usmle 2 ชุด 4 Flashcards by Heng Guu

16yo pruritic red back and chest
PHX viral
red on the back

pityriasis rosea
heral patch
scatter oral to trunk= christ mas tree

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erythemamultiform = target

Erythema marginatum = ring like irrgular margin \ RF

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Abortion with fracture of baby

hypoplastic thoracic

osteogenic imperfecta type 2

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kid suicide

inform parent + hospitalized him without parent consent

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cutaneous larva migran
bare foot on sand ancylostomas
tx?

ivermectin

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trastuzumab

ix?

heart do echo

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21 yo male SOB wheeze mediastinal mass

+ HCB AFP

mixed germ cell tumor

non seminoma

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Pancreatitis + gall stone no obstruction
no gall bladder thickening
what tX?

Lap chole

pancreatitis > 150 alanine SGPT

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42 yo IV abuse
dark urine + jaundice
BMI 30 alkaline phosphatase
best next step?

UTZ abdomen

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Hyperbilirubin

unconjugate - criger gilbert drug hemolysis
conjugate =
inc ast alt = hepatitis,
all normal = rotor + dubin
alkaline phos increase = chole, malignancy, sclerosing cholangitis
do CT or UTZ antimitochondrial

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elevator phobia

exposure therapy first time

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68yo
CHF + Low Na 
low CO dec renal afferent perfusion 
increase renin noepi
ADH
increase water resorption

Dilutional hyponatremia

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Bilat butt pain 78 yo
worse during ambulation
improve when lean or sitting
osteoarthritis of spine

spinal stenosis
painrelieve with flexion
thicken flavum, OA

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Spondyloarthro

ankylosing

pain during rest + relief when walk

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7 mo Grief + depress

TX?

Mirtazapine SSRI + psychotherapy

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Asthma impending failure

citeria

1 absent breathsound
2 absent wheeze
3 dec conscious
4 cyanosis need ET

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cc bacterial meningitis

MCC complication

hearling lloss - intelectual disability epilepsy, ADHD, absence

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man i am not suprise it come to this paranoid + mood swing increase BP, tremor dilatr pupil
what cause

coccain abuse

if PCP- nystagmus

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62yo s/p pancreatectomy + RBC 12 hr later
dec o2 sat dec BP bibasal crackle ab distend dec bowel sound CI dec
wedge increase

what happen

MI = cardiogenic shock

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38 yo stiff neck trap muscle
shoulder lower back pain difficulty sleeping
normal Crea, ESR
TX?

amityptylin - TCA

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22 yo s/p apendectomy 
\+ acetaminophen + fasting 2 days 
jaundice 
tot bili 3.3
direct 0.7

inc urinconjugate
what to do

reassure - gilbert

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systemic sclerosis

schistocyte

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MI drug eluded stent

give P2y12 receptor blocker
clopidogrel, prasugrel, ticagrelor
+ aspirin

ACEI, ARB, bblocker, statin

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47 yo
lower ab pain
inc urination + dysparyunia
Ua normal

what DX

interstitial cystitis

associated with fibromyalgia + psy

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Exudate light citeria what?

Protein >0.5 LDH > 0.6 CHF = if given diuretic can also present as exudate (25%) Transudate = pH 7.4-7.55- CHF Most time (pleural fluid PH <7.33)

Barium swallowing dilate esophagus with smooth tapering what next step

do endoscope evaluation to r/o pseudoachalasia - ca increase with intake alcohol >60yo

26yo step on nail what can occur

pseudomonas < osteomyelitis

gout most tx effective

alcohol cessation

sickle cell MCC cc

hematuria จาก sickling in renal medulla can also have nocturia polyuria Isostheuria imprie concentrating

Back pain- phx ankylosing spondylitis lumbar tender range of motion restrict what occured

vetebral fracture | assocoated with osteoporosis + spinal rigid

Asthma - horseness in the morning sorethroat need albuteral after meal what tx?

add omeprazole for GERD

caustic ingestion | approach

ABC Decontamination CXR Endoscopy 3-4 days after perforation do serial ab xray

schizo akathisia restless more arouse TX?

dec antipsychotic do not discontinue | +add propanolol / or lorazapam

65 yo 1 day swell face + fever DM3 years PE warm tender erythema to external ear well dermacrated + lymph what cause

Group A strep also erysipelas tx: ceftri cefazolin amox

poor dentition poor wound healing alcohol arthralgia | what cause

Vit C def

PCP intox TX?

Lorazepan not haloperidal

38yo HIV fever vomiting supple neck no neuro defect but papilledema what cause

crytococcus <100 CD4 AmphoB + flucytosine then fluconazole

Clozapine what is that

2nd antipsychotic treatment resist schizophrenia SE: agranulocytosis

post partum hemorrhage TX?

``` bimaunal massage oxytocin fluid uterotonic - misoprostal methylgonovin baloon tamponad embolized uterine A. THABSO ```

36yo G1P0 38AOG hearvy vaginal bleed s5 pack /year smoker 158/96,112,FH 140 , +3urine protein CC?

placenta abruption จาก preeclampsia + DIC

howthorn effect

subject know being monitored change behaviour

16 yo heavy vaginal bleeing LMP 4 month ago BP 110/60,90 blood active bleeding Hgb 10, MCV 76 hemodynamic stable TX?

high dose OCP not curretage -only do this when unstable VS

ITP TX?

observe if petechiae skin only if bleed ไห้ IgG or steroid

pamphigus vulgaris

intraepidermial IgG deposit Desmoglein 1+3 Acantholysis

5yo | refuse to answer little shy fine by herself

selective mutism

2 hour after transfusion 3837 | from?

should have use leukocyte reduction febrile non hemolytic

irradiated RBC

ไห้ใน transplant blood donated by relative immuno def

Leuko def

ไห้ใน chronic transfusion CMV HIV ptx febrile non hemolytic reduce HLA

Washed

ไห้ใน IgA def complement dependent auto immune hemolytic anemia antihis /allergy or on going

Olanzapine | before giving do what?

check FBS + lipid

ziprasidone | before giving do what?

ECG QT prolong

risperidone | before giving do what?

Prolactin

neonatal conjunctivitis

use oral erythemycin chlamydial purulent discharge watery after 5 days of life

sivenitrite irritant

lubricate

conococcal swell eye lid purulent before 5 days of life

IM ceftri cefotaxime

55yo difficulty sleeping take wine before sleeping dec concentration + mild tremor Hb 11 MCV 106 AST 80 ALT 42 DX?

DX alcoholic disorder

67 yo tremor diff with daily activity bottoning intention + mild head tremor upper extremity DX TX

Essential tremor | tx propanolol primidone clonazepam

62 yo leg pain จาก excercise then swell calf + ankle BMI 41 | PE Gastronemius medial head tender ecchymosis medial malleolus

1. rupture popliteal cyst -->extrusion of baker cyst semimembrane + gastronemius -->meniscal teal --> OA

65 yo COPD exacerbation prolong expire bilat wheezing on lorazepam gen tonic clonic seizure from what??

carbondioxide retention inc RR deep shallow breath slow inc PaO2, dec Co2, loss compensatory vasoconstriction reduce Co2 uptake by tissue dec minut vent dec Co2 uptake from tissue VQ mismatch GOAL O2 90-93

suddn lose of vision no pain BP 140/90 swell optic disc retinal hemorrhage + dilate tortouous vein cotton wool DX?

central retinal vein occlusion close angle = dilate pupil not reactive to light optic neuritis - unilat severe pain women MS

``` 45 yo myalgia weak proximal muscle 140/80 inc creatinine kinase sluggish ankle jerk ===what test to do ```

serum TSH T4 = hypothyroid not muscle biopsy slugghish ankle jerk on hypothyroid

38yo 3 wk wt loss nausea ab pain postural dizziness prednisolone given 90/60, 96 bilat tonsil enlarge hyperpigment mucosal palmar creases vitilligo +eosinophillia low 7 am cortisol what cosue

autoimmune adrenitis

malaria prophylaxis

mefloquine prophylaxis | until 4 wk after travel africa asia india

gall stone colic

elective lapchole 72hr cholecystectomy - acute chole, choledochelelithiasis, gall stone pancreatitis

urgent dialysis

``` acidosis <7.1 electrolyte K>6.5 intox = methanol glycol salicylate lithium calporate overload uremia ```

24yo runner sharp pain at fore foot

stressfracture plantar fasciitis = at plantar not dorsal = worsen in the morning

76 yo MI cath lab 5hr later hypotension back pain cold clammy skin neck vein flat chest clear normal ECG IX?

CT scan of pelvic Ab no n contrast retroperitoneal hematoma also in dissection thrombosis AV fistula cath within 12 hours TX IV fluid + supportive

vomiting elyte ?

hypokalemic hypochloremic met alkalosis | tx : PNSS + Potassium

Peritonsilar abscess hot potato trismus uvula deviation | TX?

Needle aspiration + AB

55yo visual loss temporal field difficulty look side way

craniopharyngioma - bitemp heminopsia in >20 yo ptx

19yo body dismorphic you distress about youor apperance seem to be causing you suffering interfer with your study tx?

CBT + SSRI

16 yo left thight pain + sickle TX

hydroxyurea cc= myelosupression

31 yo G1P1 s/p CS 2 days uterine firm tender foul smelling discharge tx?

clindamycin + gentamicin | = endometriosis

60yo nausea ab pain painless purple mottling od skin both feet + eosinophilia PHX cardiac catheter + cascular procedure

cholesterol emboli + AKI

1 day boy cyanosis continouous murmur not improve with 100% os DX?

cocarctation open PDA by i protagladin E1 vasodilator

36 yo fever multiple joint pain IV heroin use sex worker no palmar sole inolve tender wrist + ankle nolymphadenopathy DX

Gonococcal Disseminated DX: NAAT synovial fluid TX: ceftriaxone, emperic azithro or doxy (for chlamydial)

31yo knee pain low back pain recent UTI synovial WBC 10000 poly microb + mouth ulcer

tx: NSAID = reactive arthritis

21 yo seizure + rhinorrhea air fluid level mucosal edema in paranasal sinus + ring on CXR dx

viridan strep or staph A จาก sinusitis tx emperic metro ceftri vanco IX: CT aspiration for GS + culture Phizophus ++ destructive no ring + DM risk factor

ankylosing spondilitis

butt pain in the morning = excercise TX

shoulder pain radiate to hand + bilat joint deformity RA inc C protein constrict drooping IX?

CXR find pancoast tumor

Enoxaparin , fundaparinaus, rivarox (Xinhibitor) cant use in GFR 30ml/min will inc bleed soooo use what

unfractionated heparin instead INR 1.5-2

S?P operation give 0.45% saline + hyponat now give what

3% saline not 0.9% naa

29 yo knee pain lytic epiphysis of knee DX

giant cell tumor , soap bubble os good - over use or rapid growth sprut

37 yo women heavy vaginal bleed in first day PHX curretage +1 pregnancy failure to conceived DX?

dec ovarian reserve - dec egg quality dec estrogen dec inhibin increase FSH@@ do FSH test the function

54 yo fatigue dizziness nubm less sensitive to cold pale conjunctivae - macrocytic anemia

gastric CA B12 def pernicious anemia atropic gastritis

musculoskeletal + costochondritis sharp + sternal pain | TX?

reassure analgesic

renal transplant | tx

tmp smx prevent opportunistic PCP listeria toxo

Ua needle shape crystal uric acid lucent IX?

--> need CT of abdomen to detect stone ileus

Renal stone tX?

thiazide to reabsorb Ca | uric stone = allopurinal (hyperuricosuria)

usmle 2 ชุด 4 Flashcards

(89 cards)