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Usmle กู อย่างละ 100ข้อ > usmle 2 ชุด 4 > Flashcards

usmle 2 ชุด 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

16yo pruritic red back and chest
PHX viral
red on the back

A

pityriasis rosea
heral patch
scatter oral to trunk= christ mas tree

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2
Q

erythemamultiform = target

A

Erythema marginatum = ring like irrgular margin \ RF

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3
Q

Abortion with fracture of baby

hypoplastic thoracic

A

osteogenic imperfecta type 2

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4
Q

kid suicide

A

inform parent + hospitalized him without parent consent

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5
Q

cutaneous larva migran
bare foot on sand ancylostomas
tx?

A

ivermectin

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6
Q

trastuzumab

ix?

A

heart do echo

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7
Q

21 yo male SOB wheeze mediastinal mass

+ HCB AFP

A

mixed germ cell tumor

non seminoma

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8
Q

Pancreatitis + gall stone no obstruction
no gall bladder thickening
what tX?

A

Lap chole

pancreatitis > 150 alanine SGPT

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9
Q

42 yo IV abuse
dark urine + jaundice
BMI 30 alkaline phosphatase
best next step?

A

UTZ abdomen

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10
Q

Hyperbilirubin

A

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

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11
Q

elevator phobia

A

exposure therapy first time

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12
Q 
68yo
CHF + Low Na 
low CO dec renal afferent perfusion 
increase renin noepi
ADH
increase water resorption
A

Dilutional hyponatremia

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13
Q

Bilat butt pain 78 yo
worse during ambulation
improve when lean or sitting
osteoarthritis of spine

A

spinal stenosis
painrelieve with flexion
thicken flavum, OA

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14
Q

Spondyloarthro

ankylosing

A

pain during rest + relief when walk

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15
Q

7 mo Grief + depress

TX?

A

Mirtazapine SSRI + psychotherapy

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16
Q

Asthma impending failure

citeria

A

1 absent breathsound
2 absent wheeze
3 dec conscious
4 cyanosis need ET

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17
Q

cc bacterial meningitis

MCC complication

A

hearling lloss - intelectual disability epilepsy, ADHD, absence

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18
Q

man i am not suprise it come to this paranoid + mood swing increase BP, tremor dilatr pupil
what cause

A

coccain abuse

if PCP- nystagmus

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19
Q

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

A

MI = cardiogenic shock

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20
Q

38 yo stiff neck trap muscle
shoulder lower back pain difficulty sleeping
normal Crea, ESR
TX?

A

amityptylin - TCA

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21
Q 
22 yo s/p apendectomy 
\+ acetaminophen + fasting 2 days 
jaundice 
tot bili 3.3
direct 0.7

inc urinconjugate
what to do

A

reassure - gilbert

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22
Q

systemic sclerosis

A

schistocyte

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23
Q

MI drug eluded stent

A

give P2y12 receptor blocker
clopidogrel, prasugrel, ticagrelor
+ aspirin

ACEI, ARB, bblocker, statin

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24
Q

47 yo
lower ab pain
inc urination + dysparyunia
Ua normal

what DX

A

interstitial cystitis

associated with fibromyalgia + psy

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25
Q

Exudate light citeria what?

A

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)

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26
Q

Barium swallowing
dilate esophagus with smooth tapering

what next step

A

do endoscope evaluation to r/o pseudoachalasia - ca increase with intake alcohol >60yo

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27
Q

26yo
step on nail
what can occur

A

pseudomonas < osteomyelitis

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28
Q

gout most tx effective

A

alcohol cessation

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29
Q

sickle cell MCC cc

A

hematuria จาก sickling in renal medulla
can also have nocturia polyuria
Isostheuria imprie concentrating

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30
Q

Back pain-
phx ankylosing spondylitis
lumbar tender range of motion restrict
what occured

A

vetebral fracture

assocoated with osteoporosis + spinal rigid

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31
Q

Asthma - horseness in the morning sorethroat need albuteral after meal

what tx?

A

add omeprazole for GERD

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32
Q

caustic ingestion

approach

A

ABC
Decontamination
CXR
Endoscopy

3-4 days after perforation do serial ab xray

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33
Q

schizo akathisia restless
more arouse
TX?

A

dec antipsychotic do not discontinue

+add propanolol / or lorazapam

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34
Q

65 yo
1 day swell face + fever DM3 years
PE warm tender erythema to external ear well dermacrated + lymph

what cause

A

Group A strep also erysipelas

tx: ceftri cefazolin amox

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35
Q

poor dentition poor wound healing alcohol arthralgia

what cause

A

Vit C def

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36
Q

PCP intox TX?

A

Lorazepan

not haloperidal

37
Q

38yo
HIV fever vomiting supple neck no neuro defect
but papilledema
what cause

A

crytococcus <100 CD4
AmphoB
+ flucytosine then fluconazole

38
Q

Clozapine what is that

A

2nd antipsychotic treatment resist schizophrenia

SE: agranulocytosis

39
Q

post partum hemorrhage

TX?

A 
bimaunal massage
oxytocin
fluid 
uterotonic - misoprostal methylgonovin 
baloon tamponad
embolized uterine A.
THABSO
40
Q

36yo G1P0 38AOG
hearvy vaginal bleed s5 pack /year smoker
158/96,112,FH 140 , +3urine protein

CC?

A

placenta abruption จาก preeclampsia + DIC

41
Q

howthorn effect

A

subject know being monitored change behaviour

42
Q

16 yo heavy vaginal bleeing LMP 4 month ago
BP 110/60,90
blood active bleeding
Hgb 10, MCV 76

hemodynamic stable

TX?

A

high dose OCP not curretage -only do this when unstable VS

43
Q

ITP TX?

A

observe if petechiae skin only if bleed ไห้ IgG or steroid

44
Q

pamphigus vulgaris

A

intraepidermial IgG deposit Desmoglein 1+3 Acantholysis

45
Q

5yo

refuse to answer little shy fine by herself

A

selective mutism

46
Q

2 hour after transfusion 3837

from?

A

should have use leukocyte reduction

febrile non hemolytic

47
Q

irradiated RBC

A

ไห้ใน transplant blood donated by relative immuno def

48
Q

Leuko def

A

ไห้ใน chronic transfusion
CMV HIV ptx
febrile non hemolytic reduce HLA

49
Q

Washed

A

ไห้ใน IgA def
complement dependent auto immune hemolytic anemia
antihis /allergy or on going

50
Q

Olanzapine

before giving do what?

A

check FBS + lipid

51
Q

ziprasidone

before giving do what?

A

ECG QT prolong

52
Q

risperidone

before giving do what?

A

Prolactin

53
Q

neonatal conjunctivitis

A

use oral erythemycin

chlamydial purulent discharge watery after 5 days of life

54
Q

sivenitrite irritant

A

lubricate

55
Q

conococcal swell eye lid purulent before 5 days of life

A

IM ceftri cefotaxime

56
Q

55yo
difficulty sleeping take wine before sleeping
dec concentration + mild tremor
Hb 11 MCV 106 AST 80 ALT 42

DX?

A

DX alcoholic disorder

57
Q

67 yo tremor diff with daily activity bottoning intention + mild head tremor
upper extremity
DX
TX

A

Essential tremor

tx propanolol primidone clonazepam

58
Q

62 yo leg pain จาก excercise then swell calf + ankle BMI 41

PE Gastronemius medial head tender ecchymosis medial malleolus

A
  1. rupture popliteal cyst
    –>extrusion of baker cyst
    semimembrane + gastronemius –>meniscal teal –> OA
59
Q

65 yo
COPD
exacerbation prolong expire bilat wheezing
on lorazepam gen tonic clonic seizure from what??

A

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

60
Q

suddn lose of vision no pain
BP 140/90 swell optic disc retinal hemorrhage + dilate tortouous vein cotton wool

DX?

A

central retinal vein occlusion

close angle = dilate pupil not reactive to light
optic neuritis - unilat severe pain women MS

61
Q 
45 yo 
myalgia weak proximal muscle 
140/80 
inc creatinine kinase 
sluggish ankle jerk ===what test to do
A

serum TSH T4 = hypothyroid not muscle biopsy slugghish ankle jerk on hypothyroid

62
Q

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

A

autoimmune adrenitis

63
Q

malaria prophylaxis

A

mefloquine prophylaxis

until 4 wk after travel africa asia india

64
Q

gall stone colic

A

elective lapchole

72hr cholecystectomy
- acute chole, choledochelelithiasis, gall stone pancreatitis

65
Q

urgent dialysis

A 
acidosis <7.1
electrolyte K>6.5
intox = methanol glycol salicylate lithium calporate
overload
uremia
66
Q

24yo runner sharp pain at fore foot

A

stressfracture

plantar fasciitis = at plantar not dorsal = worsen in the morning

67
Q

76 yo MI cath lab 5hr later
hypotension back pain
cold clammy skin neck vein flat
chest clear normal ECG

IX?

A

CT scan of pelvic Ab no n contrast

retroperitoneal hematoma also in dissection thrombosis AV fistula
cath within 12 hours
TX IV fluid + supportive

68
Q

vomiting

elyte ?

A

hypokalemic hypochloremic met alkalosis

tx : PNSS + Potassium

69
Q

Peritonsilar abscess hot potato trismus uvula deviation

TX?

A

Needle aspiration + AB

70
Q

55yo
visual loss temporal field
difficulty look side way

A

craniopharyngioma - bitemp heminopsia in >20 yo ptx

71
Q

19yo body dismorphic you distress about youor apperance seem to be causing you suffering interfer with your study

tx?

A

CBT + SSRI

72
Q

16 yo left thight pain + sickle

TX

A

hydroxyurea

cc= myelosupression

73
Q

31 yo G1P1
s/p CS 2 days
uterine firm tender foul smelling discharge
tx?

A

clindamycin + gentamicin

= endometriosis

74
Q

60yo nausea ab pain painless purple mottling od skin both feet + eosinophilia

PHX cardiac catheter + cascular procedure

A

cholesterol emboli + AKI

75
Q

1 day boy
cyanosis
continouous murmur not improve with 100% os

DX?

A

cocarctation open PDA by i protagladin E1 vasodilator

76
Q

36 yo fever multiple joint pain IV heroin use sex worker no palmar sole inolve tender wrist + ankle nolymphadenopathy

DX

A

Gonococcal Disseminated
DX: NAAT synovial fluid
TX: ceftriaxone, emperic azithro or doxy (for chlamydial)

77
Q

31yo knee pain low back pain recent UTI synovial WBC 10000 poly microb
+ mouth ulcer

A

tx: NSAID = reactive arthritis

78
Q

21 yo
seizure + rhinorrhea
air fluid level
mucosal edema in paranasal sinus + ring on CXR

dx

A

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

79
Q

ankylosing spondilitis

A

butt pain in the morning = excercise TX

80
Q

shoulder pain radiate to hand + bilat joint deformity RA inc C protein constrict drooping

IX?

A

CXR find pancoast tumor

81
Q

Enoxaparin , fundaparinaus, rivarox (Xinhibitor) cant use in GFR 30ml/min will inc bleed soooo use what

A

unfractionated heparin instead INR 1.5-2

82
Q

S?P operation give 0.45% saline + hyponat now give what

A

3% saline not 0.9% naa

83
Q

29 yo knee pain
lytic epiphysis of knee

DX

A

giant cell tumor , soap bubble

os good - over use or rapid growth sprut

84
Q

37 yo women
heavy vaginal bleed in first day
PHX curretage +1 pregnancy failure to conceived

DX?

A

dec ovarian reserve - dec egg quality dec estrogen dec inhibin increase FSH@@

do FSH test the function

85
Q

54 yo
fatigue dizziness
nubm less sensitive to cold
pale conjunctivae - macrocytic anemia

A

gastric CA
B12 def
pernicious anemia
atropic gastritis

86
Q

musculoskeletal + costochondritis sharp + sternal pain

TX?

A

reassure analgesic

87
Q

renal transplant

tx

A

tmp smx prevent opportunistic PCP listeria toxo

88
Q

Ua needle shape crystal
uric acid
lucent
IX?

A

–> need CT of abdomen to detect stone ileus

89
Q

Renal stone

tX?

A

thiazide to reabsorb Ca

uric stone = allopurinal (hyperuricosuria)

Usmle กู อย่างละ 100ข้อ (10 decks)

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