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Usmle กู อย่างละ 100ข้อ > usmle 2 ชุด 5 > Flashcards

usmle 2 ชุด 5 Flashcards

(92 cards)

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1
Q

RUQ pain + gas in gall bladder no gas in billiary tree

Crepitus abdomen

A

emphysematous cholecystitis
immune, DM, Vascular copmress
+ ecoli clostridium - gas forming

tx: emergent cholecystectomy
amphicillin + sulbactam - clostridium coverage

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2
Q

Follicular thyroid cancer

biopsy?

A

invasive of tumor capsule + hema spread

Papillary = pseudomoma
Hashimoto = hurthle - large polygonal cell
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3
Q 
65yo
COPD
exacerbate 
dec BP, neck vein dilate 
\+ trachea deviation
breathsound absent = tx?
A

absent thoracostomy

penumothorax

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4
Q

reaction formation

A

unaccept loving during office visit

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5
Q

38 yo vilat wheeze + cough + crakle

clear lung field

A

Bronchitis

do supportive symptomatic treatment only

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6
Q

Cushing
moonface + central obesity + striae + glucose intolerance
from exo steroid, ACHTpituitary tumor, ectopic ACTH
TEST?

A

overnight low dose dexa suppresion test
late night cortisol salivary test
24hour urinary cortisol excretion

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7
Q

Adrenal insufficiency- hypotension, hypokalemia, hypogly

A

early morning cortisol can be overlap with cushing

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8
Q

primary hyperaldosterone

A

ratio plasma Aldosterone: Renin

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9
Q

pneumothorax

A

impair compress

ventricular filling

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10
Q

incontinence
type + patho

stress
urge
overflow

A

stress = sphincter tone dec, urethral hypermobil- multiparity, pelvic surgery, uretheral prolapse, cystocele- IX Qtip test post void resiidual , TX regel

URge= hyper destrusor

Overflow = impair destrusor contact, Bladder obstruct outlet

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11
Q

19 yo
sore throat sexual contact
38 c , erythematous pharynx + bilateral cervical lymph non tender

Ab tender lower quadrant

DX?

A

N. Gonorrhea

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12
Q

Women - normal uterus - no breast
inc FSH inc LH inc Testosterone ince Androstenedione

what occur

A

Aromatase def

mother become casculine baby osteoporosis in older age

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13
Q

overian hyper thecosis
post men
virilization insulin resist
dec LH dec FSH

dx?

A

solid appear ovary

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14
Q

5yo
sore throat +1mm vesicle on tonsil + greyish ulceration at posterior pharynx + lymph cervical bilat

what is it what cause

A

herpangina

coxsaki

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15
Q

6yo leg pain at night improve with massage + NSAID

tX?

A

reassure
growing pain at 2-12 yo
bilateral night time lower extremity

if>20yo think osteoma

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16
Q

Congenital melanocyte nevus

A

inc hair follicle + patch on upper - may grow and 5% melanoma

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17
Q

Congenital dermal melanocytosis

A

lower back sacrum + fade in time -regress

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18
Q

Liver cirrhosis + low BP Ascites Pitting edema Dec Na inc K low urine sodium due to

A

renal hypoperfusion
hepatorenal syndrome
prerenal azothemia

inc cream dec Na urine

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19
Q

MDS stop med for relationship then got worsen

tX?

A

restart paroxitine + gradual taper

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20
Q

39 wk G4P0 Abort 3 at 35wk AOG
due to leiomyoma now contact ! 2min 45sec each mod variability variable deceleration

TX?

A

Abdominal myomectomy with uterine cavity entery done
do not do vaginal labor

do CS in intramural or submucosal

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21
Q

Stable Angina Med

A

B blocker
nitrite
Ranolazine dec myocardial Ca influx
Dihydro CCB dec afterload

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22
Q

HIV bilat infiltration O2 80% CD4 160 tx ?

A

TMP SMX corticosteroid(PaO2 <70mmHg, A-a gradient >35 mmhg)
pneumocystis pneumonia

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23
Q

Abortus + mum engorge breast

tx

A

NSAID

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24
Q

DM + Ht ( 144/87)
+3 UA protein

tx?

A

intensive BP control to reduce Nephro complication

no glycemic intense = hypoglycemia > heart cc

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25
``` 25 yo G2P1 32 AOG + PID + Abruption placenta + weak pedia pulse low cardiac output dec wedge inc systemic low BP ``` DX?
hypovolumic shock
26
Central retinal artery occlusion embolism painless LOV tx?
ocular massage = anterior chamber paracentesis, hyper O2 chamber
27
SLE | low what
LOW C3 C4
28
ขาดำๆ เสก็ดๆ
venous hypertension = stasis dermatitis | == xerosis lipodermatosclerosis
29
Glaucogonoma - skin central clearing crusting scaling boarder DX?
Necrolytic migratory erythema
30
4yo | squirt L eye proptosis ( left tumor unilateral eye) esotropia optic disc pallor ( optic n atropy) cafe aulait
optic glioma | NF1 Lish nodule
31
Chronic illness + pericholecystic fluid involve infection ischemia DX TX
acalculus cholevystic | tx percutaneous cholecystectomy
32
Schizoaffective ?
MDS manic schizo/ time of delusion hallucination แต่ต้องมี 2wk with out MDS
33
HIV diarrhea | IX
stool examination for ova parasite possible non bloody= crypto > MAC> microspora> giardia
34
bipolar 1 | tx
life long lithum inhibit phosphoinositol cascade CC tremor hyponatremia
35
13yo abscess with appreanace i pull my hair when i get anxious + broken hair DX?
trichotiollomania OCD TX CBT
36
Preterm labor <32 give what
beta met toco MGsulfate | even without preeclampsia + penicillin
37
Scaphoid fracture = osteonecrosis - IX?
do CT MRI to confirm retrograde blood supply
38
31 yo G1P0 8wkAOG presistent vomiting BP 90/50 tachycardia do urinalysis for Ketone what PH ?
hypok hypocl met alkalosis hyperemesis gravidarum
39
water deprive test if +600 uring osm
primary polydipsia
40
Epiglottis IX confirm ?
ET should be perform dot delay CXR
41
64yo HA nausea phx: Dialysis erythropoietin _ BP 210/121 retinal hemorrhage จาก ?
Erythropoietin therapy
42
44yo dyspareunia chronic dry eye dry vagina cause?
inadequate lubricant sjogren 1. raynaud, RO LA + lymphocyte in salivary gland 2. non hodgkin RA parotid enlarge MALT
43
6yo congen deaf suddendrop no confusion from what?
QT prolong syndrome JERVELL potassium channel defect | propanolol + pace maker maintaining CA K MG
44
5yo diff walking + purplish non blanching rash + abdomen diffuse tender PHX viral 1wk UA blood trace protein DX?
intussusception = henoch tx NSAID supportive steroid IGA nephropathy
45
Craniopharyngiomas
calcified cholesterol motoroil 3 component solid cystic
46
Trichinellosis ??
Muscle abdominal pain fever ungual hemorrhage splinter hemorrhage retinal hemorrhage weak muscle periorbital edema eosinophillia
47
Leydig cell tumor ?
``` in testosterone inc estrogen inc aromatase Peinke crystal (eosinophil inclusion) gynecomastia precocious boy ```
48
Down syndrome infanity | 10 w AOG do what test
plasma free fetal DNA testing
49
chronic alcoholism + unconsciousness 31 c prolong QT TX?
Active rewarming
50
Acute Mania attempt to scale fence at white house terrorism HX TX?
lithium ( avoid in kidney), vlaporate (avoid in liver) 2. antipsychotic 3. olanzapine
51
5mo poor weight gain inc feeding K3 urine pH7.9 low Bicarb inc CL normal Anion gap
RTA type 1
52
CBC target thalassemia B inc hemoglobin A2 tx?
reassurance
53
23yo nasal breathing stuffy nose dry cough no wheeze rash boggy mucosa post nasal drip + dry cough tx?
topical intranasal glucocorticoid non allergic rhinitis antihistamine H1 no H2 have no Anti Ach
54
42yo DOB + wheezing med aspirin diltiazam atorvas albuterol NSAID block COX 1+2 shift to lipo inc LTC4 DX?
pseudoallerfic drug reaction known asthma rhinisinusitis polyp tx use leukotriene zileuton or leuko antagonist lukast avoid aspirin
55
inc BP Ha Bruit Right ear ?
fibromuscular dysplasia | Renal ICA
56
65yo RA acetaminophen thiazide general edema +4 protein normal BP enlarge kidney kidney biopsy?
glomerular deposition after staining ciongo apple green | AA amyloidosis associated with chronic RA IBD TB OSTEOMYELITIS fold wrong V microglobulin
57
Zenker | IX?
Barium esophagram upper sphincter dysfunction
58
alcoholic mallry weiss | patho
tear at GE junction also hiatal hernia IX endoscopy
59
tardive dyskinesia - tx
switch to quetiapine clozapine VALBENAZINE
60
``` 23yo 29AOG SOB tried excercise intolerance normal BP AF rapid ventricular response recent tonsillectomy from sore throat DX? ```
mitral stenosis from RF | recent
61
48yo TABSO cervical cancer - now with clear watery discharge DX?
vesicovaginal fistula
62
Duchenne
no dysctophin onset 20to X link + kyphosis becker 5yo
63
osteophyte diff walking DM1 hypoercholesterol DX?
Nerve DMg charcot joint B12 def DM syphilis spinal cord injury syringo myelin
64
hyper emesis gravidarum | elyte?
PH +7.45 alkalosis bicarb inc 2.8 metabolic if Paco2 Alka (0.9x bi) +14 +18 Acid (1.5x bi) +6+10 ``` DO Paco2(0.9xbicarb) 14+18 =53-57 expected paco2 is 54-50 = compensated == ok ok ok ok not exact is still ok ```
65
HX pancreatitis now abnormal mass what tx?
Endocopic drainage | pancreatic pseudocyst
66
target rash raise edge itchy tinea use?
clotrimazole + terbinafine > oral griseofluvin
67
viral sinusitis lead to
bacterial sinusitis | -purulent swelling turbinate
68
blastomycosis 3mo fever night sweat produce bough lytic bone lesion + skin verrocous crusted biopsy ?
granuloma nodule
69
23yo ulcerated non painful genital ulcer nontender lymph VDRL + HIV neg IX?
fluorescence treponemal AB absorption not biopsy @@@@@@ possible VRDL pos cdue to early infeciton
70
SLE first test
ANA | cost effective than DsDNA smith to confirm
71
42 yo fever sore throat HA maculopapular Rash trunk to entire body 3 sexual female lymphphadenopathy DX?
syphilis secondary sore throat systemic 1 dose IM PEG
72
TX hyper calcemia
severe +14 = NSS + cal tanin, loop diuretic, bisphosphonate Mode 12-14 = same asymptomatic -10= avoid thiazide lithium
73
@@@ high yield metabolic syndrome 3/5
waist male 40 women 35 FBS 100-110 TG 150 HDL male -40 women -50 central obesity DM2
74
64yo double vision downout HT DM2 cause?
nerve damage - contral infract - ischemic ok pupil dilate
75
Cat bite- tetanus vaccination 3 yo ago deep puncture wound tx?
prescribed amoxi + clavulanic | - booster tetanus who last vaccinated + 5 years
76
Post partum Endometritis = DOB after 24 hr diffuse bilat crackle ?DX
ARDS from sepsis from Endometritis
77
Ankylosing spondlitis restrictive luung dz from what>
chestwall motion restricted (enthesitis)
78
Daughter become vegetarian
reassure normal behaviour
79
42yo fever Hepc HIV Alcoholic hypertrophy thrush palpitate given moxifloxacin fluconazole ECG like torsad de point tx?
Mg Sulfate adenosine -supravent tachy Amiodarone - V tach A tachy for normal baseline QT Atropin- AV block bradycardia Sodium Bicarb- Quinedine torsad
80
Aspirin | Elyte?PH
metabolic alkalosis then aniongap met acidosis dec PaCO2 dec HCO3 near normal PH mix both = acidosis alkalosis
81
29yo vomiting abdominal pain crampy s/p appendectomy 6mo small bowel obstruction
Adhesion ladd bands proximal - early morning vomiting distal - coliky delay vomiting constipation obstipation hyperactive BS dilate loop
82
HIV Eye pain conjunctivitis keratitis fundoscopy = central necrosis widespread pale peripheral
herpes simples
83
HIV eye CMV?
no pain@ fluffly granular retinal hemorrhage conjunctivitis
84
sphincter of oddi dysfunctional | IX?
manometry
85
73yo fall hip pain dec breath sound crackle palpitation canbe arrhythmia next best step?
ECG cardiac marker CXR | surgical withing 72hr but have to stabilized ptx first
86
Neuroleptic malignant confuse stiff inc BP inc temp from antipsy TX?
Bromocriptine amantadine reverse D antagonist
87
dystonia | tx?
benztropine
88
shoulder dystochia
Mc robert | flex hiip thigh against abdomen
89
Sheehan triad | BP85/55 anemia low pulse
ishemic necrosis
90
60yo OA cervical spondylosis
bony spur limit rotation lateral bonding narrow disk space hypertrophy vetebral body
91
4yo boy vesicoureteral reflux HX UTI leukocyte esterase nitrite MCC complication
Renal scar if first UTI withing 2yo DO UTZ not cystoureteralgram but cystoureterogram = gold standard
92
focal segmented glomerular in
HIV OBESE Heroin

Usmle กู อย่างละ 100ข้อ (10 decks)

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