usmle 2 ชุด 5 Flashcards
RUQ pain + gas in gall bladder no gas in billiary tree
Crepitus abdomen
emphysematous cholecystitis
immune, DM, Vascular copmress
+ ecoli clostridium - gas forming
tx: emergent cholecystectomy
amphicillin + sulbactam - clostridium coverage
Follicular thyroid cancer
biopsy?
invasive of tumor capsule + hema spread
Papillary = pseudomoma Hashimoto = hurthle - large polygonal cell
65yo COPD exacerbate dec BP, neck vein dilate \+ trachea deviation breathsound absent = tx?
absent thoracostomy
penumothorax
reaction formation
unaccept loving during office visit
38 yo vilat wheeze + cough + crakle
clear lung field
Bronchitis
do supportive symptomatic treatment only
Cushing
moonface + central obesity + striae + glucose intolerance
from exo steroid, ACHTpituitary tumor, ectopic ACTH
TEST?
overnight low dose dexa suppresion test
late night cortisol salivary test
24hour urinary cortisol excretion
Adrenal insufficiency- hypotension, hypokalemia, hypogly
early morning cortisol can be overlap with cushing
primary hyperaldosterone
ratio plasma Aldosterone: Renin
pneumothorax
impair compress
ventricular filling
incontinence
type + patho
stress
urge
overflow
stress = sphincter tone dec, urethral hypermobil- multiparity, pelvic surgery, uretheral prolapse, cystocele- IX Qtip test post void resiidual , TX regel
URge= hyper destrusor
Overflow = impair destrusor contact, Bladder obstruct outlet
19 yo
sore throat sexual contact
38 c , erythematous pharynx + bilateral cervical lymph non tender
Ab tender lower quadrant
DX?
N. Gonorrhea
Women - normal uterus - no breast
inc FSH inc LH inc Testosterone ince Androstenedione
what occur
Aromatase def
mother become casculine baby osteoporosis in older age
overian hyper thecosis
post men
virilization insulin resist
dec LH dec FSH
dx?
solid appear ovary
5yo
sore throat +1mm vesicle on tonsil + greyish ulceration at posterior pharynx + lymph cervical bilat
what is it what cause
herpangina
coxsaki
6yo leg pain at night improve with massage + NSAID
tX?
reassure
growing pain at 2-12 yo
bilateral night time lower extremity
if>20yo think osteoma
Congenital melanocyte nevus
inc hair follicle + patch on upper - may grow and 5% melanoma
Congenital dermal melanocytosis
lower back sacrum + fade in time -regress
Liver cirrhosis + low BP Ascites Pitting edema Dec Na inc K low urine sodium due to
renal hypoperfusion
hepatorenal syndrome
prerenal azothemia
inc cream dec Na urine
MDS stop med for relationship then got worsen
tX?
restart paroxitine + gradual taper
39 wk G4P0 Abort 3 at 35wk AOG
due to leiomyoma now contact ! 2min 45sec each mod variability variable deceleration
TX?
Abdominal myomectomy with uterine cavity entery done
do not do vaginal labor
do CS in intramural or submucosal
Stable Angina Med
B blocker
nitrite
Ranolazine dec myocardial Ca influx
Dihydro CCB dec afterload
HIV bilat infiltration O2 80% CD4 160 tx ?
TMP SMX corticosteroid(PaO2 <70mmHg, A-a gradient >35 mmhg)
pneumocystis pneumonia
Abortus + mum engorge breast
tx
NSAID
DM + Ht ( 144/87)
+3 UA protein
tx?
intensive BP control to reduce Nephro complication
no glycemic intense = hypoglycemia > heart cc
25 yo G2P1 32 AOG \+ PID + Abruption placenta + weak pedia pulse low cardiac output dec wedge inc systemic low BP
DX?
hypovolumic shock
Central retinal artery occlusion embolism
painless LOV
tx?
ocular massage = anterior chamber paracentesis, hyper O2 chamber
SLE
low what
LOW C3 C4
ขาดำๆ เสก็ดๆ
venous hypertension = stasis dermatitis
== xerosis lipodermatosclerosis
Glaucogonoma - skin central clearing crusting scaling boarder
DX?
Necrolytic migratory erythema
4yo
squirt L eye proptosis ( left tumor unilateral eye) esotropia optic disc pallor ( optic n atropy) cafe aulait
optic glioma
NF1 Lish nodule
Chronic illness + pericholecystic fluid involve infection ischemia
DX
TX
acalculus cholevystic
tx percutaneous cholecystectomy
Schizoaffective ?
MDS manic schizo/ time of delusion hallucination
แต่ต้องมี 2wk with out MDS
HIV diarrhea
IX
stool examination for ova parasite
possible non bloody= crypto > MAC> microspora> giardia
bipolar 1
tx
life long lithum
inhibit phosphoinositol cascade
CC tremor hyponatremia
13yo
abscess with appreanace
i pull my hair when i get anxious + broken hair
DX?
trichotiollomania
OCD
TX CBT
Preterm labor <32 give what
beta met toco MGsulfate
even without preeclampsia + penicillin
Scaphoid fracture = osteonecrosis - IX?
do CT MRI to confirm
retrograde blood supply
31 yo G1P0 8wkAOG
presistent vomiting
BP 90/50 tachycardia
do urinalysis for Ketone
what PH ?
hypok hypocl
met alkalosis
hyperemesis gravidarum
water deprive test if +600 uring osm
primary polydipsia
Epiglottis
IX confirm ?
ET should be perform dot delay CXR
64yo
HA nausea
phx: Dialysis erythropoietin _ BP 210/121 retinal hemorrhage จาก ?
Erythropoietin therapy
44yo dyspareunia
chronic dry eye
dry vagina
cause?
inadequate lubricant
sjogren
- raynaud, RO LA + lymphocyte in salivary gland
- non hodgkin RA parotid enlarge MALT
6yo congen deaf
suddendrop
no confusion
from what?
QT prolong syndrome JERVELL potassium channel defect
propanolol + pace maker maintaining CA K MG
5yo
diff walking + purplish non blanching rash + abdomen diffuse tender
PHX viral 1wk
UA blood trace protein
DX?
intussusception = henoch
tx NSAID supportive steroid
IGA nephropathy
Craniopharyngiomas
calcified cholesterol motoroil 3 component solid cystic
Trichinellosis ??
Muscle abdominal pain fever ungual hemorrhage splinter hemorrhage retinal hemorrhage weak muscle periorbital edema eosinophillia
Leydig cell tumor ?
in testosterone inc estrogen inc aromatase Peinke crystal (eosinophil inclusion) gynecomastia precocious boy
Down syndrome infanity
10 w AOG do what test
plasma free fetal DNA testing
chronic alcoholism + unconsciousness
31 c prolong QT
TX?
Active rewarming
Acute Mania attempt to scale fence at white house
terrorism HX
TX?
lithium ( avoid in kidney), vlaporate (avoid in liver)
- antipsychotic
- olanzapine
5mo poor weight gain
inc feeding
K3 urine pH7.9
low Bicarb inc CL normal Anion gap
RTA type 1
CBC target
thalassemia B inc hemoglobin A2
tx?
reassurance
23yo nasal breathing stuffy nose dry cough
no wheeze rash
boggy mucosa
post nasal drip + dry cough
tx?
topical intranasal glucocorticoid
non allergic rhinitis
antihistamine H1 no H2 have no Anti Ach
42yo DOB + wheezing med aspirin diltiazam atorvas albuterol NSAID block COX 1+2 shift to lipo inc LTC4
DX?
pseudoallerfic drug reaction known asthma rhinisinusitis polyp
tx use leukotriene zileuton or leuko antagonist lukast avoid aspirin
inc BP Ha Bruit Right ear
?
fibromuscular dysplasia
Renal ICA
65yo
RA acetaminophen thiazide
general edema +4 protein normal BP enlarge kidney
kidney biopsy?
glomerular deposition after staining ciongo apple green
AA amyloidosis associated with chronic RA IBD TB OSTEOMYELITIS fold wrong V microglobulin
Zenker
IX?
Barium esophagram
upper sphincter dysfunction
alcoholic mallry weiss
patho
tear at GE junction also hiatal hernia
IX endoscopy
tardive dyskinesia -
tx
switch to quetiapine clozapine
VALBENAZINE
23yo 29AOG SOB tried excercise intolerance normal BP AF rapid ventricular response recent tonsillectomy from sore throat DX?
mitral stenosis from RF
recent
48yo TABSO cervical cancer -
now with clear watery discharge
DX?
vesicovaginal fistula
Duchenne
no dysctophin
onset 20to
X link + kyphosis
becker 5yo
osteophyte diff walking DM1
hypoercholesterol
DX?
Nerve DMg charcot joint
B12 def DM
syphilis spinal cord injury
syringo myelin
hyper emesis gravidarum
elyte?
PH +7.45 alkalosis
bicarb inc 2.8 metabolic
if Paco2
Alka (0.9x bi) +14 +18
Acid (1.5x bi) +6+10
DO Paco2(0.9xbicarb) 14+18 =53-57 expected paco2 is 54-50 = compensated == ok ok ok ok not exact is still ok
HX pancreatitis now abnormal mass
what tx?
Endocopic drainage
pancreatic pseudocyst
target rash raise edge itchy tinea use?
clotrimazole + terbinafine
> oral griseofluvin
viral sinusitis lead to
bacterial sinusitis
-purulent swelling turbinate
blastomycosis 3mo fever night sweat produce bough
lytic bone lesion + skin verrocous crusted
biopsy ?
granuloma nodule
23yo ulcerated non painful genital ulcer nontender lymph VDRL + HIV neg
IX?
fluorescence treponemal AB absorption not biopsy @@@@@@
possible VRDL pos cdue to early infeciton
SLE first test
ANA
cost effective than DsDNA smith to confirm
42 yo
fever sore throat HA maculopapular Rash trunk to entire body
3 sexual female
lymphphadenopathy
DX?
syphilis
secondary sore throat systemic
1 dose IM PEG
TX hyper calcemia
severe +14 = NSS + cal tanin, loop diuretic, bisphosphonate
Mode 12-14 = same
asymptomatic -10= avoid thiazide lithium
@@@ high yield
metabolic syndrome 3/5
waist male 40 women 35
FBS 100-110
TG 150
HDL male -40 women -50
central obesity DM2
64yo
double vision downout
HT DM2
cause?
nerve damage - contral infract - ischemic
ok pupil dilate
Cat bite-
tetanus vaccination
3 yo ago
deep puncture wound
tx?
prescribed amoxi + clavulanic
- booster tetanus who last vaccinated + 5 years
Post partum Endometritis = DOB after 24 hr
diffuse bilat crackle
?DX
ARDS from sepsis from Endometritis
Ankylosing spondlitis
restrictive luung dz
from what>
chestwall motion restricted (enthesitis)
Daughter become vegetarian
reassure normal behaviour
42yo
fever Hepc HIV Alcoholic hypertrophy thrush palpitate
given moxifloxacin fluconazole
ECG like torsad de point
tx?
Mg Sulfate
adenosine -supravent tachy
Amiodarone - V tach A tachy for normal baseline QT
Atropin- AV block bradycardia
Sodium Bicarb- Quinedine torsad
Aspirin
Elyte?PH
metabolic alkalosis then aniongap met acidosis
dec PaCO2
dec HCO3
near normal PH mix both = acidosis alkalosis
29yo vomiting abdominal pain crampy s/p appendectomy 6mo small bowel obstruction
Adhesion ladd bands
proximal - early morning vomiting
distal - coliky delay vomiting constipation obstipation hyperactive BS dilate loop
HIV Eye pain conjunctivitis keratitis fundoscopy = central necrosis widespread pale peripheral
herpes simples
HIV eye CMV?
no pain@ fluffly granular retinal hemorrhage conjunctivitis
sphincter of oddi dysfunctional
IX?
manometry
73yo fall hip pain dec breath sound crackle
palpitation canbe arrhythmia
next best step?
ECG cardiac marker CXR
surgical withing 72hr but have to stabilized ptx first
Neuroleptic malignant
confuse stiff inc BP inc temp from antipsy
TX?
Bromocriptine
amantadine
reverse D antagonist
dystonia
tx?
benztropine
shoulder dystochia
Mc robert
flex hiip thigh against abdomen
Sheehan triad
BP85/55 anemia low pulse
ishemic necrosis
60yo OA cervical spondylosis
bony spur limit rotation lateral bonding narrow disk space hypertrophy vetebral body
4yo boy
vesicoureteral reflux
HX UTI leukocyte esterase nitrite
MCC complication
Renal scar
if first UTI withing 2yo DO UTZ not cystoureteralgram
but cystoureterogram = gold standard
focal segmented glomerular in
HIV
OBESE
Heroin
