General Medical Surgical Conditions (GMSC)

Immune System
1. 2 Immune Structures
a. Central Immune Structures: bone marrow, thymus
b. Peripheral Immune Structures: spleen; lymph nodes
I. Endocrine Disorders
S/Sx: muscle weakness, atrophy, fatigue, tenosynovitis, CTS (Bilateral), RA
1. Anterior Pituitary Gland
a. Hyperpituitarism – 2° cancer
Gigantism Acromegaly
Definition ↑ production of GH at childhood ↑ production of GH at adulthood
Thickening of:
Clinical Nose, ears, vertebra, bosses of Forehead
9 feet tall
Manifestations Enlargement of:
hands & feet
Development Abruptly Slowly

b. Hypopituitarism – 2° genetics
Dwarfism Panhypopituitarism
Definition ↓ production of GH at childhood ↓ or absent of all anterior pituitary hormones
aka Pituitary Dwarfism
Gonadal Failure (impotence, infertility, ↓ sexual libido)
3 feet tall
Clinical Growth Hormone Insufficiency
Normal Mental Fxn
Manifestations Hypothyroidism (-) TSH (Lethargic)
No Skeletal deformities
Neurologic Sx (Headache, Blindness)
Development Abruptly Slowly

2. Posterior Pituitary Gland “Neurohypophysis” (ADH + Oxytocin)

a. Diabetes Insidious
i. ↓ production of ADH
ii. Clinical Manifestations
1. Polyuria
2. Polydipsia
3. Dehydrated
b. SIADH
i. Syndrome of Inappropriate Secretion of ADH
ii. Excessive production ADH
iii. Clinical Manifestations
1. Swelling on facial muscle tissue
2. Edema
3. Weight Gain easily
3. Thyroid Gland
a. Goiter
i. Enlargement of the thyroid gland where the iodine is deficient in the diet
1. Iodine: important substance to create the thyroid hormone
ii. ↑ TSH - ↑ thyroid mass
b. Thyroiditis
i. Inflammation of the thyroid gland
ii. 2° bacterial/viral Agent
iii. 3 Types
1. Acute Suppurative – pus formation
2. Subacute Granulomatous – cancer
3. Hashimoto’s Thyroiditis
a. F>M
b. 30 to 50 y/o
c. Autoimmune Disease

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 General Medical Surgical Conditions

d. MC Type
c. Hyperthyroidism
i. “Thyrotoxicosis”
ii. Graves’ Disease
iii. ↑ production of thyroid Hormone
iv. Clinical Manifestations
1. (+) Exophthalmos (eyeball pushed forward)
2. Ectomorph
3. Excessive Appetite
4. Diarrhea
5. Heat Intolerance
6. Palpitations
7. Shiny Hair
d. Hypothyroidism
i. Cretinism
1. ↓ production of Thyroid H. at birth
2. (+) MR
3. Congenital Hypothyroidism
ii. Myxedema
1. ↓ production of Thyroid H. at adult life
2. Clinical Manifestations
a. (+) Lethargic
b. Cold Intolerance
c. Constipation
d. Hallmark: Edema
4. Parathyroid Gland
a. Hyperparathyroidism
i. Excessive production of Parathormone
ii. Excessive Ca2+ in the blood (Hypercalcemia)
iii. Increasing the activity of the osteoclast cells
iv. Clinical Manifestations
1. Brittle Bones
2. Fractures
3. Osteoporosis
4. Proximal Muscle Weakness
b. Hypoparathyroidism
i. ↓ production of Parathormone
ii. ↓ Ca2+ in the blood (Hypocalcemia)
iii. Clinical Manifestations
1. Twitches
2. Tetany
3. Paresthesias
4. Numbness
5. (+) Trousseau Sign: carpopedal attitude of the hand (wrist flexion with flexion of the

fingers)
iv. PBEQ: Px has ↓ Ca2+ in the blood (Hypocalcemia) what do you see? A – (+) Trousseau Sign
5. Adrenal Gland
a. Addison’s Disease
i. ↓ production of Aldosterone
ii. ↓ production of Cortisol
iii. Clinical Manifestations
1. (+) Bronze Skin: sun tanned
2. ↓ CO

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3. Palpitations
4. Dehydrated
5. Cardiac Arrest
iv. Trivia: President John F. Kennedy had Addison’s Disease
b. Cushing Syndrome
i. ↑ production of cortisol
ii. Hyperfunction of Adrenal Cortex
iii. Clinical Manifestations
1. Moonface
2. Pendulum Abdomen
3. Buffalo Hump (MC Site: Nape)
4. Striae (Stretch Marks)
Cushing Disease: ↑ production of ACTH which overstimulates the Adrenal gland who then ↑ production
of cortisol
i. Clinical Manifestations (same as Cushing Syndrome)
c. Adrenogenital Syndrome
i. Excessive androgen in the females
ii. Clinical Manifestations
1. Broad Shoulders
2. Deep Voice
3. Enlargement of clitoris (resembles a male penis)
6. Pancreas
“GABIDS”: Glucagon Alpha Cell, Beta Cell Insulin, Delta Cell Somatostatin
a. Type I DM – Insulin Dependent DM
i. Autoimmune Disease (inhibits Beta Cell, no release of Insulin)
ii. (-) Insulin
𝑏𝑟𝑒𝑎𝑘𝑠 𝑑𝑜𝑤𝑛 𝑖𝑛𝑡𝑜 𝑙𝑒𝑎𝑑𝑠 𝑡𝑜
iii. New Source of ATP: Triglycerides →→→→→→→→
Ketone Acid →→→→
prone to atherosclerosis
iv. Ectomorph (d/t use of triglycerides)
v. “Ketone Prone DM”
b. Type II DM – Non-Insulin Dependent DM
i. ↓ production of insulin/↓ sensitivity of insulin receptors
ii. Obese
iii. Mx: diet/exercise
iv. “Ketone Resistant DM”
II. Gastrointestinal Disorders (GIT)
S/sx: Abdominal Pain, Visceral Pain, Dysphagia, Odynophagia, GI Bleeding, (L) Shoulder Referred Pain 2° GIT Disorder ->
Kehr’s Sign
**if the Lower Esophageal Sphincter (LES) is not relaxing: Achalasia
1. Diverticulosis
a. Benign condition where the muscosa of the colon balloons
i. Mucosa: lining
b. 2° weakness of lining of the colon
c. 65 y.o.
2. Diverticulitis
a. Infection + inflammation in the diverticula of the colon
b. Little grape like dots in colon: diverticuli
c. 2° bacterial/viral agent
d. S/Sx
i. ↑WBC
ii. High Grade Fever
iii. Nausea/Vomiting
iv. (L) Pelvic Pain
v. (L) Lower Abdominal Pain
vi. Light Colored Bloody Stool (Lower GIT)
3. Appendicitis

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a. Remember appendix connected to cecum

b. Inflammation of the vermiform of appendix
c. 2° obstruction
d. S/Sx
i. High Grade Fever
ii. Nausea/Vomiting
iii. Abdominal Pain
iv. (+) Blumberg Sign: rebound tenderness
v. (+) McBurney’s Point: location of pain (R) LQ
4. Irritable Bowel Syndrome
a. “Spastic Colon”
b. ↑ Motility of small & large intestine
c. Cause:
i. Emotional Stress
ii. Excessive intake of fatty foods
d. S/Sx:
i. Abdominal pain: relieved by defecation
5. Inflammatory Bowel Disease
a. Crohn Disease
i. Inflammation anywhere in GIT
ii. Infection usually attacks the distal/terminal portion of small intestine “Ileum”
b. Ulcerative Colitis
i. Inflammation + ulceration of the colon & rectum
1. Proctitis: inflammation of rectum
ii. S/Sx:
1. High grade fever, nausea/vomiting, diarrhea (20 stools/day)
iii. 2° to Cancer
6. Hepatitis
a. Inflammation of liver
b. MC Types (in the Board Exam)
i. Hepatitis A – HAV – mode of transmission: contaminated food & water
ii. Hepatitis B – HBV – Serum Hepatitis; mode of transmission: body & blood fluids
iii. Hepatitis C – HCV – Serum Hepatitis; mode of transmission: body & blood fluids; (+) Cirrhosis
c. Phases of Hepatitis
i. Pre-Icteric Phase – low grade fever, nausea/vomiting
ii. Icteric Phase – High grade fever, (+) jaundice
1. Hemoglobin will split at RBC Death into Heme (iron) and Globin (amino acid). Heme will
split from iron and become biliverdin which eventually changes into bilirubin and gets
absorbed by the liver.
2. In hepatitis, the liver cannot absorb bilirubin and causes (+) Jaundice
7. Cholelithiasis
a. Formation of Gallstones
b. (+) Pain (R) UQ
8. Biliary Colic
a. Gallstones get lodged in the neck of the gallbladder
9. Cholecystitis
a. Gallstones get lodged in the cystic duct
10. Cholangitis
a. If the gallstones get lodged further down the common bile duct
III. Cancer
 Rapid proliferation of anaplastic Cell
 Multiple risk factors
o Carcinogens
o Hereditary
o Low intake of Vit A,C,E

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 General Medical Surgical Conditions

o Chronic Stress
o Age -> 22 y/o
 Single Most important risk factor
 Early Warning signs
o Bleeding: cancer is well established in the body
 Most important early sign of cancer
 2° ulceration at the central part of the tumor
 Tumor: abnormal growth of new tissue that is non-functional & completes with vital blood
supply
o Lump: longer than 1 month, more than 1 location
 Red Flag Sign of Cancer
o Proximal Muscle Weakness
o ↓ DTR
C hange in Bowel/Bladder habits (pencil like stool)
A sore throat that does not heal in 6 weeks
U nsual bleeding/discharge
T hickening/lump in the body
I ndigestion/difficulty swallowing
O bvious change in the size of a mole (Normal <6mm)
N aging cough/hoarseness of voice

5 Classifications of Tissues
1. Epithelial Tissues
a. Covers the external body surface
b. Function: protection, excretion, absorption
c. Lines the internal spaces, ducts/glands
d. If (+) Tumor in Epithelial Tissues: Carcinoma
Tissue of Origin Benign Malignant
Squamous Cell Carcinoma (Top Layer of Epithelium)
Surface of Epithelium Papilloma Transitional Cell Carcinoma (Middle Layer of Epithelium)
Basal Cell Carcinoma (Bottom Layer of Epithelium)
Epithelial Lining of
Adenoma Adenocarcinoma
Duct/Gland
Pigmented Cells Nevus (Mole) Melanoma

2. Connective Tissue
a. Most Abundant Tissue
b. Fibrous & elastic tissue (bone, muscle, cartilage, fat, soft tissue)
c. If (+) tumor in Connective Tissue: sarcoma
Tissue of Origin Benign Malignant
Adipose Tissue Lipoma Liposarcoma
Osteosarcoma
M > F; 10 to 25 y/o
Cause: “Osteoblast Cells”
Bone Osteoma Affected
- Upper end of humerus
- Lower end of femur (Knee Joint)
- Upper end of tibia/fibula (Knee Joint)
Blood Vessel Hemangioma Hemaniosarcoma
Chondrosarcoma
M = F; 40 y/o
Cartilage Chondroma
Cause: “Cartilage Cells”
Most Malignant Tumor of Sternum & Scapula
Fibrous Tissue Fibroma Fibrosarcoma
Smooth Muscle Leiomyoma Leiomyosarcoma
Striated Muscle Rhabdomyoma Rhabdomyosarcoma
Special Bone Tumor Ewing Sarcoma

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Cause: defect in chromosome #22

B > F; 5 to 16 y.o.
(+) onion skin: overlapping of periosteum
(+) Intramedullary Tumor

3. Nerve Tissue
a. Brain, SC, Nerves
b. If (+) tumor in nerve tissue: named after the type of cells involved
c. Often Benign

Tissue of Origin Benign Malignant

Nerve Cells Neuroma
Glial Cells Gliosis Glioma
Nerve Sheath Neurilemmoma Neurilemic Sarcoma
Ganglion Ganglio Neuroma Neuroblastoma
Meninges Meningioma Meningeal Sarcoma
Retina Retinoblastoma

4. Lymphatic Tissue
a. Lymphatics & Lymph nodes

Tissue of Origin Benign Malignant

Lymphoma

A. Hodgkin’s Lymphoma
- Painless enlargement of lymph nodes
- Cause: Epstein-Barr Virus
Lymph Nodes
- S/Sx: high grade fever, edema, night sweat
B. Non-Hodgkin’s Lymphoma
- Painless enlargement of lymph nodes
- Cause: Congenital/Prolonged Exposure to UVR
- S/Sx: low grade fever, edema, itching

5. Hematopoietic Tissue
a. Blood & blood forming organs
Tissue of Origin Benign Malignant
Leukemia
- abnormal multiplication of immature WBC
- Leukemic Cells: inhibits the (N) production of blood cells
Bone Marrow
(-) RBC: Anemia
(-) WBC: infection
(-) Platelets: excessive bleeding

IV. AIDS
 Acquired Immunodeficiency Syndrome
 Virus: Human Immunodeficiency Virus (HIV)
1. Pathophysiology
a. Retro Virus: changes code from RNA Code -> Viral DNA Code
i. Reverse Transcriptase: responsible for converting RNA into DNA
b. Reduction of CD4 Helper T-Cell
i. Cytotoxic: “Virus Killer”
ii. Helper: Activation of Cytotoxic T-Cell
iii. Memory: “Memory”
iv. Suppressor: Inhibits activity of T-Cells
2. Mode of Transmission
a. Body & blood fluids
b. Maternal-fetal transmission

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c. High Risk for Transmission

i. Unprotected Sexual intercourse
ii. Contaminated Needles
d. Low Risk for Transmission
i. Contact by: kissing
e. No Risk for Transmission
i. Contact by: Hugging
3. Opportunistic Infection
a. Pneumocystis Carinii Pneumonia (PBEQ)
b. Herpes Simplex 1-2
c. Cytomegalovirus Infection
d. Toxoplasmosis
4. Laboratory Evidence
a. ELISA – Enzyme Linked Immunosorbent Assay
i. (+) 30,000-50,00 HIV Copies in Blood
b. Absolute CD4 Helper T-Cell Count
i. Normal: 800-1200 per cubic milliliter of blood
ii. (+) 200-500 per cubic milliliter of blood
5. Treatment
a. NRTI – Nucleoside Reverse Transcriptase Inhibitor
i. Ex. Azidothymidine
V. Chronic Fatigue Syndrome
 Disabling fatigue with other complaints
 F>M; 20 to 30 y.o.
1. Diagnostic Criteria (2 Major)
a. Relapsing Fatigue for >6 months
b. Exclusion of Chronic Condition
2. Must possess 6-8 symptoms criteria
a. Fatigue
b. Low Grade Fever
c. Sore Throat
d. Lymph Nodes: painful/tender
e. Muscle Weakness
f. Muscle Discomfort
g. Arthralgia: joint pain
h. Sleep disturbances
i. Headache
j. Cognitive impairment
3. Contraindication
a. Bed Rest (leads to more fatigue)
4. Management
a. Low to moderate aerobic exercises

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