USMLE step 2 ชุด 2 Flashcards by Heng Guu

82 yo epigastric pain hyperlipidemia DM
PMX cholelithiasis
smoker TB positive
Do ECG

Atypical MI in DM women elder

epigastric vomitng nausea

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38 to DOB mocoid sputum 6 mo bulging frontanelle prominant saclp vein (+99% percentile)
IX อะไร

CT scan brain

hydrocephalous

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Post opt atelectasis most severe during 2 nd night

low PaO2, increase hypervent

Respi alkalosis

decrease PaCO2

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25 hr baby vomit green
mom มี CFTR F 508
BP 80/50 NGT placed CXR: dilate loop

Next step what

do contrast Enema หา CF CC คือ ,icrocolon: meconium ileus gastrografen, r/o hirshprung if dilate biopsy anorectal monometry

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suicidal ideation hearing voice mute motionless resist all instruction to move
= catatonia

Tx อะไร

Benzo (lorazepam) or ECT

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43 yo knee pain chrondocalcinosis + effusion DM mild hepatomegaly

= pseudogout need to check whatt

Ironstudy = hemochromatosis = bronze skin DM hyperthyroid listeria vibrio yersinia

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Cluster HA
awake at night

what TX

Iithium
varapamil
if acute 100% O2

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DOB dysphagia
blurr vison จาก cured fish

what TX

give equine antitoxin therapy

= botulism

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75 yo back pain 
diff walking urination
prostate CA 
hyper reflexia
weak Lower extremity

T10-11 worse at night

IV steroid spinal cord compression next do MRI

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19 yo มี 6 mo amenorrhea menarch 11, atop 9 months ago
soccer player no men after medroxyprogesterone challange

risk of what

Bone fracture

functional hypothalamic

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children lymphadinitis

MCC คือ?

staph A.

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Methyl phenidate common side effect

dec appetite > wt loss> insomnia

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PAD give Aspirin, reduce stroke MI

indication of given simvastatin

40 year
DM
HPN
LDL 190

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33 yo SOB pounding(water hammer, corrigan upstroke rapid collapse of peripheral pulse) heart aware of heart beat when lying left side BP 150/45, HR 73
what DX

AR
จาก RF
Decrescendo + diastolic wide pulse pressure

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16 mo old baby cnat stand hypertonic LE UE babinski absent

cerebral palsy non progressive motor dysfunction splastic diplegia premature

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Myopathy normal CK ESR

what

steroid, cushing , painless

Muscle atropy by stroid , AKT-1 X no insulin growth factor

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Myopathy increase ESR
normal CK

what

Polymyalgia rheumatica pain stiff

temporal arteritisด้วยความที่หลอดเลือดนี้ส่งแขนงไปเลี้ยงกล้ามเนื้อและอวัยวะบนศีรษะและใบหน้านอกกระโหลก อาการที่เกิดจึงเกิดกับศีรษะและใบหน้า คือ อาการปวดศีรษะรุนแรง มักจะเกิดเฉียบพลันรุนแรง ปวดกราม ปวดลิ้น อาการรุนแรง เรื้อรัง ไม่หาย บางคนอาจคลำหลอดเลือดที่ว่าได้ชัดเจน
อาจมีอาการปวดไหล่ ปวดสะโพก ปวดร้าวตามตัวที่เรียกว่า

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Myopathy increase CK
increase ESR

what?

inflame arthritis

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myopathy increase CK

normal ESR

statin induce hypothyroid

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preeclampsia 36 wk AOG +1 protein

do what

urine protein to creatinin ratio test

gold standard for qualift the proteinuria >0.3 or 24 hr 300mg

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32 yo progressive SOB no chest pain
มี viral 2 ek
bibasal crackle inc JVP +2 edema
EKG- dilate ventricle with diffuse hypokinesia

suggest CHF dilate จาก viral myocarditis COXB> parvo > HHS> Adeno> Entero

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VitB 12 loss what

loss propioperception of LE จาก dorsal column

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in baby hypovolumia, hypernatremia tx

NSS 0.9% use fluid resus

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Deliruim flutuation cognitive poor attention disorient

high dose steroid

induce psychosis evil children จาก steroid

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53 yo homeless men DOB candida lung bilat crackle = consolidation pneymonia IX:?

ventilation/ perfusion mismatch cause hypoxemia R>L intrapulmonary shunting

66 yo skin wound shiungle hx skin change oozing crust | IX:

skin biopsy r/o SCC ( chronic wound burn scar)

34 yo BOV goes blind when stand up enlarge blind spot | what dx

papilledem a swelling of optic nerve head

i never feel good and have low self esteem eversince college 5 year ago my low energy always feel down DX

dysthymia

PCP HIV on ppt SIADH | serum 2Na+g/18+Bun/2.8 osm 275(low)-295(high)

normal paraprotein, hyperlipid high = hypergly low - hypovolumic- UNa <40 vomit diarrhea dehydrate UNa >40 diuretic adrenal insuff euvolumic - u osmole <100 bronchogenic polydipsia > 100 osm- SIADH hypervolumic CHF nephrotic

Pregnancy appendectomy cute

use mid line vertical laparotomy not laparoscopic

34 yo cough blood + wheeze right side + dense opacity in right upper lobe ทำไรต่อ

place patient on isolation respi ถ้า 600ml/24hr , 100ml/hr do CT bronchoscope if persistent embolized

22 yo knee pain catching while walking unabel to extend swell PE no pain or crepitus no varus or valgus IX อะไร

Do MRI meniscal tear | from soccer tournament (rotational on plantar foot)

Depress 2 mo + evil saying shout spoke rapidly standing up all night writting letter suicide attempt TX ?

lithium calporate > 2nd quitapine lamotrigine

underweight pregnancy

growth restriction

17 yo adnexal fullness + ovarian cyst, calcified hyperechoic

cystic teratoma dermoid CC ischemic necrosis, จาก torsion, rupture + free fluid

PRegnancy 20-30 min- moderate insensity excercise??

waking jogging no gymnastic

TOF crescendo decresendo systolic murmur | manuver

knee chest position will increase systemic vascular resistance kink femoral A.

68 yo COPD SOB without relieve กิน methylprednisolone ipratropium albuteral E tube insert when <7.1, PaCo2 60 tx อะไร

non invasive PEEP also pulmonary edema ARDS early extubate

Schizo

lateral enlarge of ventricular

15 yo sexually active get chlamydia + gonorrhea swap IX ?

NAAT gold standard not urine marijuana

HIV chest pain diaphoresis nausea recurrent vomiting coccain injected conjuntivae dilate pupil widen mediastinum effusion DX:

esophageal perforation

mallory weiss

mucosal tear EDG heal spontaneous

Boerhaave transmural tear

gever dyspnea odynophagia subcutaneous emphysema CT exophagography with gastrografin pleural effusion

เห็น meta myelocyte + myelocyte ดู LAP Leukocyte alkaline phosphatase

``` high = leukemoid reaction = infection Low = CML ```

24 yo + CKD transplant + immune supression burning pain at wrist at night DX TX

carpal tunnel | TX: wrist splint at night

Febrile seizure at 2 yo

tx reassure do not hospitalized for observation send home from emergency

BP 220/120 treat next morning confuse seizure normal breath what TX?

look out nitroprusside

intensive glycemic control prevent

microvascular retinopathy / not macrovascular MI STROKE

32 yo both hand tingling BOV HA Dizzi touch pain sense dec on upper extremity optic neuritis papilledema disc hypermic swollen IX?

MRI periventricular supial

72 yo s/p shingle difficulty urination palpable lower ab mass cough /diphenhydramine, hydroxyzine, chlopheniramine tx ?

First gen H | anticholinergic -> M of para symp - detruser hypocontract

``` SLE in pregnancy Edema mimic preeclampsia arthritis hematuria proteinuria Hypertension WBC + RBC cast on UA ``` IX อะไร

Renal Biopsy

3 days old cyanosis right hand 96% o2 right feet 85% o2 sat lactic acidosis etiology

thickening of tunica media in aortic arch coarctation dec femoral pulse 4 sec capillary fill

Hyponat ดู serum osm

290 + = hypergly renal failure DI high NA central DI Low Na Nephrogenic DI - 290 ดู urine osm -100 คือ primary poly dipsia both low malnutrition +100 ดู urina NA +25 SIADH adrenal insuff hypothyroid -25 volume depression CHF Cirrhosis

Fall incident coin 4.5 cm in lung | previous CXR

STABLE no work up New - do CT chest benign= serial CT suspect = PET biopsy highly suspect - excision

47 yo coffee ground emesis | black tarry stool weakness pale conjunctivae

inc BUN/CR Upper GI bleed tachy cardia = volume depletion inc urea form Break down hemoglobin urea reabsorption in proximal tube

inevitable abortion

vaginal bleeding dilate cervix product of conception see felt above os UTZ show sac in lower segment

34 yo HA given pain killer, new Ht 185/105 irregular S4 continuous murmur thoughtout thorax CXR ?

erosion of inferior costal surface Cocarctation of aorta = systolic murmur blood flow pass narrow aorta at left infraclavicular interscapular notching erosion of 3-8 rib steonotic signs

Pan hypopituitary will have whatttt | to aldosterone

normal secrete depend on renin

4 wk s/p rhinoplasty wheezing nostril | what cause

nasal septal perforation other can cause this is coccain syphilis TB sarcoid wegener

PTx CHF left vent dysfunction holosystolic murmur MR occur due to left ventricular dilate

increase renin norepi ADH will inc SVR inc blood volume will inc preload and LEDVคือ wedge pressure นั่นเอง dec contractility dec cardiac index volume loss dec LEVDV, dec CI, inc SVR sympathetic MI will dec CI inc SVR and normal LVEDV

syccinylcholine cardiac arrhythmia dur to

electrolyte influx Na and efflux L severe hyperkalemia

16 yo facial hair BMI 20

inc 17 hydroxyprogesterone inc testosterone inc DHT non classical adrenal hyperplasia = dec 21 hydroxylase

Vagina lesion not painful

Klep granulation no lymph syphilis chlamydia is painful node

loud snoring depression

mood disorder due to another medication condition osa = low mood irritability

8 yo fever cough paroxysmal ppt by eating subcutaneous emphysema IX?

do CXR to r/o pneumothorax

8 yo boy maroon colored stool well cooperative + painless IX?

tecnetium 99 pertechnetate scan for meckel diverticulum

36 yo AB distend flatus loss wt sweat arthralgia enlarge non tender inguinal node ulcer on buccal IX อะไร

HIV testing

45 yo HIV GI + B symptom splenomegally CMV igG (-), CD 4,22 AKP 412 3mm TB test

Azithromycin MAC

80 yo PHX DM MI stroke BP 78/48 HR 124 DM sacral ulcer venous statis FBS 250 inc mix venous O2 sat คือจากอะไร

Reduce cardiac afterload | from sepsis shock

RA pressure + PCWP

preload

SVR

After load

Asper staph avscess lymphadenitis

chronic granulomatous test dihydroorhamine nitroblue tetrazolium

54 yo fever chill dysphagia drooling 38.8 c, muffle voice tongue displace posterier superior bilateral crepitus submandibular

ludwig angina teeth root | molar mandibular

68 yo DM hypothyroid hypercholesteral on dialysis crea 3.2-3.5 platelet dysfunction normal pt count

uremic tx BT only | tx DDAVP

23 yo motor accident give fluid 2.5 L BP 70/30 multiple bruise extremly cold neck vein flat small left vent cavity + EF 75%

hypovolumic shock

32 yo 3 days fever cough sputum clear crackle on right vase occasional wheeze IX

CXR - CAP CXR needed for diagnosis then give AB

inferior MI

papillary muscle displacement MR blood leak back to left atriu, increase diastolic overload inc LVEDP + left vent filling pressure

AF origin is pulmonary vein

mcc ectopic foci cardiac tissue extend to pulomo vein มี elctrical

67 yo forgetful fear of demential like now i feel low useless teary lose sleep

MDS | pseudo dementia

4 mo poorfeeding pallor web neck shield chest triplephalangeal thumb tachy systolic murmur anemia Macrocytic anemia low Rt count defect in programmed cell death in progenitor cell AD

diamon black fan anemia

Fanconi

AR pancytopenia macrocytosis cafe micro eye short shoe kidney no thumb

inferior MI

2 3 avf

lateral MI

23 avf + 1 avl V5 V6

bed wetting 7 yo tx?

demopressin | imipramine ( due to SE suicide cardio toxi)

died this is painful loss i amhere to help you though it

advise

valgus abduct

medial collateral ligament | tx ice rest compress elevation

mesenteric ischemia and atherosclerosis met acidosis abrupt when cardiac emboli

AF infective endocarditis IV staph

52 yo black stool ab discomfort food help with pain gain wt drink beer PT ab tender right side + bruit

PUD

pregnancy clear fluid leak when stand up tx chlamydia at 10 wk all normal

urinary incontinence stress inc abdominal pressure

HIV diarrhea

<180 low grade fever = crypto acid fasting <100 no fever - isosporidium + crampy pain <50 FEVER = MAC, hematochezia ab pain = CMV

12 yo boy right groin pain knee pain limping 90% for weight 60% for height hip movement limited right food outword excertional movement of thight on flex hip slipped capital femoral epiphysis displace femoral head loss abduction internal rotation

tx surgical pinning of femoral head

phenelzine

MAOi prevent deamination of Dopamine, Norepi, S

micrognathia

edward

microopthalmia + cutis plasia

platau

3yo sickle fever no cough no cold no thing no DOB ptx plenic sequest crisis organism?

s pneumonia - dispite vaccination cause of non typable MCC SEPSIS meningiococcal

USMLE step 2 ชุด 2 Flashcards

(95 cards)