usmle 2 ชุด 3 Flashcards by Heng Guu

31 yo
low grade fever dry cough chest pain charpe during inhale/ cough knee pain
PHX: army + erythema nodule on shin
lower lobe infiltrate + hilum prominant

cause?

coccidoides immitis - arizona

arthralgia
erythema multiforme

tx : keto/ fluconazole

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43 yo
Epigastric pain not relieved by antacid, sensation by heavy lifiting and take 10-15 mins to go away
PHx: SLE, Prednisolone, ECG normal

IX??

Excercise
ECG
atypical angina

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35 yo
IV abused, right side weakness 2 hr
night sweat + malaise 7 d, 38.9C, BP 159/96, HR 112, RR 18

IX: MRI single infract MCA + vegetation Aortic value + regurgitation
AB + blood culture done

TX อะไรต่อ

continue current care + observation
Cardio embolic stroke - septic emboli
AB can help with infective endocarditis emboli –> no need heparin or aspirin

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65 yo 
temporal HA, visual disturbance, neck stiff
giant cell arthritis 
tx : compliance muscle weakness
difficulty climbing CK + ESR normal

DX อะไร

Drug induce myopathy

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psy
althought i dont have evergy i still cant sleep and up most night i drag myself to work but cant get things done no motive
PHX: aggressive sleepless brillent idea

what is DX

Bipolar 1 acute depression
2nd generation antipsychotic = quetiapine, lurasidorn, Lamotrigine

Que lame larua

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Family with APC

screen at

40 then repeat Q5 years

or 10 years before dx then Q5 years

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IBD UC Crohn

screen?

8 years after DX then Q1-3 years repeat

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Classic FAP

screen

Age 10 repeat 1 year

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HNPCC

screen

Age 20 to the repeat Q 1-2 years

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23 years african american
AB for UTI
now urine dark
+ prussian blue

what cause

G6PD
Oxidative stress
also from nitofuran

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pulmonary emboli

Ca hemostasis ???

Alkalosis dissociation from albumin
causing CA to bind
= hypocalcemia
increase affinity of albumin fro Ca

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22 yo fever sore throat malaise 
2 week honduras travel
38.8 C
130/70
110
tonsil enlarge + white exudate
\+ supraclavicular lymph + axillary lymph + anemia
มี low WBC @@@@@

what DX?

EBV
AHA + throbocytopenia
cross reactivity AC to RBC platelet
= hemolysis and inc rt count

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9 month old
swell hand feet 38.3 restricted movement soft tissue swelling
+ adopt จาก nigeria

DX?

sickle cell dactylitis
microvascular occlusion

tx: hydration

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pseudogout

constipation fatigue calcium stone

narrow joint + calcified in between

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Ducchene

IX: gold standard

do genetic testing not muscle biopsy @@

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26 yo
red watery eye tearing
granular conjunctive chemosis follicular
PHX wheeze

dx:?

allergic rhinitis

If viral = sandy gritty burning follicular bumpy like allergic

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23 yo
injury anterior dilocation humerus
dmg axillary N.
what will happen

shoulder abduct weakness flat deltoid

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84 yo 2 wk confusion weaker sleep move somnolent but arousable
strength 4/5 right
3/5 left
PHX: dementia

subdural hematoma = rupture bridging vein- elder alcoholic cerebral atrophy- acute HA + confusion + focal neuro def

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Hypertrophy heart

Heart sound ?

systolic crecendo decrescendo = aortic stenosis

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32 yo ADHD trouble since kid
forgetfulness distract disorganiz impulse
PHX coccain opoid abuse
tx?

ATOMOXETINE = non stimulat = noepi reuptake inhibitor/ non addictive

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26 yo
 agitate  distract strike nuse
VS 37.2/160/90 / 126/18
pupil normal rigid upper extremity
\+ nystagmus 
tx?

Benzo

เกิดจาก phencyclidine

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36 yo G3P2 15wk AOG UTZ at 13 wk
มี nuchal thickness
IX:??

amniocentesis

15-20 karyotyping diagnosis
10-13 choriocenthesis

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40 yp G 1 P 2
35 wk AOG
uterine contraction + asymptomatic strep to

TX?

reassure + discharge

penicillin only at labor + 37 wk aog
Given before it will regrow anyway so no point

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women who just got break up
(-) RH not alloimmunized given
what to do

give Anti D immunoglobulin at 28-32 wk

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``` 15 mo old boy teething nasal congest low grade fever given acetaminophen + numbing cream now cyanosis nail finger PHX: bronchitis VS 90/60 158 30 pulse Ox 86 from what ```

Normal arterial partial pressure of O2 = methemoglobinemia จาก topical anesthetic dapsone nitrite TX mythylene blue NADPH electron acceptor

kidney stone = what

calcium oxalate

RTA + hyperparathyroid ?

calcium phosphate stone

``` 23 yo red colored urine ABdominal pain, nausea VS 38.3 120/80 102 16 tender RUQ lab- anemia MCHC 46(high) MCV 88(normal) RT increase (autoimmune PNH) (LOWRT = leukemia, aplastic, infection) ```

hereditary sperocytosis - congen RB defect

55yo low grade fever tooth extraction MR + mobil mass what cause

strep sanguinis อยู่ใน viridan group S. mitis S oralis S mutan S sobrinus S millen

40 wk AOG 2 days cold sore chicken pox on mum small blanching erythema papule pustule all except palm + sole TX

reassure erythema toxicum neonatum

pupil large no corneal reflex, ptosis nystagmus rotational @@ no gag reflex loss temp sensation face and opposite trunk= where is the lesion

lateral medullar | vertebral artery

hypoglossal hemiplegia

ASA > medial medullar

weak masticator jaw jerk no no position tactile face

chew pon lateral @@

hemifacial trunck ataxia

medial pon

``` 4 yo itching private part PHX UTI atopic dermatitis++ spare groin genital perianal excoriation dry antecubital popliteal fossae what infection? ```

helminth infection enterobius TX albendazole

36yo G2P1 32 wk AOG back pain radiate down to LE increase at the end of the day ankle edema wide gait tx?

reassure conservative exagerate lordosis progesterone joint laxity dec lumbar support

15 yo multiple otitis media pneumonia | low CD4 CD8 all IgG what DX?

Bruton

15 yo multiple otitis media pneumonia | normal B cell count but all all IG

common variable disease

2 days old jaundince large tongue horseness what cause

thyroid dysgenesis

prolong QRS TX? mechanism

NaHCO3, Sodium carbonate help allevate depression action on myocardium sodium channel TCA inhibit fast sodium channel in HIS PERKINJI fiber

``` 34 yo 3 wk B symptom HIV CD 80 missouri + scatter lung crackle bilateral nodular opacity hilar lymph urine histoplasma what TX ? ```

itraconazole or ampho B

HIV cryptococcus tx?

flucytosine

psy | performance anxiety restrict to social fear of embarrasing

social anxiety disorder

30yo floating spot BOV PHX penetrating injury visual loss PE perilimbal flush caused by ?

caused by uncovering hidden antigen sympathetic opthalmia eye injury immune mediate inflame after injury eg. uveitis blindness develop patho unknown

Av block mobitz 2 1 AVnode progress and prolong

excercise atropine improve | vagal worsen

AV block mobitz 2 2 below AV node constant prolong

atropine worsen vagal improve

MDS but still depress do what next tx?

Bupropion or 2nd gen apriprazole/lithium thriodothyronine Phenelzine = MOA CI with SSRI

Trauma hard sign

``` pulsatile bleeding bruit expanding hematoma ischemia distal no pulse cool extremity ``` tx explore

trauma soft sign

neuro bony no pulse hx hemorrhage IX? CT angio, Doppler UTZ, extremity index

66 yo Ha, insomnia, Vomiting PHX: COPD, HNT, Lipidemia puncture wound 1 wk piror + ciprofloxacin other tiotropium salmeterol theophyllin BP 150/80, 115,18 dec breath sound + MAT single ventricular beat what cause

Throphyllin toxicity - met by Chy- Ciprofloxacin inhibit C450

Risperidone | mode of action

Block serotonin 2 A + Dopamine D2 receptor= dec extrapyrimidal side effect = prolactinoma

Blood transfusion | side effect

Anaphylactic = minute -wheeze shock uticaria - recipent IgA Ab tx: washed RBC + intramuscular Epinephrine Lung injury - 6 hr- RDS- leukocyte Ab primary hypotension- minute = Angiotensin converting enzyme inhibitor = xbradykinin ABO mismatch - chill fever flank pain Febrile non hemolytic - 1-6 hr leukocyte release cytokine

variable decel cause

cord compress oligo prolapse cord tx maternal repositioning amnioinfusion

23 yo lower back pain morning stiffness over hour reduce flexion of spine + tender sacral IX?

Xray of sacroiliac ankylosing spondilytis not HLAV7 มีแต่ 5% positive = non specific

3yo oral pain 2 sinus infection + cellulitis + periodental inflammation from what?

leukocyte adhesion no pus omphalitis | poor healing + neutrophil

46 yo Adult cellulitis IV drug Hep C, septic arthritis Alcohol 1 pint/day 2 days later improve + มี delusion + diaphoresis what TX?

Lorazepam

64yp Dry cough wt loss pain right arm PHX travel CT ,ี rt upper lung lesion

superior pulmonary sulcus tumor + horner atrophy of intrinsic muscle hoarseness

Dx malignant hypertension + papilledema + retinal hemorrhage or cerebral edema + non locaized neuro sign - vomiting confusion

hypertensive encephalopathy

Cehcet

painfulmouth + genital ulcer

SLE

non painful mouth ulcer + swell hand wrist + stiff 15 mins morning stiff, weakness lymphadenopathy low PLT, 2 proteinuria UA Migratory no joint destruction

psy i am losing my mind accident to small child when driving what tx?

serotonin - OCD first line | fluoxitine fluvoxamine citralopram

left scrotal mass 22 yo can be compressed by SMA = above testis not transluminate inc size during valsava what cause?

dilation of pampiniform plexus = dec insupine position tx : ligation in youngage

open heart surgery coronary bypass grafting = tamponade after inc diastolic pressure IX?

2Decho urgernt

Pregnant Active varicella herpes simplex gold standard TX

CS HSV need prophylaxis acyclovie calacyclovir at 36 wk AOG

37 yo sudden SOB HX ms use wheel chair + saccadic speech - reduce breathsound + dull on left lower lung DX:??

HIV 200+ CD can get varicella live attenuate | other? what are vaccine

HIB TET HEB B PV

COPD with dyspnea cough no need fever sputum need what TX

AB azothro gluoro amoxi clav no need culture

64 yo chest pain knife like | DX dissection + DOB cant lie flat

Aortic valvue insufficency from HT marfan coccain other tamponad stroke mi

67 yo B symptom Hypothyroid HT gout early satiety from splenomegally HB 8.6 Plt 268 Leuko 42800 what DX?

CML chromosome 22 tyrosine kinase imantinib

AML caused by

DNA methylation mutation

vaccine for HIV

PCV13 TD Varicella Hep B + influenza Hib not helpful cos non typable -> infect no meningicoccal

intergluteal swell pain bloog ting + coccyx tip tenderness + purulent + nofever not abscess r/o DX?

Pilonidal disease - obese sedentary life style | infect hair follical

Hidradenitis

dissecting folliculitis armpit + inguinal scalp | painful + brown deformity

``` 2 yo Bruise anemia posterier cervical lymph LAB low WBC, low Plt, low CBC what ```

aplastic anemia from 1. chloram 2. benzene 3. radiation 4. insecticide

Fanconi?

hyperpigmented on trunk neckcafe hypogonad skeleton deformity pancytopenia at 4 yo@@

Diamon Black

only RBC dec reticulocyte brith -3mo of life

if + URTI anemia bone pain DX?

AML in adult

4 mo hold bottle then drop on the ground + black butt | DX?

congenital dermal melanocytosis mongolian spot benign reassure

cutaneous stigmata?

dimple on sacral DX sacral UTZ

elder decrease REM dec slow wave diff falling asleep monitoring sleep tx

reassurance

Pink skin

co poisoning

45yo excess hair growth hyppothyroid on levothyroxin BMI 24 ths normal IX?

DX DHEA + Testosterone low DHEA, increase testosterone = ovarian Ca CHEA increase adrenal tumor

27 yo G1P0 28 AOG no felt movement doppler no fetal heart IX?

abdominal ultrasound must confirm with ultrasound first before Dx next step\ do fetal autopsy plcental evaluation + karyotype + APS

severe pre eclampsia

``` crea 1.1 PT <100k transaminitis visual PE ``` use hydralazine

LEgpain numbness hair spare distal pulse deminish lgiht touch sensation deminish weakankle flex what to do

heparin not doppler

``` 19 yo BMI 15 low BP low pulse low body temp electrolyte imbalance ``` what to do

admit nutritional rehab + psychotherapy

1 mo holo systolic VSD | what to do

Echo to determine size location | 1cm small can close before 2 years

DKA extracellular shift K what to do

1 IV 2 insulin 3K 4 bicarb

Linear association

do not analysis cos of confounding

39 yo hip pain cant lie on right side pain on outer surface smoke HT lipidemia pain when pressure apply DX?

trochanteric bursitis

Aortolliac peripheral vascular

thigh hip pain claudication erectile dysfunction | from excercise

67yo HA coronary bypass 7y BP 184/120 upper AB systolic diastolic bruit dx?

Renal artery stenosis resistance HT >3 region DX renal duplex UTZ AT angio

omeprazole + laryngeal erosion

8wk

DM prognosis ?

serum anion gap + beta hydroxy butyrate | use nitroprusside test to detect acetone acetoacetate

1mo bloody stool eczema vomiting milk protein induce enterocolitis

milk protein induce enterocolitis tx non diary or soy use hydrolyzed formula

achilles reflex can be absent when inc age dont confuse with MS

old ppl stuffs

78 yo urinary incontinence + disorient IX?

UA culture to r/o UTI to check for stress uridynamic

usmle 2 ชุด 3 Flashcards

(97 cards)