usmle 2 ชุด 4 Flashcards
16yo pruritic red back and chest
PHX viral
red on the back
pityriasis rosea
heral patch
scatter oral to trunk= christ mas tree
erythemamultiform = target
Erythema marginatum = ring like irrgular margin \ RF
Abortion with fracture of baby
hypoplastic thoracic
osteogenic imperfecta type 2
kid suicide
inform parent + hospitalized him without parent consent
cutaneous larva migran
bare foot on sand ancylostomas
tx?
ivermectin
trastuzumab
ix?
heart do echo
21 yo male SOB wheeze mediastinal mass
+ HCB AFP
mixed germ cell tumor
non seminoma
Pancreatitis + gall stone no obstruction
no gall bladder thickening
what tX?
Lap chole
pancreatitis > 150 alanine SGPT
42 yo IV abuse
dark urine + jaundice
BMI 30 alkaline phosphatase
best next step?
UTZ abdomen
Hyperbilirubin
unconjugate - criger gilbert drug hemolysis
conjugate =
inc ast alt = hepatitis,
all normal = rotor + dubin
alkaline phos increase = chole, malignancy, sclerosing cholangitis
do CT or UTZ antimitochondrial
elevator phobia
exposure therapy first time
68yo CHF + Low Na low CO dec renal afferent perfusion increase renin noepi ADH increase water resorption
Dilutional hyponatremia
Bilat butt pain 78 yo
worse during ambulation
improve when lean or sitting
osteoarthritis of spine
spinal stenosis
painrelieve with flexion
thicken flavum, OA
Spondyloarthro
ankylosing
pain during rest + relief when walk
7 mo Grief + depress
TX?
Mirtazapine SSRI + psychotherapy
Asthma impending failure
citeria
1 absent breathsound
2 absent wheeze
3 dec conscious
4 cyanosis need ET
cc bacterial meningitis
MCC complication
hearling lloss - intelectual disability epilepsy, ADHD, absence
man i am not suprise it come to this paranoid + mood swing increase BP, tremor dilatr pupil
what cause
coccain abuse
if PCP- nystagmus
62yo s/p pancreatectomy + RBC 12 hr later
dec o2 sat dec BP bibasal crackle ab distend dec bowel sound CI dec
wedge increase
what happen
MI = cardiogenic shock
38 yo stiff neck trap muscle
shoulder lower back pain difficulty sleeping
normal Crea, ESR
TX?
amityptylin - TCA
22 yo s/p apendectomy \+ acetaminophen + fasting 2 days jaundice tot bili 3.3 direct 0.7
inc urinconjugate
what to do
reassure - gilbert
systemic sclerosis
schistocyte
MI drug eluded stent
give P2y12 receptor blocker
clopidogrel, prasugrel, ticagrelor
+ aspirin
ACEI, ARB, bblocker, statin
47 yo
lower ab pain
inc urination + dysparyunia
Ua normal
what DX
interstitial cystitis
associated with fibromyalgia + psy
Exudate light citeria what?
Protein >0.5
LDH > 0.6
CHF = if given diuretic can also present as exudate (25%)
Transudate = pH 7.4-7.55- CHF Most time (pleural fluid PH <7.33)
Barium swallowing
dilate esophagus with smooth tapering
what next step
do endoscope evaluation to r/o pseudoachalasia - ca increase with intake alcohol >60yo
26yo
step on nail
what can occur
pseudomonas < osteomyelitis
gout most tx effective
alcohol cessation
sickle cell MCC cc
hematuria จาก sickling in renal medulla
can also have nocturia polyuria
Isostheuria imprie concentrating
Back pain-
phx ankylosing spondylitis
lumbar tender range of motion restrict
what occured
vetebral fracture
assocoated with osteoporosis + spinal rigid
Asthma - horseness in the morning sorethroat need albuteral after meal
what tx?
add omeprazole for GERD
caustic ingestion
approach
ABC
Decontamination
CXR
Endoscopy
3-4 days after perforation do serial ab xray
schizo akathisia restless
more arouse
TX?
dec antipsychotic do not discontinue
+add propanolol / or lorazapam
65 yo
1 day swell face + fever DM3 years
PE warm tender erythema to external ear well dermacrated + lymph
what cause
Group A strep also erysipelas
tx: ceftri cefazolin amox
poor dentition poor wound healing alcohol arthralgia
what cause
Vit C def
PCP intox TX?
Lorazepan
not haloperidal
38yo
HIV fever vomiting supple neck no neuro defect
but papilledema
what cause
crytococcus <100 CD4
AmphoB
+ flucytosine then fluconazole
Clozapine what is that
2nd antipsychotic treatment resist schizophrenia
SE: agranulocytosis
post partum hemorrhage
TX?
bimaunal massage oxytocin fluid uterotonic - misoprostal methylgonovin baloon tamponad embolized uterine A. THABSO
36yo G1P0 38AOG
hearvy vaginal bleed s5 pack /year smoker
158/96,112,FH 140 , +3urine protein
CC?
placenta abruption จาก preeclampsia + DIC
howthorn effect
subject know being monitored change behaviour
16 yo heavy vaginal bleeing LMP 4 month ago
BP 110/60,90
blood active bleeding
Hgb 10, MCV 76
hemodynamic stable
TX?
high dose OCP not curretage -only do this when unstable VS
ITP TX?
observe if petechiae skin only if bleed ไห้ IgG or steroid
pamphigus vulgaris
intraepidermial IgG deposit Desmoglein 1+3 Acantholysis
5yo
refuse to answer little shy fine by herself
selective mutism
2 hour after transfusion 3837
from?
should have use leukocyte reduction
febrile non hemolytic
irradiated RBC
ไห้ใน transplant blood donated by relative immuno def
Leuko def
ไห้ใน chronic transfusion
CMV HIV ptx
febrile non hemolytic reduce HLA
Washed
ไห้ใน IgA def
complement dependent auto immune hemolytic anemia
antihis /allergy or on going
Olanzapine
before giving do what?
check FBS + lipid
ziprasidone
before giving do what?
ECG QT prolong
risperidone
before giving do what?
Prolactin
neonatal conjunctivitis
use oral erythemycin
chlamydial purulent discharge watery after 5 days of life
sivenitrite irritant
lubricate
conococcal swell eye lid purulent before 5 days of life
IM ceftri cefotaxime
55yo
difficulty sleeping take wine before sleeping
dec concentration + mild tremor
Hb 11 MCV 106 AST 80 ALT 42
DX?
DX alcoholic disorder
67 yo tremor diff with daily activity bottoning intention + mild head tremor
upper extremity
DX
TX
Essential tremor
tx propanolol primidone clonazepam
62 yo leg pain จาก excercise then swell calf + ankle BMI 41
PE Gastronemius medial head tender ecchymosis medial malleolus
- rupture popliteal cyst
–>extrusion of baker cyst
semimembrane + gastronemius –>meniscal teal –> OA
65 yo
COPD
exacerbation prolong expire bilat wheezing
on lorazepam gen tonic clonic seizure from what??
carbondioxide retention
inc RR deep shallow breath slow inc PaO2, dec Co2, loss compensatory vasoconstriction reduce Co2 uptake by tissue
dec minut vent dec Co2 uptake from tissue VQ mismatch GOAL O2 90-93
suddn lose of vision no pain
BP 140/90 swell optic disc retinal hemorrhage + dilate tortouous vein cotton wool
DX?
central retinal vein occlusion
close angle = dilate pupil not reactive to light
optic neuritis - unilat severe pain women MS
45 yo myalgia weak proximal muscle 140/80 inc creatinine kinase sluggish ankle jerk ===what test to do
serum TSH T4 = hypothyroid not muscle biopsy slugghish ankle jerk on hypothyroid
38yo
3 wk wt loss nausea ab pain postural dizziness
prednisolone given
90/60, 96 bilat tonsil enlarge hyperpigment mucosal palmar creases vitilligo
+eosinophillia low 7 am cortisol what cosue
autoimmune adrenitis
malaria prophylaxis
mefloquine prophylaxis
until 4 wk after travel africa asia india
gall stone colic
elective lapchole
72hr cholecystectomy
- acute chole, choledochelelithiasis, gall stone pancreatitis
urgent dialysis
acidosis <7.1 electrolyte K>6.5 intox = methanol glycol salicylate lithium calporate overload uremia
24yo runner sharp pain at fore foot
stressfracture
plantar fasciitis = at plantar not dorsal = worsen in the morning
76 yo MI cath lab 5hr later
hypotension back pain
cold clammy skin neck vein flat
chest clear normal ECG
IX?
CT scan of pelvic Ab no n contrast
retroperitoneal hematoma also in dissection thrombosis AV fistula
cath within 12 hours
TX IV fluid + supportive
vomiting
elyte ?
hypokalemic hypochloremic met alkalosis
tx : PNSS + Potassium
Peritonsilar abscess hot potato trismus uvula deviation
TX?
Needle aspiration + AB
55yo
visual loss temporal field
difficulty look side way
craniopharyngioma - bitemp heminopsia in >20 yo ptx
19yo body dismorphic you distress about youor apperance seem to be causing you suffering interfer with your study
tx?
CBT + SSRI
16 yo left thight pain + sickle
TX
hydroxyurea
cc= myelosupression
31 yo G1P1
s/p CS 2 days
uterine firm tender foul smelling discharge
tx?
clindamycin + gentamicin
= endometriosis
60yo nausea ab pain painless purple mottling od skin both feet + eosinophilia
PHX cardiac catheter + cascular procedure
cholesterol emboli + AKI
1 day boy
cyanosis
continouous murmur not improve with 100% os
DX?
cocarctation open PDA by i protagladin E1 vasodilator
36 yo fever multiple joint pain IV heroin use sex worker no palmar sole inolve tender wrist + ankle nolymphadenopathy
DX
Gonococcal Disseminated
DX: NAAT synovial fluid
TX: ceftriaxone, emperic azithro or doxy (for chlamydial)
31yo knee pain low back pain recent UTI synovial WBC 10000 poly microb
+ mouth ulcer
tx: NSAID = reactive arthritis
21 yo
seizure + rhinorrhea
air fluid level
mucosal edema in paranasal sinus + ring on CXR
dx
viridan strep or staph A จาก sinusitis
tx emperic metro ceftri vanco
IX: CT aspiration for GS + culture
Phizophus ++ destructive no ring + DM risk factor
ankylosing spondilitis
butt pain in the morning = excercise TX
shoulder pain radiate to hand + bilat joint deformity RA inc C protein constrict drooping
IX?
CXR find pancoast tumor
Enoxaparin , fundaparinaus, rivarox (Xinhibitor) cant use in GFR 30ml/min will inc bleed soooo use what
unfractionated heparin instead INR 1.5-2
S?P operation give 0.45% saline + hyponat now give what
3% saline not 0.9% naa
29 yo knee pain
lytic epiphysis of knee
DX
giant cell tumor , soap bubble
os good - over use or rapid growth sprut
37 yo women
heavy vaginal bleed in first day
PHX curretage +1 pregnancy failure to conceived
DX?
dec ovarian reserve - dec egg quality dec estrogen dec inhibin increase FSH@@
do FSH test the function
54 yo
fatigue dizziness
nubm less sensitive to cold
pale conjunctivae - macrocytic anemia
gastric CA
B12 def
pernicious anemia
atropic gastritis
musculoskeletal + costochondritis sharp + sternal pain
TX?
reassure analgesic
renal transplant
tx
tmp smx prevent opportunistic PCP listeria toxo
Ua needle shape crystal
uric acid
lucent
IX?
–> need CT of abdomen to detect stone ileus
Renal stone
tX?
thiazide to reabsorb Ca
uric stone = allopurinal (hyperuricosuria)
