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Usmle กู อย่างละ 100ข้อ > usmle 2 ชุด 3 > Flashcards

usmle 2 ชุด 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

31 yo
low grade fever dry cough chest pain charpe during inhale/ cough knee pain
PHX: army + erythema nodule on shin
lower lobe infiltrate + hilum prominant

cause?

A

coccidoides immitis - arizona

  1. arthralgia
  2. erythema multiforme

tx : keto/ fluconazole

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2
Q

43 yo
Epigastric pain not relieved by antacid, sensation by heavy lifiting and take 10-15 mins to go away
PHx: SLE, Prednisolone, ECG normal

IX??

A

Excercise
ECG
atypical angina

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3
Q

35 yo
IV abused, right side weakness 2 hr
night sweat + malaise 7 d, 38.9C, BP 159/96, HR 112, RR 18

IX: MRI single infract MCA + vegetation Aortic value + regurgitation
AB + blood culture done

TX อะไรต่อ

A

continue current care + observation
Cardio embolic stroke - septic emboli
AB can help with infective endocarditis emboli –> no need heparin or aspirin

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4
Q 
65 yo 
temporal HA, visual disturbance, neck stiff
giant cell arthritis 
tx : compliance muscle weakness
difficulty climbing CK + ESR normal

DX อะไร

A

Drug induce myopathy

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5
Q

psy
althought i dont have evergy i still cant sleep and up most night i drag myself to work but cant get things done no motive
PHX: aggressive sleepless brillent idea

what is DX

A

Bipolar 1 acute depression
2nd generation antipsychotic = quetiapine, lurasidorn, Lamotrigine

Que lame larua

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6
Q

Family with APC

screen at

A

40 then repeat Q5 years

or 10 years before dx then Q5 years

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7
Q

IBD UC Crohn

screen?

A

8 years after DX then Q1-3 years repeat

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8
Q

Classic FAP

screen

A

Age 10 repeat 1 year

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9
Q

HNPCC

screen

A

Age 20 to the repeat Q 1-2 years

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10
Q

23 years african american
AB for UTI
now urine dark
+ prussian blue

what cause

A

G6PD
Oxidative stress
also from nitofuran

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11
Q

pulmonary emboli

Ca hemostasis ???

A

Alkalosis dissociation from albumin
causing CA to bind
= hypocalcemia
increase affinity of albumin fro Ca

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12
Q 
22 yo fever sore throat malaise 
2 week honduras travel
38.8 C
130/70
110
tonsil enlarge + white exudate
\+ supraclavicular lymph + axillary lymph + anemia
มี low WBC @@@@@

what DX?

A

EBV
AHA + throbocytopenia
cross reactivity AC to RBC platelet
= hemolysis and inc rt count

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13
Q

9 month old
swell hand feet 38.3 restricted movement soft tissue swelling
+ adopt จาก nigeria

DX?

A

sickle cell dactylitis
microvascular occlusion

tx: hydration

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14
Q

pseudogout

A

constipation fatigue calcium stone

narrow joint + calcified in between

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15
Q

Ducchene

IX: gold standard

A

do genetic testing not muscle biopsy @@

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16
Q

26 yo
red watery eye tearing
granular conjunctive chemosis follicular
PHX wheeze

dx:?

A

allergic rhinitis

If viral = sandy gritty burning follicular bumpy like allergic

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17
Q

23 yo
injury anterior dilocation humerus
dmg axillary N.
what will happen

A

shoulder abduct weakness flat deltoid

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18
Q

84 yo 2 wk confusion weaker sleep move somnolent but arousable
strength 4/5 right
3/5 left
PHX: dementia

A

subdural hematoma = rupture bridging vein- elder alcoholic cerebral atrophy- acute HA + confusion + focal neuro def

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19
Q

Hypertrophy heart

Heart sound ?

A

systolic crecendo decrescendo = aortic stenosis

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20
Q

32 yo ADHD trouble since kid
forgetfulness distract disorganiz impulse
PHX coccain opoid abuse
tx?

A

ATOMOXETINE = non stimulat = noepi reuptake inhibitor/ non addictive

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21
Q 
26 yo
 agitate  distract strike nuse
VS 37.2/160/90 / 126/18
pupil normal rigid upper extremity
\+ nystagmus 
tx?
A

Benzo

เกิดจาก phencyclidine

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22
Q

36 yo G3P2 15wk AOG UTZ at 13 wk
มี nuchal thickness
IX:??

A

amniocentesis

15-20 karyotyping diagnosis
10-13 choriocenthesis

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23
Q

40 yp G 1 P 2
35 wk AOG
uterine contraction + asymptomatic strep to

TX?

A

reassure + discharge

penicillin only at labor + 37 wk aog
Given before it will regrow anyway so no point

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24
Q

women who just got break up
(-) RH not alloimmunized given
what to do

A

give Anti D immunoglobulin at 28-32 wk

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25
Q 
15 mo old boy teething 
nasal congest low grade fever 
given acetaminophen + numbing cream
now cyanosis nail finger
PHX: bronchitis 
VS 90/60 158 30
pulse Ox 86
from what
A

Normal arterial partial pressure of O2 = methemoglobinemia จาก topical anesthetic dapsone nitrite
TX mythylene blue NADPH electron acceptor

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26
Q

kidney stone = what

A

calcium oxalate

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27
Q

RTA + hyperparathyroid ?

A

calcium phosphate stone

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28
Q 
23 yo red colored urine 
ABdominal pain, nausea 
VS 38.3 120/80 102 16 tender RUQ
lab- anemia MCHC 46(high) MCV 88(normal) RT increase (autoimmune PNH)
(LOWRT = leukemia, aplastic, infection)
A

hereditary sperocytosis - congen RB defect

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29
Q

55yo
low grade fever tooth extraction MR + mobil mass
what cause

A

strep sanguinis อยู่ใน viridan group

S. mitis S oralis S mutan S sobrinus S millen

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30
Q

40 wk AOG
2 days cold sore chicken pox on mum
small blanching erythema papule pustule all except palm + sole

TX

A

reassure erythema toxicum neonatum

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31
Q

pupil large no corneal reflex, ptosis nystagmus rotational @@
no gag reflex loss temp sensation face and opposite trunk=
where is the lesion

A

lateral medullar

vertebral artery

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32
Q

hypoglossal hemiplegia

A

ASA > medial medullar

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33
Q

weak masticator jaw jerk no no position tactile face

A

chew pon lateral @@

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34
Q

hemifacial trunck ataxia

A

medial pon

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35
Q 
4 yo 
itching private part 
PHX UTI atopic dermatitis++ spare groin genital
perianal excoriation 
dry antecubital popliteal fossae
what infection?
A

helminth infection
enterobius

TX albendazole

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36
Q

36yo
G2P1
32 wk AOG
back pain radiate down to LE increase at the end of the day ankle edema wide gait

tx?

A

reassure conservative
exagerate lordosis

progesterone joint laxity
dec lumbar support

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37
Q

15 yo multiple otitis media pneumonia

low CD4 CD8 all IgG what DX?

A

Bruton

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38
Q

15 yo multiple otitis media pneumonia

normal B cell count but all all IG

A

common variable disease

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39
Q

2 days old
jaundince large tongue horseness
what cause

A

thyroid dysgenesis

40
Q

prolong QRS TX? mechanism

A

NaHCO3, Sodium carbonate help
allevate depression action on myocardium sodium channel

TCA inhibit fast sodium channel in HIS PERKINJI fiber

41
Q 
34 yo
3 wk B symptom HIV CD 80 missouri
\+ scatter lung crackle 
bilateral nodular opacity
hilar lymph urine histoplasma
what TX ?
A

itraconazole or ampho B

42
Q

HIV cryptococcus tx?

A

flucytosine

43
Q

psy

performance anxiety restrict to social fear of embarrasing

A

social anxiety disorder

44
Q

30yo floating spot BOV
PHX penetrating injury visual loss PE perilimbal flush
caused by ?

A

caused by uncovering hidden antigen
sympathetic opthalmia eye injury
immune mediate inflame after injury

eg. uveitis blindness develop patho unknown

45
Q

Av block mobitz 2 1 AVnode progress and prolong

A

excercise atropine improve

vagal worsen

46
Q

AV block mobitz 2 2 below AV node constant prolong

A

atropine worsen vagal improve

47
Q

MDS but still depress
do what next
tx?

A

Bupropion or 2nd gen apriprazole/lithium thriodothyronine

Phenelzine = MOA CI with SSRI

48
Q

Trauma hard sign

A 
pulsatile bleeding 
bruit 
expanding hematoma
ischemia distal
no pulse
cool extremity

tx explore

49
Q

trauma soft sign

A

neuro
bony
no pulse
hx hemorrhage

IX? CT angio, Doppler UTZ, extremity index

50
Q

66 yo
Ha, insomnia, Vomiting
PHX: COPD, HNT, Lipidemia

puncture wound 1 wk piror + ciprofloxacin
other tiotropium salmeterol theophyllin

BP 150/80, 115,18
dec breath sound + MAT single ventricular beat

what cause

A

Throphyllin toxicity - met by Chy- Ciprofloxacin inhibit C450

51
Q

Risperidone

mode of action

A

Block serotonin 2 A + Dopamine D2 receptor= dec extrapyrimidal side effect = prolactinoma

52
Q

Blood transfusion

side effect

A

Anaphylactic = minute -wheeze shock uticaria - recipent IgA Ab tx: washed RBC + intramuscular Epinephrine
Lung injury - 6 hr- RDS- leukocyte Ab
primary hypotension- minute = Angiotensin converting enzyme inhibitor = xbradykinin
ABO mismatch - chill fever flank pain
Febrile non hemolytic - 1-6 hr leukocyte release cytokine

53
Q

variable decel cause

A

cord compress
oligo
prolapse cord

tx maternal repositioning
amnioinfusion

54
Q

23 yo lower back pain morning stiffness over hour reduce flexion of spine + tender sacral
IX?

A

Xray of sacroiliac
ankylosing spondilytis
not HLAV7 มีแต่ 5% positive = non specific

55
Q

3yo oral pain 2 sinus infection + cellulitis + periodental inflammation
from what?

A

leukocyte adhesion no pus omphalitis

poor healing + neutrophil

56
Q

46 yo
Adult cellulitis IV drug Hep C, septic arthritis
Alcohol 1 pint/day
2 days later improve + มี delusion + diaphoresis
what TX?

A

Lorazepam

57
Q

64yp
Dry cough wt loss pain right arm
PHX travel
CT ,ี rt upper lung lesion

A

superior pulmonary sulcus tumor + horner atrophy of intrinsic muscle hoarseness

58
Q

Dx malignant hypertension + papilledema + retinal hemorrhage or cerebral edema + non locaized neuro sign - vomiting confusion

A

hypertensive encephalopathy

59
Q

Cehcet

A

painfulmouth + genital ulcer

60
Q

SLE

A

non painful mouth ulcer + swell hand wrist + stiff 15 mins morning stiff, weakness lymphadenopathy low PLT, 2 proteinuria UA
Migratory no joint destruction

61
Q

psy
i am losing my mind
accident to small child when driving
what tx?

A

serotonin - OCD first line

fluoxitine fluvoxamine citralopram

62
Q

left scrotal mass 22 yo
can be compressed by SMA = above testis not transluminate inc size during valsava

what cause?

A

dilation of pampiniform plexus = dec insupine position

tx : ligation in youngage

63
Q

open heart surgery coronary bypass grafting
= tamponade after
inc diastolic pressure
IX?

A

2Decho urgernt

64
Q

Pregnant
Active varicella herpes simplex
gold standard

TX

A

CS

HSV need prophylaxis acyclovie calacyclovir at 36 wk AOG

65
Q

37 yo sudden SOB HX ms use wheel chair + saccadic speech - reduce breathsound + dull on left lower lung
DX:??

A

PE

66
Q

HIV 200+ CD can get varicella live attenuate

other? what are vaccine

A

HIB
TET
HEB B
PV

67
Q

COPD with dyspnea cough no need fever sputum need what

TX

A

AB azothro gluoro amoxi clav

no need culture

68
Q

64 yo chest pain knife like

DX dissection + DOB cant lie flat

A

Aortic valvue insufficency from HT marfan coccain other tamponad stroke mi

69
Q

67 yo B symptom
Hypothyroid HT gout early satiety from splenomegally
HB 8.6 Plt 268 Leuko 42800

what DX?

A

CML
chromosome 22 tyrosine kinase
imantinib

70
Q

AML caused by

A

DNA methylation mutation

71
Q

vaccine for HIV

A

PCV13
TD
Varicella
Hep B + influenza

Hib not helpful cos non typable -> infect
no meningicoccal

72
Q

intergluteal swell pain bloog ting + coccyx tip tenderness + purulent + nofever not abscess r/o

DX?

A

Pilonidal disease - obese sedentary life style

infect hair follical

73
Q

Hidradenitis

A

dissecting folliculitis armpit + inguinal scalp

painful + brown deformity

74
Q 
2 yo
Bruise anemia posterier cervical lymph 
LAB
low WBC, low Plt, low CBC
what
A

aplastic anemia from

  1. chloram
  2. benzene
  3. radiation
  4. insecticide
75
Q

Fanconi?

A

hyperpigmented on trunk neckcafe
hypogonad skeleton deformity
pancytopenia at 4 yo@@

76
Q

Diamon Black

A

only RBC dec reticulocyte brith -3mo of life

77
Q

if + URTI
anemia bone pain
DX?

A

AML in adult

78
Q

4 mo hold bottle then drop on the ground + black butt

DX?

A

congenital dermal melanocytosis
mongolian spot
benign reassure

79
Q

cutaneous stigmata?

A

dimple on sacral DX sacral UTZ

80
Q

elder decrease REM dec slow wave
diff falling asleep monitoring sleep

tx

A

reassurance

81
Q

Pink skin

A

co poisoning

82
Q

45yo
excess hair growth hyppothyroid on levothyroxin
BMI 24 ths normal
IX?

A

DX DHEA + Testosterone

low DHEA, increase testosterone = ovarian Ca

CHEA increase adrenal tumor

83
Q

27 yo G1P0 28 AOG
no felt movement doppler no fetal heart
IX?

A

abdominal ultrasound
must confirm with ultrasound first before Dx

next step\ do fetal autopsy plcental evaluation + karyotype + APS

84
Q

severe pre eclampsia

A 
crea 1.1
PT <100k
transaminitis
visual 
PE

use hydralazine

85
Q

LEgpain numbness hair spare distal pulse deminish
lgiht touch sensation deminish weakankle flex

what to do

A

heparin

not doppler

86
Q 
19 yo
BMI 15 
low BP
low pulse  low body temp
electrolyte imbalance

what to do

A

admit nutritional rehab + psychotherapy

87
Q

1 mo holo systolic VSD

what to do

A

Echo to determine size location

1cm small can close before 2 years

88
Q

DKA extracellular shift K

what to do

A

1 IV
2 insulin
3K
4 bicarb

89
Q

Linear association

A

do not analysis cos of confounding

90
Q

39 yo
hip pain
cant lie on right side pain on outer surface smoke HT lipidemia pain when pressure apply
DX?

A

trochanteric bursitis

91
Q

Aortolliac peripheral vascular

A

thigh hip pain claudication erectile dysfunction

from excercise

92
Q

67yo
HA coronary bypass 7y
BP 184/120 upper AB systolic diastolic bruit
dx?

A

Renal artery stenosis
resistance HT >3 region
DX renal duplex UTZ AT angio

93
Q

omeprazole + laryngeal erosion

A

8wk

94
Q

DM prognosis ?

A

serum anion gap + beta hydroxy butyrate

use nitroprusside test to detect acetone acetoacetate

95
Q

1mo
bloody stool eczema vomiting
milk protein induce enterocolitis

A

milk protein induce enterocolitis

tx
non diary or soy
use hydrolyzed formula

96
Q

achilles reflex can be absent when inc age dont confuse with MS

A

old ppl stuffs

97
Q

78 yo
urinary incontinence + disorient
IX?

A

UA culture to r/o UTI

to check for stress uridynamic

Usmle กู อย่างละ 100ข้อ (10 decks)

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