndrome
Non alcoholic fatty liver disease
Hyperuciemia

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7
Q

Dynamic testing

A

Suppression tests asses endocrine hyperfunction

Stimulation tests asses endocrine hypofunction

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8
Q

Hyperthyroidism

A

Exophthalmos 👀👀👀
Cause: Graves
Hashimoto initially

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9
Q

Hypothyroidism

A

Cold intolerance 🥶🥶🥶

Cause: Hashimoto
Iodine deficiency

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10
Q

Primary hyperparathyroidism

A

Bones stones abdominal moans and psychic groans

Cause: MEN - multiple endo neoplasia
Renal failure

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11
Q

Hypoparathyroidism

A 
Neuropsych - seizures anxiety depression 
Neuromuscular - paresthesia
CV - hypotension
Autonomic - biliary colic
Other - cataract

Causes: DiGeorge

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12
Q

Cushings disease

A

Cushing’s syndrome 2ry to hyper ACTH secretion

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13
Q

Cushing’s syndrome

A

Presentation 🐂👹 Buffalo hump
Pink abdominal Striae
Hirsutism

Cause: overproduction of cortisol or ingestion of exogenous corticosteroids

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14
Q

Pseudo cushing’s

A

Cause: chronic alcoholism

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15
Q

Addison’s disease

A

1ry adrenal insufficiency

Presentation 🧂❤️🧡💛💜💙💚; hyperpigmentation
Salt craving
Hypotension

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16
Q

Hypopituitariasm

A

Cause: seller mass on pituitary
Result: vision loss

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17
Q

Vein puncture

A 
Tie tourniquet
Fist
Palpate
Clean &amp; air dry
Gloves
Re tie
Anchor vein
Insert needle
Release tourniquet once blood is flowing
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18
Q

Torus palatinus

A

Harmless bony growth in palate

No surgery indicated

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19
Q

Pharyngitis

A

Presentation: sort throat, headache and nausea (homunculum)

Cause: Viral or bacterial (GABHS)

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20
Q

GABHS “group A streptococcus”

A 
NO COUGH
Fever
Kids (3-14)
Tonsillitis exudate
Swollen nodes
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21
Q

Criteria for GABHS (5)

A

CENTOR score

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22
Q

Otitis externa

A

Presentation: drainage from ear
Pain upon palpating of external ear

Cause: bacteria entering a break in the skin of ear canal

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23
Q

Otosclerosis

A

Cause: Abnormal growth around stapes

Result: progressive hearing loss

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24
Q

Types of otosclerosis

A

1 conductive - ossicle sclerosis into a single immovable mass

2 sensorineural - otic capsule sclerosis

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25
Conductive hearing loss causes
Cerulean impaction Middle ear fluid (should be air) Fixation of ossicles Obstruction, ie tumor
26
Sensorineural hearing loss causes (inner ear)
Meniere MS Ototoxic drugs Hereditary
27
Bacterial sinusitis
“Double sickening”: get better then get even worse
28
Laryngotracheitis (croup)
Presentation: fever barking cough Inhalation stridor CT: steeple sign
29
Epiglottitis
Presentation: bare fever Tripodding Lateral CT: large epiglottis
30
Murmur grading system
1 barely audible 2 soft but easily heard 3 loud 4 loud + thrill 5 loud + thrill (heard with minimal contact to chest) 6 loud + thrill (heard without stethoscope)
31
S3
Abrupt deceleration of blood flow across mitral valve
32
S4
Increased LV end diastolic stiffness which decreases compliance
33
Parietal abdominal pain
Via somatic pain fibers 2ry to parietal peritoneal-itis LOCALIZED aggravated by Moving, alleviated by remaining still
34
Visceral abdominal pain
Visceral pain fibers 2ry to distention, stretching/contraction and ischemia NOT LOCALIZED
35
Referred abdominal pain
Originates in gut but felt somewhere else
36
Abdominal exam order
Inspect Auscultation Percuss Palpate
37
RLQ organs
Appendix | Ovary
38
LLQ organs
Colon
39
Bowel sounds
Normal 5-34/min Absent = none for 2 min Long lasting intestinal obstruction or perforation, ischemic mesentery Decreased = none for 1 min Increased: diarrhea
40
Tests for Ascites (⬆️ peritoneal fluid)
1 shifting dullness test Supine: percuss borders of tympani and dullness Lateral recumbent: ➕ dullness shifts to inferior side, tympani on superior side 2 test for fluid wave Supine Pt rests hands on chest
41
Special tests for appendicitis
1 McBurneys tender point 2 Rovsings: LLQ ➡️ RLQ 3 Psoas: pt raise R thigh against resistance Or L lateral recumbent extend R hip 4 obturator sign: R flex hip & knee and IR
42
Special test for biliary colic (gallbladder)
1 murphys: palpated deeply under right costal margin Deep breath Palpate deeper ➕ pain and sudden stop in inspiratory effort
43
Special test for kidney inflammation/distention
Lloyd’s punch at costovertebral angle
44
Signs of parietal inflammation “acute abdomen”
1 guarding: voluntary (pt consciously protect abdomen against palpation); involuntary (unconscious tightening of abdominal wall musculature upon palpation) 2 rigidity: pretty much involuntary guarding 3 rebound tenderness: push deep then let go ➕ pain upon rebound, not pushing deep
45
Constipation criteria
``` 1 Rome: at least 2 of the following <3 shits a day Straining Lumpy/hard stool Sensation of incomplete defecation Manuel maneuvering required to shit ``` 2 Bristol: 1 & 2 is constipation
46
Gastroenteritis “stomach flu”
Diarrhea | Vomiting
47
Viral gastroenteritis (70%)
🤮🤮🤮Noravirus 🛳💸 12-48 uncontrollable vomiting Recovery 36 past onset Rotavirus You will get this by 5 if unvaccinated
48
Bacterial gastroenteritis
1 salmonella - onset 12-36 2 C. difficile 🏥🏥🏥- Antibiotic exposure 3 E. coli - onset <5 days, lasts 2 weeks 🌋🏃🏽‍♂️🏝🚶🏽‍♂️⛰ travelers diarrhea
49
Parasitic gastroenteritis
Giardia Fatty floating stool
50
Irritable bowel syndrome is NOT a disease
Altering constipation☁️ diarrhea 🌧 Abdominal pain Abdominal distention Laxatives don’t help😔
51
Osteopathic constipation
Mesenteric RELEASE
52
Osteopathic diarrhea
ganglion INHIBITION
53
Gonadarche
Activation of gonads by FSH & LH from ant pit
54
Obstetrical history
Grava(#)Para(👶🏼) I.e. G3P3, 3 pregnancies total 3 live births G3P(TPAL) Term, Premie (>20), Abortion (<20), Live I.e. G4P2112 (4 total pregnancies, 1 abortion at 14 weeks, 1 fatal demise at 28 weeks)
55
Pap smear
Women 21 to 65 Every year: if abnormal Pap smear Every 3 years: if consecutive normal Pap smears Every 5 years: if consecutively normal Pap smears &; ➖ HPV
56
Mammogram
<50 or earlier if high risk
57
Cervical cancer
99% due to high risk HPV strains Monitor via Pap smear
58
What does Pap smear collect
Ectocervix Endocervix Transitional zone SCJ squamocolumnar junction
59
No further Pap smear needed if...
Hysterectomy for non cancerous reasons If hysterecotomy for cervical cancer, then continue surveillance for residual cells
60
Pelvic exam vs Pap smear
Internal and external genitalia vs ONLY cervix Pelvic exam - visual and bimanual
61
Ectopic pregnancy
Dull, Pelvic pain BloodY discharge Pregnancy: Vomiting, tender tiddies DO A PREGNANCY TEST
62
UTI
Dysuria Cause: E. coli Diagnosis: Lloyd’s punch
63
The 5 Ps
``` Partners Practices Prevention of pregnancy Prevention of STIs Past history of STIs ```
64
Gonorrhea
Bacterial Presentation: discharge, pelvic pain and dysuria
65
Chlamydia
Bacterial Presentation: pain during sex, discharge, bleeding, dysuria
66
Syphilis
Bacterial 1 chancre 2 joint pain Latent 3 neurosyphilis
67
Genital herpes
Viral Burning followed by vesical appearance
68
Trichomonasia
Protozoa foul smelling vaginal discharge
69
HPV
Genital warts
70
Split s2
1 wide physiologic 2 fixed 3 reverse/paradoxical
71
Early ejection
Systolic sound right after #1 Cause: pathological halting of aortic and pulmonic calves as they open Intensity decreases w inspiration
72
Systolic clicks
Systolic sound midway between s1 and s2 Cause: mitral valve prolapse Squatting delays sound Standing make sound earlier
73
Opening snap
Diastolic right after s2 Cause: mitral valve stenosis; abrupt deceleration of blood flow into ventricles
74
S3
Diastolic halfway between s2 and s1 Pathologically “ventricular gallop” Cause: ⬆️ LV filling pressure and abrupt deceleration of inflow from mitral
75
S4
“Atrial gallop” Cause: ventricular hypertrophy
76
Chronic bronchitis
Daily productive cough for 3 months for 2 consecutive years
77
Percussing over lungs should be
Resonant
78
Percussing over abdomen should be
Tympanic over intestines | Dull over organs
79
Pneumothorax percussion is
Hyper resonant
80
Effusion and emphysema percussion is
Dull
81
Jugular A wave
Atria contracting
82
Jugular V wave
Atria are filling
83
Decompression thoracentesis
2nd intercostal space just superior to 3rd rib margin at midclavicular line I.e. pneumothorax
84
Chest tube
4th intercostal space just superior to 5th rib margin at mid or anterior axillary line line
85
Splenomegaly
Dullness at mid axillary line
86
Cervical transformation zone
Between old and new SCJ Most common site for precancerous growth

PCM II MIDTERM (1 decks)

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