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Usmle กู อย่างละ 100ข้อ > Usmle 2 ชุด 1 > Flashcards

Usmle 2 ชุด 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Substernal chest pain + diaphoresisคือหายใจไม่ค่อยได้
Sweat
จะได้ยิน HS อะไร

A

4th HS
เพราะเป็น MI

4 th Hs stiff ventricular ทำไห้เกิด atrial gallop
Abnormal in young, ven hypertrophy, MI

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2
Q

3 rd HS หละคือ อะไร

A

Turbulent flow to fentricle จาก inc volume

Abnormal ใน Heart fail
High out put
Restrict cardiomyo pathy

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3
Q

Sub sternal chest pain + s1-4 elevate แล้วมี พวก autonomic sympathetic ดหมือน dilate pupil hypertension sweat

เป็นจากอะไร

A 
Coccain intox
สามารถทำไห้เกิด
1 dissection
2 MI
3 intracranial hemorrhage ได้

Tx : benzo, aspirin, reperfusion

Ci: bblocker

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4
Q

Citeria APAS มีอะไรบ้าง

3 ข้อตอบมา

A

3 loss ก่อน 10wk
1 loss หลัง 10 wk
Pre eclampsia ก่อน 34(plcental insuff)

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5
Q

เศร้า ผัวตาย ไปทำงานได้ นอนบนโซฟา

A

Presistent complex berevement disorder

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6
Q

Back pain
คลำ lumbosacral spine ได้ step off
(-) straight leg

A

Spondylolisthesus (แตกหลังบวม)

Herniated disc

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7
Q

Dyphenhydramine intox

A

Dry dilate
Blurr
Hot
Dec bowel sound

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8
Q

8cm -1 station ลงเร็ว

ทำไรต่อ

A

Expectant

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9
Q

RA vasculitis neutropenia splenomegaly

คือ ปวดข้อ มีผื่น(mononeuritis multiplex necrotizing skin lesion) ม้ามโต

คิดถึงอะไร

A

Felty syndrome
มี immune complex ต่อ neutrophilและเกร็ดเลือดทำไห้เกิดการทำลายเกร็ดที่ม้าม

Ix: anti CCP, anti RF, ESR(เอาที่85), CBC กับ blood smear

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10
Q

3-4 wk clinical pneumonia
CA มี interstitial infiltrate
มี lymph nodeโต
Ca+10

โรคอะไร
Biopsy
Treatment

A

Sarcoidosis
Cough dyspnea, bilat hilar adeno
Skin uveitis erythema nodosum arthritis= lofgren sundrome

Bx non caseating granulomatous

^ ACE

Tx steroid

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11
Q

HS
Wide fix splitting S2
เจอใน2ที่คืออะไร

A

ASD

MI ถ้า มี delay relaxationและ closure aortic valve

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12
Q

Pulsus paradoxus

คือ เจอในไหน

A

หายใจแล้ว +10 sbp

Tamponad หรือ severe asthma หรือ COPD, constrictive pericarditis, shock

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13
Q

61 involuntary shaking + rigidity ,gait normal

คือ อะไร
Tx อะไร

A

Parkinson
คือเป็นแค่ early ไม่จำเป็นต้องมีครบ

Trihexyphenidyl - antichlorinergic

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14
Q

Essential tremor

Tx อะไร

A

B blocker 1st

Clonazepam 2 nd

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15
Q

27 yo fat
Take OCP แล้วมี progressive intermittent HA dull 5/10 palpilledema

Dx
Cc

A

ไม่เกี่ยวกับ ocp เลย
แค่ fat female ก็มี
“Paeudo tumor cerebri” ได้แล้วนะ

Cc คือ blindness
ถ้ามี VS defect Cn6 ไปก่อน

Hx อันอื่นที่ relate คือ steroid vitamin A

Tx wt reduction
acetazolamide
Shunting
Optic nerve fenestration

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16
Q

50 ปี anemic symptom
Easily forget tried mostly
กินเบีย

Anemic + ^ MCV(+110),normal MCHC

Test

A

คืออออออ
ทำ blood smear หา megaloblastic
Vit B folate

Suspect percenius anemia

Non megaloblastic
Myelisplastic 
ALL
Drg induce hydroxyurea zidovuldin 
Liver 
Alcohol????
Hypothyroid
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17
Q

AIHA

Lab จะเป็นไง

A 
Anemia
^ reticulocyte
^ bilirubin
^ LDH
 Dec haptoglobin
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18
Q 
29 yo
170/110 pulse 72
 2 อาทิตมี nosebleed anterior packing
No murmur
Ecg T wave inversion V5V6(lateral) down slope st depress(คือ มี LVH)

Normal coag

คิดถึงอะไร

A

Coarctation

Ix bilat arm leg bp

Nosebleed leg claudicatio
Brachial femoral delay
Left interscapular systolic or continuous murmur

Ecg left ven hyperteophy
Xray notching interior 3-> 8 rib

Echo confirm

Tx baloon or stent

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19
Q

Renal calculi

Prevent โดยอะไร

A

Low sodium intake
Inc fluid intake
Normal Ca diet

Inc Na ทำไห้ Ca excrete เยอะขึ้น

Tx thiazide reduce Ca excrete

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20
Q

Heart burn
Tight chest
Esophagus ไม่มิ peristalsis
Bilateral crackle

A

Systemic sclerosis
Tissue fibrosis vascular dysfunction

Fatigue
Telangiecrasia sclerodactyly digital ulcer calcinosis cutis
Arthalgia contracture myalgia
Esophageal dysmotility dysphagia dyspepsia
Raynaud

Ix antinuclear antibody
Anti topoisomere antibody

Lung interstitial lung pulmo htn
Kidney acleroderma renal crisis oliguria thrombocytopenia MAHA
Myocardial fibrosis pericarditis

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21
Q

Esophageal spam monometry

A

Periodic high amplitude non peristaltic

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22
Q

Eosinophilic esophagitis

A

Hypercontract

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23
Q

Dm nephropathy

ไช้อะไร test ดีสุด

A

Albumin/ crea ratio

Check microalbuminuria nv<30ใน24ชม

Dipstick check 300mg ใน 24 ชม
ไม่มีrole utz, ogtt

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24
Q

มาด้วย clinical pneumonia + asthma
Admit ไห้ atb steroid
Wbc ขึ้น neutrophil สูง
มาจสกอะไร

A

Medication effect
Leukocytosis

Migration, Release, inhibit apoptosis

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25
Q

EBV
Clinical อะไร
Dx อะไร

A

Clinical fever tonsilitis lymph hepatosplenomeg
Atb rash หลัง amoxicillin

Dx : monospot test 25% false neg 1week
Atypical lymphocyte
Hepatitis

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26
Q

Outier 1 value in 10

A

Mean mire than mode or median

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27
Q

Subdural hematoma (()

A

Tearing bridging vein

Cerebral atrophy elder alcoholism warfarin (hip fracture)prone to this

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28
Q

Mi แล้วไปใส่ stent

แล้วขามี livedoreticularis กับนิ้วเท้าฟ้า
Ekg มี q wave no murmur

Dx เป็น

A

Artheri embolism จาก stent
“Blue toe syndrome”
Cholesterol partially occlude arterioles
ทำไห้เกิด cerebral infract Intestinal ischemia Gi bleed, pancreatitis , AKI(2wk)

Retina = hollen hoorst plague bright yello refractile plaque

30วัน+ หลัง stent

Tx supportive

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29
Q

Parkinson
Treat แล้วมี hallucination
MS score 20
จากยาอะไร

A

Dopamine agonist pramipexoleไช้ใน Parkinson <65ปี

Tx คือ switching pramipexole to levodopa

ถ้าไม่ได้» anti psycho quetapine, primavabserin

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30
Q

Lead toxicity clinical เป็นไงบ้าง

A

Gi abdopain :constipation anorexia
Neuro peripheral neuropathy ataxia tendemgait fail
Hema. anemia

Impair purin ทำไห้มี hyperurecemia ในเลือด

Ix zinc protophophyrin level

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31
Q

Chlamydia GS ไม่เห็นต้องทำอะไร

A

NAAT

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32
Q

Hyper k
Rate ไห้ยังไง

Ekg เจออะไรท่องมานะ

A

Max peripheral 10meq/hr
Max central 20meq/hr

Tall peak t
No p wave
Wide QRS
Sine wave

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33
Q

Hyper k
Rate ไห้ยังไง

Ekg เจออะไรท่องมานะ

A

Max peripheral 10meq/hr
Max central 20meq/hr

Tall peak t
No p wave
Wide QRS
Sine wave

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34
Q

meniere clinical

A

vertigo
Nausea
Tinnitus
Hearling loss

จาก inc endolymp pressure

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35
Q

BPPV

A

Lose calcium debrid in semi circular canal

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36
Q

Otosclerosis

A

Lose mobility of the ossicle

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37
Q

Hypertrophy heart EKG?

A

aVR + aVL R wave มาจบกัน

38
Q 
RLP pain radiate to groin 2 weeks 
\+ furuncle right thight
มี DM type 1 
Extend leg Pain
Flex leg Pain

DX ต้องทำ

A 
CT scan 
Diff 
Psoas Abscess 
สามารถเป็นจาก  osteomyelitis
Diverticulitis 
HIC 
Crohn
39
Q

MEth amp toxicity

A

Bug under skin High BP pupil dilate sweat agressive con

40
Q

Flat occiput, Anterior displacement right ear

Hx Breech

A

Postural deformity of neck

Congen torticollis head tolt to over side

41
Q

HIV become weird high bleed pressure
Anemia microcytic inc reticulocyte
low plat

more IX?

A

Peripheral blood smear
TTP- low ADAMTS 13, Inc VWFm ทำไห้เกิด clot inc bleeding time helmet schistocyte some time renal failure neyro fever

TX plasma exchange steroid retuximab

42
Q

indication for delivery

A

fetal tachy cardia 130/min

not UTI strep infection

43
Q

Alzheimer AF stop coagulation
Brain lesion on parietal ใหญ่ๆ ยาวๆๆ

คือ

A

Amyloid angiopathy === alzheimer

44
Q

Cramping + heavy bleeding passing pale mass
BHCG +
Empty endometrial

DX

A

complete abortion

45
Q

Moving around in sleep cant control kicking pushing over
Feel like loss or trap in wood
awake quickly and transient to become fully alert

A

rapid eye movement sleep behaviour disorder

46
Q

Generalized tonic clonic 28 yo women missing 2 dose then become seizure

what drug short acting

A

of alprazolam short BENZO withdrawal of benzo

Triazolam
midazolam
Oxazolam

47
Q

Asthma after excercise

tx

A

inhale albuterol 10 mins before excercise/ or leukotriene

48
Q

Lipid lowering agent

indication

A

DM 2 uncontrol + 40 yo

190 LDL

49
Q

Dignosis of liver failure

A

sign of hepatic encephalopathy
ALT AST +1000
INR > 1.5

50
Q

Epigastric To RLQ pain with WBC increase neutrophilเด่น
APPENDICITIS

TX

A

JUST do LAPAROSCOPIC APPENDECTOMY

ไม่ต้อง UTZ

51
Q

PID ดูว่ามี nausea vomiting, Pregnancy, tubo abscess

ไหม ถ้ามี กฌ admit

A

cefotetan, cefoxitin + Doxy

52
Q

APGAR 6

A

PEEP if HR <60 start chest compression

53
Q

DM neuropathy delay gastric paresis dysphagia hypogly

TX

A

small frequent meal + metochlopromide, erythromycin

54
Q

Adult APKD MCC cc

A

hepatic cyst

55
Q

AKI TX

A

IVF to prevent tubular necrosis

56
Q

24 yo women knee pain worse when climbing stair + cigarette BMI 26

A

TX extension of knee while compressing patella = compression test stretch thigh muscle = oatekki femoral pain syndrome squat and running

57
Q

Patella tendonitis

Clinical

A

jumper tender at inferior patella

58
Q

OSgood schlatter

Clinical

A

growth spur tender tibial tubercle

59
Q

Hypernatremia

IX

A

euvolumin = free water supplement
hypo volumic = symptomatic give 0.9% NSS until stable
Hypovolumic = not symptomatic = D5 water

60
Q

high serum osmole(+295)

DX

A

inadequate ADH/ nephrogenic DI

hypernat hypovolumia

61
Q

64 yo Abdomen distend +chemo + radiation, drink alcohol normal VS
JVP 9cm fluid wave hepatomegaly

DX

A

inelastic pericardium= จาก constrictive pericarditis จาก radiation
antracyclin

62
Q

36 yo DOB palpation retristernal pain + 3 วัน cold
DX: MI

TX

A

Aspirin ASAP inhibit TXA2 antiplatelet

63
Q 
18 mo
Rash ที่ mouth axillar  inguinal
otitis media 
T 39, BP 89/52 HR 145 RR 28
Flaccid erythematous slough perioral
A

Staph scalded skin
==+ nikolsky sign blister fever

Tx Vancomycin nafcillin

Strep - scarlet fever - no nikolsky sign จาก pharyngitis

64
Q

Motor accident s/p bowel repair 2 days post opt hypotension vasospasm

Blue finger

Caused from what?

A

Noepi + induce vasospasm + mesenteric ischemic vasospasm + abdominal pain

65
Q

Acute dystonia
Akathesia
Parkinson

TX

A

Benztropine

66
Q

Tardive dyskinesia
Mouth twitch

Tx

A

Valbenzine

67
Q

s/p appendectomy post pot 1 day icteric normal CBC increase tot bilirubin

A

Gilbert
low UDGO transferase
provoke by stress infection fasting surgery excercise

68
Q

Brain dead

A

no deep tendon reflex
EEG
Doppler UZ Angiography
Cerebral blood flow

69
Q

Ectopic pregnancy

IX:

A

Do TV UZ

Culdo only detect rupture ectopic

70
Q

PW sore throat dysphagia
odynophagia tonsin erythema

Approach

A

Viral - conjunctivitis rhinorrhea oral ulcer supportive

Bacterial palate petechiae exudate edema
ทำ rapid antigen test ถ้า - รอ culture/ ถ้า + คือ strep pharyngitis treat โดย amoxicillin

71
Q

Androgen insensitivity

Chromosome
clinical

A 
X link of androgen 
46 XY ( no menses girl)

Absent uterus upper vagina crypto testes
minimal pubic hair

72
Q

Mullarian agensis

Chromosome
Clinical ?

A 
46 XX
Hypoplastic mullarian 
Absent uterus upper vagina
Normal ovary
Normal pubic hair
73
Q

Transverse vaginal septum

A

malformation uro sinus Mullerian duct

Only abnormal vagina

74
Q

Born at home 5 day later brusibility

inc PT PTT

A

K def

75
Q 
19 yo (young) dry cough HA 
Weak rash on arm leg mild fever 
Erythema pharyngeal
interstitial marking 
Pleural effusion
A

Mycoplasma pneumonia

tx azithromycin

76
Q

32 yo ascending paralysis
Past med colorado Tick

IX treatment?

A

Meticulous search localized or more pronounce in 1 leg ต้องกอนเลือดเพื่อสร้าง toxin, no autonomic like GB

77
Q

Celiac มี fecal fat

what test

A

Xylose test

78
Q

Heat stroke

tx?

A

ice immerse fluid electrolyte no antipyretic

79
Q

2 month anterior wall MO
Now DOB extertional dyspnea มี Deep q wave I, Avl, V2-5st elevation

DX?

A

ventricular aneurysm

80
Q 
S/P MI 
1wk
2wk
1mo
3mo
5-3month 
CC?
A 
1wk- septal rupture, papillary muscle rupture
2wk- free wall rupture
1mo- angina
3mo- pericarditis
5-3month - ventricular aneurysm
81
Q

Esterogen therapy
require more : tyroxin
because

A

Estrogen increase TGB

82
Q

steroid therapy
require ledd tyroxin
because

A

Steroid dec TGB?

83
Q

Right HA around Eye 2 hr
Halo sign
non reactive dilate pupil
Erythematous lacrimation VA dec

DX

A

Acute angle glaucoma

40+ yo asian

84
Q 
Milk alkali 
constipation
Abdominal pain
urinary frequency 
Thirst
A

Milk alkali hypercalcemia
renal vasoconstriction
inhibit NaKcl inhibit ADH

85
Q

if stable + FAST ทำอะไรต่อ

A

CT scan

86
Q

Centricular premature complex + syncope episode

A

Reentrant ventricular arrhythmia

87
Q

12 month baby vomit diarrhea fever

A

fluid 20 ml/kg/ PNSS

D5 not use for resus

88
Q

Bipolar become psy given first gen antipsychotic
มีfever high BP

dopamine

A

neuroleptic malignany syndrome

89
Q

24 yo dry cough 2 mo backpain
pulmonary nodule
- retroperitoneal lymphadenopathy

A

Do scrotal UTZ จาก testical Ca 15-35 yo
unilateral painless testical nodule
AFP UTZ BHCG

90
Q

<25 yo sex active do swap for chlamydia + gonorrhea

A

cos it is asymptomatic

ทำ NAAT gold standard

91
Q

Tamponad

A

dec left ventricular preload

Usmle กู อย่างละ 100ข้อ (10 decks)

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