Usmle 2 ชุด 1 Flashcards by Heng Guu

Substernal chest pain + diaphoresisคือหายใจไม่ค่อยได้
Sweat
จะได้ยิน HS อะไร

4th HS
เพราะเป็น MI

4 th Hs stiff ventricular ทำไห้เกิด atrial gallop
Abnormal in young, ven hypertrophy, MI

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3 rd HS หละคือ อะไร

Turbulent flow to fentricle จาก inc volume

Abnormal ใน Heart fail
High out put
Restrict cardiomyo pathy

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Sub sternal chest pain + s1-4 elevate แล้วมี พวก autonomic sympathetic ดหมือน dilate pupil hypertension sweat

เป็นจากอะไร

Coccain intox
สามารถทำไห้เกิด
1 dissection
2 MI
3 intracranial hemorrhage ได้

Tx : benzo, aspirin, reperfusion

Ci: bblocker

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Citeria APAS มีอะไรบ้าง

3 ข้อตอบมา

3 loss ก่อน 10wk
1 loss หลัง 10 wk
Pre eclampsia ก่อน 34(plcental insuff)

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เศร้า ผัวตาย ไปทำงานได้ นอนบนโซฟา

Presistent complex berevement disorder

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Back pain
คลำ lumbosacral spine ได้ step off
(-) straight leg

Spondylolisthesus (แตกหลังบวม)

Herniated disc

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Dyphenhydramine intox

Dry dilate
Blurr
Hot
Dec bowel sound

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8cm -1 station ลงเร็ว

ทำไรต่อ

Expectant

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RA vasculitis neutropenia splenomegaly

คือ ปวดข้อ มีผื่น(mononeuritis multiplex necrotizing skin lesion) ม้ามโต

คิดถึงอะไร

Felty syndrome
มี immune complex ต่อ neutrophilและเกร็ดเลือดทำไห้เกิดการทำลายเกร็ดที่ม้าม

Ix: anti CCP, anti RF, ESR(เอาที่85), CBC กับ blood smear

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3-4 wk clinical pneumonia
CA มี interstitial infiltrate
มี lymph nodeโต
Ca+10

โรคอะไร
Biopsy
Treatment

Sarcoidosis
Cough dyspnea, bilat hilar adeno
Skin uveitis erythema nodosum arthritis= lofgren sundrome

Bx non caseating granulomatous

^ ACE

Tx steroid

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HS
Wide fix splitting S2
เจอใน2ที่คืออะไร

ASD

MI ถ้า มี delay relaxationและ closure aortic valve

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Pulsus paradoxus

คือ เจอในไหน

หายใจแล้ว +10 sbp

Tamponad หรือ severe asthma หรือ COPD, constrictive pericarditis, shock

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61 involuntary shaking + rigidity ,gait normal

คือ อะไร
Tx อะไร

Parkinson
คือเป็นแค่ early ไม่จำเป็นต้องมีครบ

Trihexyphenidyl - antichlorinergic

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Essential tremor

Tx อะไร

B blocker 1st

Clonazepam 2 nd

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27 yo fat
Take OCP แล้วมี progressive intermittent HA dull 5/10 palpilledema

Dx
Cc

ไม่เกี่ยวกับ ocp เลย
แค่ fat female ก็มี
“Paeudo tumor cerebri” ได้แล้วนะ

Cc คือ blindness
ถ้ามี VS defect Cn6 ไปก่อน

Hx อันอื่นที่ relate คือ steroid vitamin A

Tx wt reduction
acetazolamide
Shunting
Optic nerve fenestration

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50 ปี anemic symptom
Easily forget tried mostly
กินเบีย

Anemic + ^ MCV(+110),normal MCHC

Test

คืออออออ
ทำ blood smear หา megaloblastic
Vit B folate

Suspect percenius anemia

Non megaloblastic
Myelisplastic 
ALL
Drg induce hydroxyurea zidovuldin 
Liver 
Alcohol????
Hypothyroid

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AIHA

Lab จะเป็นไง

Anemia
^ reticulocyte
^ bilirubin
^ LDH
 Dec haptoglobin

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29 yo
170/110 pulse 72
 2 อาทิตมี nosebleed anterior packing
No murmur
Ecg T wave inversion V5V6(lateral) down slope st depress(คือ มี LVH)

Normal coag

คิดถึงอะไร

Coarctation

Ix bilat arm leg bp

Nosebleed leg claudicatio
Brachial femoral delay
Left interscapular systolic or continuous murmur

Ecg left ven hyperteophy
Xray notching interior 3-> 8 rib

Echo confirm

Tx baloon or stent

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Renal calculi

Prevent โดยอะไร

Low sodium intake
Inc fluid intake
Normal Ca diet

Inc Na ทำไห้ Ca excrete เยอะขึ้น

Tx thiazide reduce Ca excrete

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Heart burn
Tight chest
Esophagus ไม่มิ peristalsis
Bilateral crackle

Systemic sclerosis
Tissue fibrosis vascular dysfunction

Fatigue
Telangiecrasia sclerodactyly digital ulcer calcinosis cutis
Arthalgia contracture myalgia
Esophageal dysmotility dysphagia dyspepsia
Raynaud

Ix antinuclear antibody
Anti topoisomere antibody

Lung interstitial lung pulmo htn
Kidney acleroderma renal crisis oliguria thrombocytopenia MAHA
Myocardial fibrosis pericarditis

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Esophageal spam monometry

Periodic high amplitude non peristaltic

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Eosinophilic esophagitis

Hypercontract

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Dm nephropathy

ไช้อะไร test ดีสุด

Albumin/ crea ratio

Check microalbuminuria nv<30ใน24ชม

Dipstick check 300mg ใน 24 ชม
ไม่มีrole utz, ogtt

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มาด้วย clinical pneumonia + asthma
Admit ไห้ atb steroid
Wbc ขึ้น neutrophil สูง
มาจสกอะไร

Medication effect
Leukocytosis

Migration, Release, inhibit apoptosis

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EBV Clinical อะไร Dx อะไร

Clinical fever tonsilitis lymph hepatosplenomeg Atb rash หลัง amoxicillin Dx : monospot test 25% false neg 1week Atypical lymphocyte Hepatitis

Outier 1 value in 10

Mean mire than mode or median

Subdural hematoma (()

Tearing bridging vein Cerebral atrophy elder alcoholism warfarin (hip fracture)prone to this

Mi แล้วไปใส่ stent แล้วขามี livedoreticularis กับนิ้วเท้าฟ้า Ekg มี q wave no murmur Dx เป็น

Artheri embolism จาก stent “Blue toe syndrome” Cholesterol partially occlude arterioles ทำไห้เกิด cerebral infract Intestinal ischemia Gi bleed, pancreatitis , AKI(2wk) Retina = hollen hoorst plague bright yello refractile plaque 30วัน+ หลัง stent Tx supportive

Parkinson Treat แล้วมี hallucination MS score 20 จากยาอะไร

Dopamine agonist pramipexoleไช้ใน Parkinson <65ปี Tx คือ switching pramipexole to levodopa ถ้าไม่ได้>> anti psycho quetapine, primavabserin

Lead toxicity clinical เป็นไงบ้าง

Gi abdopain :constipation anorexia Neuro peripheral neuropathy ataxia tendemgait fail Hema. anemia Impair purin ทำไห้มี hyperurecemia ในเลือด Ix zinc protophophyrin level

Chlamydia GS ไม่เห็นต้องทำอะไร

NAAT

Hyper k Rate ไห้ยังไง Ekg เจออะไรท่องมานะ

Max peripheral 10meq/hr Max central 20meq/hr Tall peak t No p wave Wide QRS Sine wave

Hyper k Rate ไห้ยังไง Ekg เจออะไรท่องมานะ

Max peripheral 10meq/hr Max central 20meq/hr Tall peak t No p wave Wide QRS Sine wave

meniere clinical

vertigo Nausea Tinnitus Hearling loss จาก inc endolymp pressure

BPPV

Lose calcium debrid in semi circular canal

Otosclerosis

Lose mobility of the ossicle

Hypertrophy heart EKG?

aVR + aVL R wave มาจบกัน

``` RLP pain radiate to groin 2 weeks + furuncle right thight มี DM type 1 Extend leg Pain Flex leg Pain ``` DX ต้องทำ

``` CT scan Diff Psoas Abscess สามารถเป็นจาก osteomyelitis Diverticulitis HIC Crohn ```

MEth amp toxicity

Bug under skin High BP pupil dilate sweat agressive con

Flat occiput, Anterior displacement right ear | Hx Breech

Postural deformity of neck | Congen torticollis head tolt to over side

HIV become weird high bleed pressure Anemia microcytic inc reticulocyte low plat more IX?

Peripheral blood smear TTP- low ADAMTS 13, Inc VWFm ทำไห้เกิด clot inc bleeding time helmet schistocyte some time renal failure neyro fever TX plasma exchange steroid retuximab

indication for delivery

fetal tachy cardia 130/min | not UTI strep infection

Alzheimer AF stop coagulation Brain lesion on parietal ใหญ่ๆ ยาวๆๆ คือ

Amyloid angiopathy === alzheimer

Cramping + heavy bleeding passing pale mass BHCG + Empty endometrial DX

complete abortion

Moving around in sleep cant control kicking pushing over Feel like loss or trap in wood awake quickly and transient to become fully alert

rapid eye movement sleep behaviour disorder

Generalized tonic clonic 28 yo women missing 2 dose then become seizure what drug short acting

of alprazolam short BENZO withdrawal of benzo Triazolam midazolam Oxazolam

Asthma after excercise tx

inhale albuterol 10 mins before excercise/ or leukotriene

Lipid lowering agent | indication

DM 2 uncontrol + 40 yo | 190 LDL

Dignosis of liver failure

sign of hepatic encephalopathy ALT AST +1000 INR > 1.5

Epigastric To RLQ pain with WBC increase neutrophilเด่น APPENDICITIS TX

JUST do LAPAROSCOPIC APPENDECTOMY | ไม่ต้อง UTZ

PID ดูว่ามี nausea vomiting, Pregnancy, tubo abscess | ไหม ถ้ามี กฌ admit

cefotetan, cefoxitin + Doxy

APGAR 6

PEEP if HR <60 start chest compression

DM neuropathy delay gastric paresis dysphagia hypogly TX

small frequent meal + metochlopromide, erythromycin

Adult APKD MCC cc

hepatic cyst

AKI TX

IVF to prevent tubular necrosis

24 yo women knee pain worse when climbing stair + cigarette BMI 26

TX extension of knee while compressing patella = compression test stretch thigh muscle = oatekki femoral pain syndrome squat and running

Patella tendonitis | Clinical

jumper tender at inferior patella

OSgood schlatter | Clinical

growth spur tender tibial tubercle

Hypernatremia IX

euvolumin = free water supplement hypo volumic = symptomatic give 0.9% NSS until stable Hypovolumic = not symptomatic = D5 water

high serum osmole(+295) DX

inadequate ADH/ nephrogenic DI | hypernat hypovolumia

64 yo Abdomen distend +chemo + radiation, drink alcohol normal VS JVP 9cm fluid wave hepatomegaly DX

inelastic pericardium= จาก constrictive pericarditis จาก radiation antracyclin

36 yo DOB palpation retristernal pain + 3 วัน cold DX: MI TX

Aspirin ASAP inhibit TXA2 antiplatelet

``` 18 mo Rash ที่ mouth axillar inguinal otitis media T 39, BP 89/52 HR 145 RR 28 Flaccid erythematous slough perioral ```

Staph scalded skin ==+ nikolsky sign blister fever Tx Vancomycin nafcillin Strep - scarlet fever - no nikolsky sign จาก pharyngitis

Motor accident s/p bowel repair 2 days post opt hypotension vasospasm Blue finger Caused from what?

Noepi + induce vasospasm + mesenteric ischemic vasospasm + abdominal pain

Acute dystonia Akathesia Parkinson TX

Benztropine

Tardive dyskinesia Mouth twitch Tx

Valbenzine

s/p appendectomy post pot 1 day icteric normal CBC increase tot bilirubin

Gilbert low UDGO transferase provoke by stress infection fasting surgery excercise

Brain dead

no deep tendon reflex EEG Doppler UZ Angiography Cerebral blood flow

Ectopic pregnancy | IX:

Do TV UZ | Culdo only detect rupture ectopic

PW sore throat dysphagia odynophagia tonsin erythema Approach

Viral - conjunctivitis rhinorrhea oral ulcer supportive Bacterial palate petechiae exudate edema ทำ rapid antigen test ถ้า - รอ culture/ ถ้า + คือ strep pharyngitis treat โดย amoxicillin

Androgen insensitivity Chromosome clinical

``` X link of androgen 46 XY ( no menses girl) ``` Absent uterus upper vagina crypto testes minimal pubic hair

Mullarian agensis Chromosome Clinical ?

``` 46 XX Hypoplastic mullarian Absent uterus upper vagina Normal ovary Normal pubic hair ```

Transverse vaginal septum

malformation uro sinus Mullerian duct | Only abnormal vagina

Born at home 5 day later brusibility | inc PT PTT

K def

``` 19 yo (young) dry cough HA Weak rash on arm leg mild fever Erythema pharyngeal interstitial marking Pleural effusion ```

Mycoplasma pneumonia tx azithromycin

32 yo ascending paralysis Past med colorado Tick IX treatment?

Meticulous search localized or more pronounce in 1 leg ต้องกอนเลือดเพื่อสร้าง toxin, no autonomic like GB

Celiac มี fecal fat what test

Xylose test

Heat stroke | tx?

ice immerse fluid electrolyte no antipyretic

2 month anterior wall MO Now DOB extertional dyspnea มี Deep q wave I, Avl, V2-5st elevation DX?

ventricular aneurysm

``` S/P MI 1wk 2wk 1mo 3mo 5-3month CC? ```

``` 1wk- septal rupture, papillary muscle rupture 2wk- free wall rupture 1mo- angina 3mo- pericarditis 5-3month - ventricular aneurysm ```

Esterogen therapy require more : tyroxin because

Estrogen increase TGB

steroid therapy require ledd tyroxin because

Steroid dec TGB?

Right HA around Eye 2 hr Halo sign non reactive dilate pupil Erythematous lacrimation VA dec DX

Acute angle glaucoma | 40+ yo asian

``` Milk alkali constipation Abdominal pain urinary frequency Thirst ```

Milk alkali hypercalcemia renal vasoconstriction inhibit NaKcl inhibit ADH

if stable + FAST ทำอะไรต่อ

CT scan

Centricular premature complex + syncope episode

Reentrant ventricular arrhythmia

12 month baby vomit diarrhea fever

fluid 20 ml/kg/ PNSS | D5 not use for resus

Bipolar become psy given first gen antipsychotic มีfever high BP dopamine

neuroleptic malignany syndrome

24 yo dry cough 2 mo backpain pulmonary nodule - retroperitoneal lymphadenopathy

Do scrotal UTZ จาก testical Ca 15-35 yo unilateral painless testical nodule AFP UTZ BHCG

<25 yo sex active do swap for chlamydia + gonorrhea

cos it is asymptomatic | ทำ NAAT gold standard

Tamponad

dec left ventricular preload