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Usmle กู อย่างละ 100ข้อ > USMLE 2 ชุด 6 > Flashcards

USMLE 2 ชุด 6 Flashcards

(90 cards)

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1
Q

3yo strep throat nontender UA blood +2

wilms tumor IX?

A

CT scan for met pulmo

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2
Q

25to SOB sue accessory muscle intubate next morning extubate + albuterol now tremor when lift hand with muscle
IX?weakness

A

check electrolyte

albuterol - hypok

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3
Q

56 yo DOB
work for home insulation plumbing now inc BP, digital clubbing bibasal crackle pleural calcifiation
caused

A

dec diffuse lung capacity

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4
Q

67yo forgetfulness sad concerned
pseudodementia cognitive impair
tx?

A

SSRI

alzheimer = no concerned no worry no distress

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5
Q

65yo worsen memory board base gait carotid bruit enlarge ventricle
urinary incontinence

A

normal pressure hydrocephalous

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6
Q

baby sitter burn baby spare what

A

flexor

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7
Q

35yo edema at the end of the day hypoalbuminemia dec Na UA fatty cast = nephrotic

cc?

A

hypercoag los protein C s anti thrombin
anemia loss transferrin
Vit D los calciferal binding protein
dec thyroxin dec TBG

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8
Q

lung nodule

malignancy

A

+2 cm 60yo smoking speculated = surgical
+8mm fine needle biopsy
-4mm - no risk just FU

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9
Q

COPD tx

A

stop smoking

spo2 88 need O2 therapy

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10
Q

Heparin induce thrombocytopenia

IX TX

A

serotonin release assay

stop heparin give agratoban foundaparinus

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11
Q

25yo transient LOV bruit on mandibular angle inc renin inc aldosterone
IX?

A

CT scan angio fibromuscular dysplasia

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12
Q

24yo dyspareunia no thinging no pain no external pain but internal exam intolerance DX?

A

genitopelvic pain/ penetration disorder

TX? kegel

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13
Q

trigerminal neural gia

A

demyelination of nerve nuclei = jawpain V2 V3 unilateral in MS bilateral

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14
Q

48yo UTI PID given ceftri IV culture ecoli sensitive to ceftri genito cipro tmpsmx

ไห้ยายังไง PID

A

uncomplicated nonpregnancy healthy = fluoroquinolone + TMP SMX oral

complicated: DM CKD immune hospital aquired vomit sepsis = IV fluoroquinolone aminoglycoside cephalosporin

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15
Q

42 yo RA treated with infliximab now erupt papule painful

DX?

A

herpes

valacyclovir

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16
Q

74yo POP prolapse, tx

?

A

passary fitting = poor surgical candidate (HF OBESE DM)
if symptomatic
1pelvic pressure 2 bowel bladder problem 3 sexual 4 erosion

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17
Q

withdrawal symptom?
heroine
cocain, amph
serotonin

A

heroine= dilate pupil lacrimation hyperactive bowel crampy diarrhea normal temp piloerect

Coccain, amph= inc appetitie insomnia severe depress

serotonin= erectric shock neuro + paresthesia

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18
Q 
7yo 
1 wk cook outside and eat + prior diarrhea 
2 days prior bloody diarrhea 
diffuse abdominal pain
icteric +2edema

LAB will show ? CBC

A

dec platelet
HUS
microangiopathic hemolytic anemia
schistocyte

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19
Q

acute intermittent porphyria

A

psychic
neuropathic tingling finger
urinary porphobilinigen

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20
Q

squat

A

inc after load

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21
Q

30yo sob swell lower extremity
+ d dimer
risk factor?

A

activated protein C resistance
factor 5 leiden hyper coagubility
factor 5 not response to anticoag C slower degrade , normal PT PTT

DIC + Cirrhosis= antithrombin Def

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22
Q

Asian newborn

dec UGT activity until 2 wk

A

20-25 exchange transfusion

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23
Q

reoutine testing colon
sigmoidoscopy
colonoscopy
FOBT

A

colon at 50yo
sigmoidoscopy Q5y
colonoscopy Q10
FOBT yearly

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24
Q

Thiazide hyperglycemia watch out ?

A

chlorthalidone

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25
Bartonella ?
<100 CD4 vascular cutaneous lesion B symptom hyperspleenomegaly TX? doxy erythromycin first then antiretroviral
26
Cancer related Anorexia | TX?
Progesterone Analog Megestrol
27
Sepsis | TX?
PNSS FIRST@@if fail use dopamine
28
Prostate met | tx
orchiectomy then radiation therapy
29
Cystic fibrosis kid recurrent URTI | use AB?
Vancomycin both methicillin resistance staph+ pseudo | if cefepine = staph methicillin sensitive + pseudo
30
45yo Recurrent sinusitis otitis joint back pain on ibuprofen aspirin otoscopy tympanic rupture UA protein +2 blood +2 DO
Qualitative antibody in serum granulomatous + poly angitis C-ANCA PR MPO skin livedoreticularis non healing ulcer
31
TX dialectic biofeedback supportive
dialectic - boarderline biofeedback- pain disorder supportive- psychotic + in crisis
32
Recommended vaccine influenza TD/Tdap Pneumococcus
influenza- from 19 ++ anually TD/Tdap- Every 10 years Pneumococcus- 19-64 - PPSV23 - lung liver heart smoker DM PPSV23+13 - csf leak cochlear implant ,sickle, aspleia, HIV, malignant , CKD 65- dose PSV 13, then PPSV23 each year later
33
15 yo breast lump tender mom die of breast Ca tx?
schedule follow up affter next month - Fibroadenoma estrogen progesterone = premens tenderness @@@ should be examine at least one mens cycle
34
37yo weak up cos sternal chest pain only climb2 flight before dyspnea ECG ambulatory st elevation at 1 aVL V4 V6 coronary angio = no obstruction TX?
Ditiazem= vasospastic angina intimal hyperreactive during sleep , Smoking TX: CCB dihydropyridone amlo, felodipine
35
penetrate trauma LUQ spleen colon + tender rebound | even FAST - do what?
OPEN LAP | hemodynamic instability peritonitis blood from NG or rectal exam
36
38yo homeless muscle pain stiffness alcoholic injection use high blood unable to open jaw spasm nect ?? cause by
toxin mediate neuropathy? | tetanus > block release on inhibitory GABA door health excess no vaccine or booster
37
38 yo 2 days abrasion thigh worsen spread to bottoch calf fever 39 BP 82/60 tender on palpate loss sensation to light touch DX?
necrotizing fascitis strep O staph A clostridium pain out of porportion erythema swelling air in CT black dot == crepitus
38
therapy not work i can see that your lack of improvement has been fustrating
les focus on a small goal we can agree on
39
RA = difficulty gripping coffee cup in the morning | involve what?
cevical spine spine subluxation cord compression rheumatoid nodule subcutaneous
40
Pneumothorax spontaneous- size
small -2 cm= observe supplement O2 | +2CM needle thoracostomy = 14-18 --> 2,3 ICS mid clavicular line
41
23yo 38 wk AOG rupture + Epidermal -8 cm dilate cervix unchange after 4 hr tx?
CS arrest 6hr inadequate contraction, 4hr adequate contraction = CS second stage 2he multipara, 3hr nulli note amino infusion if variable decel induce at 41 wk AOG 36wk see fetal presentation Active stage 6cm cervix <1.2,1.5cm/hr latent nulli 20hr, multi 14hr allow 24 hr + oxy 12-18hr then CS
42
Boy 10yo | HA visual disturb vomiting bilat eyelid retraction limit upward gaze preferdownwardgaze pupil sluggish to light ??
pinealoma block CSF, compress tectum associated GERM CELL tumor Precocious male + BHCG 9yo- BIG penis
43
Craniopharyngioma presentation
only visual disturbance
44
54 yo difficulty walking proximal weakness pain fall hyporeflex HT on thiazide metropolol + bruid carotid premature vent contraction IX?
electrolyte disturbance | low K cause cramp weak hyporeflex arrhythmia Premature ventricular beat
45
Risk for breast Cancer
Hormone replace nulliparity increase age at first time birth alcohol consumption (done dependent <1day)
46
Pagent
Bone resorption sclerosis cortical thickening bowing HA normal CA@@@@@@ normal P@@@@@@@ inc alkaline phos inc urine hydroxyproline - inc bone turn over Bone scan focal inc uptae TX bisphosphanate
47
MM | LAB?
inc Ca inc P inc AKP inc hydroxyproline
48
primary hyperparathyroid
inc CA dec P inc AKP
49
neonatal polycythemia
HCT >65 from 1 hypoxia, DM, Ht, IUGR 2 Twin delay cord clamping 13,18,21 respi cyanosis apnea, red skin TX IV fluid glucose partial exchange transfusion
50
HT cause IUGR placental insufficiency inc spiral A resistance from coccain tobbaco alcohol
head sparring 2/3rd trimester
51
OSA relax pharyngeal muscle
intermittent upper airway collapse
52
``` 32yo tick bite myalgia, confuse, HA, non lymphadenopathy inc lymphocyte inc ARP inc ALT low WBC low Plt TX? ```
Doxy DX: Ehelichiosis
53
45yo dyspnea - Abdominal distand - farmer edema inc JVP, dec heart sound CXR Ring calcified heart prominent X+ y descent
TB constrictive pericarditis
54
Chikungunya
macular rash wrist pain dec WBC HA conjunctivitis TX: supportive metrotrexate for joint chronic
55
``` 4mo pneumocystis jirovecii + oral thrush leukocyte 18000 lymphocyte 45 neutrophil 50% no ADA def ``` WHAT from
Dec CD4****** lymphocyte count HIV infection
56
Phagocytosis what organism | chronic granulomatous :#
Aspergilous staph A | serratia CAT +
57
Low PH urine
uric acid stone TX : potassium citrate allopurinol
58
Ca stone
``` TX : thizaide oxalate restriction allopurinol potassium citrate ```
59
32 yo SOB at night liver enlarge ankle edema 3rd heart sound enlarge cardiac sihouette pleural effusion non st changes texas travel ??
viral infection | viral myocarditis
60
PEdiatric 3yo constipation small fissure at anal verge tx?
begin oral alxative | limit cow milk inc diet fiber
61
variceal hemorrhage | tx
1 fluid 2 ocreotide 3 ceftriaxone endoscopy within 12 hr band ligation sclerotherapy uncontrol balloon tamponad for recurrent TIP shunt
62
Boarderline personality
depress easily angry paranoid cut wrist | associated child abuse
63
riluzole
glutamate inhibitor
64
orthostatic proteinuria in 14 yo boy what next step
repeat urine dipstick
65
egg shell liver cyst
hydatid cyst
66
stroke ptx can have weakness fall alot lead to
rhabdomyosis hyperkalemia if +6.5 use Ca gluconate แล้วค่อยไห้ fluid diuretic resin hemodialysis kayexalate other b blocker digoxin DM TN hemodialysis Renal endstage dec, GFR normal but dec K secretion normal aldosterone = CHF, cirrhosis low aldosterone = DM nephropathy, NSAIDm inter nephritis
67
Alzheimer can develop
incontinence in later stage
68
ABO incompatibility mother o baby AB,a,b
mild jaundice only
69
HELLP
centrilobular necrosis hematoma thrombi in portal capillary system distension of liver capsule pulmonary edema by vasospasm of arterial inc after load inc capillary pulmonary pressure
70
male seminoma non seminoma
seminoma + BHCG | Non seminoma - large mediastinal mass + BHCG, +AFP
71
smudge center of eye enlarge color wash out , eye pain, 1 side what dx
optic neuritis associated MS acute in 2 wk afferent pupil defect IX MRI @@@@
72
60 yo scrotal pain dysuria pain during urination
Ecoli acute epidydymis +35 coliform bac > UA culture -35 sexually transmitted NAAT chlamydia gonorrhea
73
Turett citeria DX? TX?
1 motor + 1 tic throat clearing grimance blink jerk shrugging TX anti dopamine - tetrabenzine > most effective Anti psycho A2 agonist clonidine
74
Jaundice + pancreatitis | IX?
CT NOT UTZZZZZ
75
Risperidone
2nd gen antipsy block D2 inc prolactin galactorrhea irregular mass infertility
76
``` Screening BCA Cervical pap Colon Ca HIC Hyper lipid HT OSteoporosis ```
``` BCA -50yo (q2y) Cervical pap- 21-65 (Q3y) Colon Ca- 50 (FOB yearly, COLONO q10y) HIV - 15-65 (1 time) Hyper lipid- MEN 35lipid profile Q5year HT- +18year every 2 years OSteoporosis - 65 + dexa ```
77
``` 68yo HT dizziness BP 140/90 right arm BP 100/76 left arm 4th heart sound systolic carotid bruit เป็น ? ```
subclavian A. occlusion MCC sharp by curvature more tubulent flow ไม่ไช่ AA arch narrowing = subclavian steal syndrome ``` Mostly asymptomatic ถ้ามี symptom 1. ischemia B > pain fatigue paresthesia 2. vertebrobasilar ischemia - dizziness ataxia dysequilibrium > ถ้า excercise Dilate upper ext Artery blood not go to brain 3. bruit on affected side ``` IX: doppler UTZ or MRI Angiogram if coarctation lower extremity affected more not each side arm @@@@
78
joint replacement infect
<3mo staph A pseudomonas | >3mo propioni Bac staph epidermidis no fever no inc WBC แต่ ,u impair gait sinus tract formation
79
Diff lifting swallowing (choking) | DX ได้อะไรบ้าง
polyomyositis - proximal weakness, difficulty climbing, inc muscle enzyme creatinine, AST, ANA , JO ,$endomyseal ต้อง screen cancer ด้วยนะ Fibromyalgia 1 pain 2 women middle age 3 trigger trapezius 4 +3month 5 normal LAB Polymyalgia rheumatica 1 age +50 2 stiff pain shoulder hip 3 temporal arteritis 4 inc ESR Dermatomyositis = + skin lesion $Perimyseal $perivascular B cell CD$ IX biopsy tx prednisolone MTX azathioprine
80
Chylothorax etiology ?
cardiac surgery / down syndrome / noonan
81
slip capital femoral epiphysis etiology IX ?
obese aldolescence boy associated with hypothyroid dec growth hormone 1 pain 2 fall off 3 dec range of motion dec $internal rotation $abduction $flextion IX: CXR $$TX immediate screw fixation
82
leg calve perthes ?
Boy 5-7 yo ( younger) | AVN hip
83
Vasoapsatic angina
<50 yo smoking occur at night < 15mins resolved IX: ambu ECG ST elevation/ no coronary angio defect # TX: CC blocker to prevent nitroglycerin treat
84
TB can cause adrenal ?
Adrenal insufficiency retain K + H, normal Anion gap met acidosis hypotension
85
Obturator N.
sensory ข้างๆ ไข่ + Adductor
86
sup peroneal
เท้า นิ้ว 2 ถึง 5
87
deep peroneal
ระหว่าง 1-2
88
37 yo RF | heart??? cause
mitral stenosis ไม่ไช่ AR& dyspnea hemoptysis orthersyndrome > compress recurrent laryngeal , AF may + stroke PE lough opening snap mid diastolic rumble > patches on face malar rashes @@ AV anastomosis IX: ECG Pmitral RVH tall V1V2 TTE visualization
89
atopic dermatitis | ร่างกายสร้าง อะไรไม่ได้
ร่างกายสร้าง corneum ไม่ได้ allergen เลยเข้าไปได้ inc risk dry env stress over heat detergent
90
Eczematous
เริ่มด้วยแดงก่อนแล้วค่อยแข็ง ฺbaby face scalp extensor adult flexor

Usmle กู อย่างละ 100ข้อ (10 decks)

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