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PCM II MIDTERM > ALL > Flashcards

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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
Q

Conductive hearing loss causes

A

Cerulean impaction
Middle ear fluid (should be air)
Fixation of ossicles
Obstruction, ie tumor

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26
Q

Sensorineural hearing loss causes (inner ear)

A

Meniere
MS
Ototoxic drugs
Hereditary

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27
Q

Bacterial sinusitis

A

“Double sickening”: get better then get even worse

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28
Q

Laryngotracheitis (croup)

A

Presentation: fever
barking cough
Inhalation stridor

CT: steeple sign

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29
Q

Epiglottitis

A

Presentation: bare fever
Tripodding

Lateral CT: large epiglottis

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30
Q

Murmur grading system

A

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)

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31
Q

S3

A

Abrupt deceleration of blood flow across mitral valve

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32
Q

S4

A

Increased LV end diastolic stiffness which decreases compliance

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33
Q

Parietal abdominal pain

A

Via somatic pain fibers
2ry to parietal peritoneal-itis

LOCALIZED

aggravated by Moving, alleviated by remaining still

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34
Q

Visceral abdominal pain

A

Visceral pain fibers
2ry to distention, stretching/contraction and ischemia

NOT LOCALIZED

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35
Q

Referred abdominal pain

A

Originates in gut but felt somewhere else

36
Q

Abdominal exam order

A

Inspect
Auscultation
Percuss
Palpate

37
Q

RLQ organs

A

Appendix

Ovary

38
Q

LLQ organs

A

Colon

39
Q

Bowel sounds

A

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
Q

Tests for Ascites (⬆️ peritoneal fluid)

A

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
Q

Special tests for appendicitis

A

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
Q

Special test for biliary colic (gallbladder)

A

1 murphys: palpated deeply under right costal margin
Deep breath
Palpate deeper

➕ pain and sudden stop in inspiratory effort

43
Q

Special test for kidney inflammation/distention

A

Lloyd’s punch at costovertebral angle

44
Q

Signs of parietal inflammation “acute abdomen”

A

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
Q

Constipation criteria

A 
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
Q

Gastroenteritis “stomach flu”

A

Diarrhea

Vomiting

47
Q

Viral gastroenteritis (70%)

A

🤮🤮🤮Noravirus 🛳💸
12-48 uncontrollable vomiting
Recovery 36 past onset

Rotavirus
You will get this by 5 if unvaccinated

48
Q

Bacterial gastroenteritis

A

1 salmonella - onset 12-36

2 C. difficile 🏥🏥🏥- Antibiotic exposure

3 E. coli - onset <5 days, lasts 2 weeks
🌋🏃🏽‍♂️🏝🚶🏽‍♂️⛰ travelers diarrhea

49
Q

Parasitic gastroenteritis

A

Giardia

Fatty floating stool

50
Q

Irritable bowel syndrome is NOT a disease

A

Altering constipation☁️ diarrhea 🌧
Abdominal pain
Abdominal distention

Laxatives don’t help😔

51
Q

Osteopathic constipation

A

Mesenteric RELEASE

52
Q

Osteopathic diarrhea

A

ganglion INHIBITION

53
Q

Gonadarche

A

Activation of gonads by FSH & LH from ant pit

54
Q

Obstetrical history

A

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
Q

Pap smear

A

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
Q

Mammogram

A

<50 or earlier if high risk

57
Q

Cervical cancer

A

99% due to high risk HPV strains

Monitor via Pap smear

58
Q

What does Pap smear collect

A

Ectocervix
Endocervix
Transitional zone
SCJ squamocolumnar junction

59
Q

No further Pap smear needed if…

A

Hysterectomy for non cancerous reasons

If hysterecotomy for cervical cancer, then continue surveillance for residual cells

60
Q

Pelvic exam vs Pap smear

A

Internal and external genitalia vs ONLY cervix

Pelvic exam - visual and bimanual

61
Q

Ectopic pregnancy

A

Dull, Pelvic pain
BloodY discharge
Pregnancy: Vomiting, tender tiddies

DO A PREGNANCY TEST

62
Q

UTI

A

Dysuria

Cause: E. coli

Diagnosis: Lloyd’s punch

63
Q

The 5 Ps

A 
Partners
Practices
Prevention of pregnancy
Prevention of STIs
Past history of STIs
64
Q

Gonorrhea

A

Bacterial

Presentation: discharge, pelvic pain and dysuria

65
Q

Chlamydia

A

Bacterial

Presentation: pain during sex, discharge, bleeding, dysuria

66
Q

Syphilis

A

Bacterial

1 chancre
2 joint pain
Latent
3 neurosyphilis

67
Q

Genital herpes

A

Viral

Burning followed by vesical appearance

68
Q

Trichomonasia

A

Protozoa

foul smelling vaginal discharge

69
Q

HPV

A

Genital warts

70
Q

Split s2

A

1 wide physiologic
2 fixed
3 reverse/paradoxical

71
Q

Early ejection

A

Systolic sound right after #1

Cause: pathological halting of aortic and pulmonic calves as they open

Intensity decreases w inspiration

72
Q

Systolic clicks

A

Systolic sound midway between s1 and s2

Cause: mitral valve prolapse

Squatting delays sound
Standing make sound earlier

73
Q

Opening snap

A

Diastolic right after s2

Cause: mitral valve stenosis; abrupt deceleration of blood flow into ventricles

74
Q

S3

A

Diastolic halfway between s2 and s1

Pathologically “ventricular gallop”

Cause: ⬆️ LV filling pressure and abrupt deceleration of inflow from mitral

75
Q

S4

A

“Atrial gallop”

Cause: ventricular hypertrophy

76
Q

Chronic bronchitis

A

Daily productive cough for 3 months for 2 consecutive years

77
Q

Percussing over lungs should be

A

Resonant

78
Q

Percussing over abdomen should be

A

Tympanic over intestines

Dull over organs

79
Q

Pneumothorax percussion is

A

Hyper resonant

80
Q

Effusion and emphysema percussion is

A

Dull

81
Q

Jugular A wave

A

Atria contracting

82
Q

Jugular V wave

A

Atria are filling

83
Q

Decompression thoracentesis

A

2nd intercostal space just superior to 3rd rib margin at midclavicular line

I.e. pneumothorax

84
Q

Chest tube

A

4th intercostal space just superior to 5th rib margin at mid or anterior axillary line line

85
Q

Splenomegaly

A

Dullness at mid axillary line

86
Q

Cervical transformation zone

A

Between old and new SCJ

Most common site for precancerous growth

PCM II MIDTERM (1 decks)

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