usmle 2 ชุด 3 Flashcards
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?
coccidoides immitis - arizona
- arthralgia
- erythema multiforme
tx : keto/ fluconazole
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??
Excercise
ECG
atypical angina
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
continue current care + observation
Cardio embolic stroke - septic emboli
AB can help with infective endocarditis emboli –> no need heparin or aspirin
65 yo temporal HA, visual disturbance, neck stiff giant cell arthritis tx : compliance muscle weakness difficulty climbing CK + ESR normal
DX อะไร
Drug induce myopathy
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
Bipolar 1 acute depression
2nd generation antipsychotic = quetiapine, lurasidorn, Lamotrigine
Que lame larua
Family with APC
screen at
40 then repeat Q5 years
or 10 years before dx then Q5 years
IBD UC Crohn
screen?
8 years after DX then Q1-3 years repeat
Classic FAP
screen
Age 10 repeat 1 year
HNPCC
screen
Age 20 to the repeat Q 1-2 years
23 years african american
AB for UTI
now urine dark
+ prussian blue
what cause
G6PD
Oxidative stress
also from nitofuran
pulmonary emboli
Ca hemostasis ???
Alkalosis dissociation from albumin
causing CA to bind
= hypocalcemia
increase affinity of albumin fro Ca
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?
EBV
AHA + throbocytopenia
cross reactivity AC to RBC platelet
= hemolysis and inc rt count
9 month old
swell hand feet 38.3 restricted movement soft tissue swelling
+ adopt จาก nigeria
DX?
sickle cell dactylitis
microvascular occlusion
tx: hydration
pseudogout
constipation fatigue calcium stone
narrow joint + calcified in between
Ducchene
IX: gold standard
do genetic testing not muscle biopsy @@
26 yo
red watery eye tearing
granular conjunctive chemosis follicular
PHX wheeze
dx:?
allergic rhinitis
If viral = sandy gritty burning follicular bumpy like allergic
23 yo
injury anterior dilocation humerus
dmg axillary N.
what will happen
shoulder abduct weakness flat deltoid
84 yo 2 wk confusion weaker sleep move somnolent but arousable
strength 4/5 right
3/5 left
PHX: dementia
subdural hematoma = rupture bridging vein- elder alcoholic cerebral atrophy- acute HA + confusion + focal neuro def
Hypertrophy heart
Heart sound ?
systolic crecendo decrescendo = aortic stenosis
32 yo ADHD trouble since kid
forgetfulness distract disorganiz impulse
PHX coccain opoid abuse
tx?
ATOMOXETINE = non stimulat = noepi reuptake inhibitor/ non addictive
26 yo agitate distract strike nuse VS 37.2/160/90 / 126/18 pupil normal rigid upper extremity \+ nystagmus tx?
Benzo
เกิดจาก phencyclidine
36 yo G3P2 15wk AOG UTZ at 13 wk
มี nuchal thickness
IX:??
amniocentesis
15-20 karyotyping diagnosis
10-13 choriocenthesis
40 yp G 1 P 2
35 wk AOG
uterine contraction + asymptomatic strep to
TX?
reassure + discharge
penicillin only at labor + 37 wk aog
Given before it will regrow anyway so no point
women who just got break up
(-) RH not alloimmunized given
what to do
give Anti D immunoglobulin at 28-32 wk
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
Normal arterial partial pressure of O2 = methemoglobinemia จาก topical anesthetic dapsone nitrite
TX mythylene blue NADPH electron acceptor
kidney stone = what
calcium oxalate
RTA + hyperparathyroid ?
calcium phosphate stone
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)
hereditary sperocytosis - congen RB defect
55yo
low grade fever tooth extraction MR + mobil mass
what cause
strep sanguinis อยู่ใน viridan group
S. mitis S oralis S mutan S sobrinus S millen
40 wk AOG
2 days cold sore chicken pox on mum
small blanching erythema papule pustule all except palm + sole
TX
reassure erythema toxicum neonatum
pupil large no corneal reflex, ptosis nystagmus rotational @@
no gag reflex loss temp sensation face and opposite trunk=
where is the lesion
lateral medullar
vertebral artery
hypoglossal hemiplegia
ASA > medial medullar
weak masticator jaw jerk no no position tactile face
chew pon lateral @@
hemifacial trunck ataxia
medial pon
4 yo itching private part PHX UTI atopic dermatitis++ spare groin genital perianal excoriation dry antecubital popliteal fossae what infection?
helminth infection
enterobius
TX albendazole
36yo
G2P1
32 wk AOG
back pain radiate down to LE increase at the end of the day ankle edema wide gait
tx?
reassure conservative
exagerate lordosis
progesterone joint laxity
dec lumbar support
15 yo multiple otitis media pneumonia
low CD4 CD8 all IgG what DX?
Bruton
15 yo multiple otitis media pneumonia
normal B cell count but all all IG
common variable disease
2 days old
jaundince large tongue horseness
what cause
thyroid dysgenesis
prolong QRS TX? mechanism
NaHCO3, Sodium carbonate help
allevate depression action on myocardium sodium channel
TCA inhibit fast sodium channel in HIS PERKINJI fiber
34 yo 3 wk B symptom HIV CD 80 missouri \+ scatter lung crackle bilateral nodular opacity hilar lymph urine histoplasma what TX ?
itraconazole or ampho B
HIV cryptococcus tx?
flucytosine
psy
performance anxiety restrict to social fear of embarrasing
social anxiety disorder
30yo floating spot BOV
PHX penetrating injury visual loss PE perilimbal flush
caused by ?
caused by uncovering hidden antigen
sympathetic opthalmia eye injury
immune mediate inflame after injury
eg. uveitis blindness develop patho unknown
Av block mobitz 2 1 AVnode progress and prolong
excercise atropine improve
vagal worsen
AV block mobitz 2 2 below AV node constant prolong
atropine worsen vagal improve
MDS but still depress
do what next
tx?
Bupropion or 2nd gen apriprazole/lithium thriodothyronine
Phenelzine = MOA CI with SSRI
Trauma hard sign
pulsatile bleeding bruit expanding hematoma ischemia distal no pulse cool extremity
tx explore
trauma soft sign
neuro
bony
no pulse
hx hemorrhage
IX? CT angio, Doppler UTZ, extremity index
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
Throphyllin toxicity - met by Chy- Ciprofloxacin inhibit C450
Risperidone
mode of action
Block serotonin 2 A + Dopamine D2 receptor= dec extrapyrimidal side effect = prolactinoma
Blood transfusion
side effect
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
variable decel cause
cord compress
oligo
prolapse cord
tx maternal repositioning
amnioinfusion
23 yo lower back pain morning stiffness over hour reduce flexion of spine + tender sacral
IX?
Xray of sacroiliac
ankylosing spondilytis
not HLAV7 มีแต่ 5% positive = non specific
3yo oral pain 2 sinus infection + cellulitis + periodental inflammation
from what?
leukocyte adhesion no pus omphalitis
poor healing + neutrophil
46 yo
Adult cellulitis IV drug Hep C, septic arthritis
Alcohol 1 pint/day
2 days later improve + มี delusion + diaphoresis
what TX?
Lorazepam
64yp
Dry cough wt loss pain right arm
PHX travel
CT ,ี rt upper lung lesion
superior pulmonary sulcus tumor + horner atrophy of intrinsic muscle hoarseness
Dx malignant hypertension + papilledema + retinal hemorrhage or cerebral edema + non locaized neuro sign - vomiting confusion
hypertensive encephalopathy
Cehcet
painfulmouth + genital ulcer
SLE
non painful mouth ulcer + swell hand wrist + stiff 15 mins morning stiff, weakness lymphadenopathy low PLT, 2 proteinuria UA
Migratory no joint destruction
psy
i am losing my mind
accident to small child when driving
what tx?
serotonin - OCD first line
fluoxitine fluvoxamine citralopram
left scrotal mass 22 yo
can be compressed by SMA = above testis not transluminate inc size during valsava
what cause?
dilation of pampiniform plexus = dec insupine position
tx : ligation in youngage
open heart surgery coronary bypass grafting
= tamponade after
inc diastolic pressure
IX?
2Decho urgernt
Pregnant
Active varicella herpes simplex
gold standard
TX
CS
HSV need prophylaxis acyclovie calacyclovir at 36 wk AOG
37 yo sudden SOB HX ms use wheel chair + saccadic speech - reduce breathsound + dull on left lower lung
DX:??
PE
HIV 200+ CD can get varicella live attenuate
other? what are vaccine
HIB
TET
HEB B
PV
COPD with dyspnea cough no need fever sputum need what
TX
AB azothro gluoro amoxi clav
no need culture
64 yo chest pain knife like
DX dissection + DOB cant lie flat
Aortic valvue insufficency from HT marfan coccain other tamponad stroke mi
67 yo B symptom
Hypothyroid HT gout early satiety from splenomegally
HB 8.6 Plt 268 Leuko 42800
what DX?
CML
chromosome 22 tyrosine kinase
imantinib
AML caused by
DNA methylation mutation
vaccine for HIV
PCV13
TD
Varicella
Hep B + influenza
Hib not helpful cos non typable -> infect
no meningicoccal
intergluteal swell pain bloog ting + coccyx tip tenderness + purulent + nofever not abscess r/o
DX?
Pilonidal disease - obese sedentary life style
infect hair follical
Hidradenitis
dissecting folliculitis armpit + inguinal scalp
painful + brown deformity
2 yo Bruise anemia posterier cervical lymph LAB low WBC, low Plt, low CBC what
aplastic anemia from
- chloram
- benzene
- radiation
- insecticide
Fanconi?
hyperpigmented on trunk neckcafe
hypogonad skeleton deformity
pancytopenia at 4 yo@@
Diamon Black
only RBC dec reticulocyte brith -3mo of life
if + URTI
anemia bone pain
DX?
AML in adult
4 mo hold bottle then drop on the ground + black butt
DX?
congenital dermal melanocytosis
mongolian spot
benign reassure
cutaneous stigmata?
dimple on sacral DX sacral UTZ
elder decrease REM dec slow wave
diff falling asleep monitoring sleep
tx
reassurance
Pink skin
co poisoning
45yo
excess hair growth hyppothyroid on levothyroxin
BMI 24 ths normal
IX?
DX DHEA + Testosterone
low DHEA, increase testosterone = ovarian Ca
CHEA increase adrenal tumor
27 yo G1P0 28 AOG
no felt movement doppler no fetal heart
IX?
abdominal ultrasound
must confirm with ultrasound first before Dx
next step\ do fetal autopsy plcental evaluation + karyotype + APS
severe pre eclampsia
crea 1.1 PT <100k transaminitis visual PE
use hydralazine
LEgpain numbness hair spare distal pulse deminish
lgiht touch sensation deminish weakankle flex
what to do
heparin
not doppler
19 yo BMI 15 low BP low pulse low body temp electrolyte imbalance
what to do
admit nutritional rehab + psychotherapy
1 mo holo systolic VSD
what to do
Echo to determine size location
1cm small can close before 2 years
DKA extracellular shift K
what to do
1 IV
2 insulin
3K
4 bicarb
Linear association
do not analysis cos of confounding
39 yo
hip pain
cant lie on right side pain on outer surface smoke HT lipidemia pain when pressure apply
DX?
trochanteric bursitis
Aortolliac peripheral vascular
thigh hip pain claudication erectile dysfunction
from excercise
67yo
HA coronary bypass 7y
BP 184/120 upper AB systolic diastolic bruit
dx?
Renal artery stenosis
resistance HT >3 region
DX renal duplex UTZ AT angio
omeprazole + laryngeal erosion
8wk
DM prognosis ?
serum anion gap + beta hydroxy butyrate
use nitroprusside test to detect acetone acetoacetate
1mo
bloody stool eczema vomiting
milk protein induce enterocolitis
milk protein induce enterocolitis
tx
non diary or soy
use hydrolyzed formula
achilles reflex can be absent when inc age dont confuse with MS
old ppl stuffs
78 yo
urinary incontinence + disorient
IX?
UA culture to r/o UTI
to check for stress uridynamic
