USMLE 2 ชุด 10

Question 1

35 yo foot ball
R knee pain knee bent 
foot plant + pop
มี large effusion on knee 
can bend but cant straighten 
no extend
yes flex

DX?

Answer 1

quadricep tendon rupture

from rectus femoris vastus laterais vastus medialis vastus intermedius

sudden contract defect above patella

ถ้า patella tear = palpate defect below IX : MRI

Question 2

Meniscal tear

Answer 2

docking or catching

Question 3

36 yo PPD ได้ 12 mm

not treat

Answer 3

5mm = HIV, known case, nodular CXR, immune suppression
10 mm - immigrant endemic, resident, employee, UI DM CKD children <4yo
15 mm- normal healty ppl

if + 3 mo IR
หรือ 6-9 mo I
หรือ 4mo R

Question 4

autism

Answer 4

you are correct that child mildstone

i like to get more test

Question 5

DM
acute panc
Livedoreticularis
AKI

RISK for ?

Answer 5

cholesterol emboli

Question 6

urinalysis envelop shape

Answer 6

ethylene glycol (urine calcium oxalate crystal)

Question 7

dec CBC
dec PLt
dec WTB

IX?

Answer 7

bone marrow Bx
ALL
bone pain lymph(+25%), blast (<5)
hepatosplenomeg

Question 8

s/p OR BT 2 U, BM stransplant
2 wk after = rash bloodly diarrhea hepatitis

DX?

Answer 8

Graft Vs Host

activation of DONOR T LYMPHOCYTE

Question 9

SAIDH

TX?

Answer 9

Fluid restriction

lab hyponat
serum osm <275
u osmole >100

urine NA >40

Question 10

Amebic abscess

Answer 10

Metronidazole is ok no need for drain?

Question 11

Echinococcus

Answer 11

aspirate + albendazole

Question 12

42yo
joint pain
finger pain
DOB
dark urine 
fever
ESR + RF elevate

DX?

Answer 12

infective endocarditis

Question 13

65 yo L thigh pain inc BP
pain on ROM
inc alkaline phosphatase
cortical thicken femur 
DX?

Answer 13

paget
CC : hearing loss arthritis spinal stenosis

IX xray osterolytic lesion scleroticx

TX bisphosphonate

Question 14

8 mo fever

Answer 14

LP no CT

Question 15

orthostatic hypotension from hypovolumia

Answer 15

dec renal perfusion

aldosterone inc Na resorb K excrete
dec urine osm

Fractional excretion Na <1%

Question 16

Multiple sclerosis from

Answer 16

Low Vit D smoking cold clinate
transcient neuro
UHTHOFF + LHERMITTE
IOP

Question 17

Vaccine –> GBS

Answer 17

Ascending symmetric paralysis

Question 18

HSV

Answer 18

bell palsy

Question 19

HIV prophylaxis

Answer 19

<200 - PCP= TMPSMX
<150- HISTO= Itraconazole
<100 TOXO = TMPSMX
<50 MAC = Azithro

200-150-100-50
T-I-T-Z

Question 20

sucide บอกว่าไม่เป็นไร

Answer 20

Involuntary hospitalized (individual)

Question 21

Cyclosporin

SE

Answer 21

Gum hyperplasia
nephrotic inc K
Neuro tox - HA BOV
Hypergly

inhibit interleukin 2

Question 22

LV failure

which drug improve survival

Answer 22

ACE
ARB
BB
Mineralocorticoid receptor antagonist

Question 23

Swell ankle feel low energy
hypotension
13 MI 17
21 yo

hypocholesterolemia
dehydrate renal, elyte depleteion
hypercarotenemia

DX?

Answer 23

Anorexia

มี osteopenia

Question 24

EEG =

sharp triphrasic sync

Answer 24

creutzfeld Jakob

spongiofrom enceph โดย Prion

Question 25

spinal epidural abscess staph ok มี 10 ;yo vack feet lower E tingling numb IX?

Answer 25

MRI

Question 26

OA initial TX

Answer 26

``` NSAID topical NSAID steroid hyaluronic surgery ```

Question 27

ALL + pregnancy แต่ไม่อยาก chemo

Answer 27

Obtain court order for chemo

Question 28

53 yo + BPV

Answer 28

endometrial biopsy ไม่ต้อง UTZ

Question 29

75 yo high pitch ringing bilat sensory HL

Answer 29

presbycusis

Question 30

32 yo 14 wk AOG DM1 Ht Proteinuria from?

Answer 30

DM neph

Question 31

delusion

Answer 31

>1 mo longer

Question 32

Brief psycho

Answer 32

<1 Mo

Question 33

trauma no ab pain แต่ UA + 50-100CBC IX?

Answer 33

CT หา renal trauma ``` Retrograde cystouretherogram if + gross hematuria diff urinating bloody meatus suprapubic pain ```

Question 34

MS | TX?

Answer 34

Methyl prednisolone , plasma exchange | CT= periventricular white matter corpus callosum

Question 35

lead poisoning Cap blood leak IX

Answer 35

venous lead level | EDTA dimer for lead 45 ++

Question 36

MSA band ischemia IX?

Answer 36

CT angio

Question 37

alcohol hepatitis | LAB

Answer 37

inc GGT inc ferritin AST 230 ALT 110

Question 38

17 yo leg pain thigh running

Answer 38

sickle cell | avascular necrosis femor head