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Usmle กู อย่างละ 100ข้อ > usmle 2 ชุด 5 > Flashcards

usmle 2 ชุด 5 Flashcards

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USMLE® Step 1 flashcards
1
Q

RUQ pain + gas in gall bladder no gas in billiary tree

Crepitus abdomen

A

emphysematous cholecystitis
immune, DM, Vascular copmress
+ ecoli clostridium - gas forming

tx: emergent cholecystectomy
amphicillin + sulbactam - clostridium coverage

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2
Q

Follicular thyroid cancer

biopsy?

A

invasive of tumor capsule + hema spread

Papillary = pseudomoma
Hashimoto = hurthle - large polygonal cell
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3
Q 
65yo
COPD
exacerbate 
dec BP, neck vein dilate 
\+ trachea deviation
breathsound absent = tx?
A

absent thoracostomy

penumothorax

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4
Q

reaction formation

A

unaccept loving during office visit

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5
Q

38 yo vilat wheeze + cough + crakle

clear lung field

A

Bronchitis

do supportive symptomatic treatment only

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6
Q

Cushing
moonface + central obesity + striae + glucose intolerance
from exo steroid, ACHTpituitary tumor, ectopic ACTH
TEST?

A

overnight low dose dexa suppresion test
late night cortisol salivary test
24hour urinary cortisol excretion

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7
Q

Adrenal insufficiency- hypotension, hypokalemia, hypogly

A

early morning cortisol can be overlap with cushing

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8
Q

primary hyperaldosterone

A

ratio plasma Aldosterone: Renin

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9
Q

pneumothorax

A

impair compress

ventricular filling

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10
Q

incontinence
type + patho

stress
urge
overflow

A

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

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11
Q

19 yo
sore throat sexual contact
38 c , erythematous pharynx + bilateral cervical lymph non tender

Ab tender lower quadrant

DX?

A

N. Gonorrhea

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12
Q

Women - normal uterus - no breast
inc FSH inc LH inc Testosterone ince Androstenedione

what occur

A

Aromatase def

mother become casculine baby osteoporosis in older age

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13
Q

overian hyper thecosis
post men
virilization insulin resist
dec LH dec FSH

dx?

A

solid appear ovary

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14
Q

5yo
sore throat +1mm vesicle on tonsil + greyish ulceration at posterior pharynx + lymph cervical bilat

what is it what cause

A

herpangina

coxsaki

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15
Q

6yo leg pain at night improve with massage + NSAID

tX?

A

reassure
growing pain at 2-12 yo
bilateral night time lower extremity

if>20yo think osteoma

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16
Q

Congenital melanocyte nevus

A

inc hair follicle + patch on upper - may grow and 5% melanoma

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17
Q

Congenital dermal melanocytosis

A

lower back sacrum + fade in time -regress

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18
Q

Liver cirrhosis + low BP Ascites Pitting edema Dec Na inc K low urine sodium due to

A

renal hypoperfusion
hepatorenal syndrome
prerenal azothemia

inc cream dec Na urine

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19
Q

MDS stop med for relationship then got worsen

tX?

A

restart paroxitine + gradual taper

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20
Q

39 wk G4P0 Abort 3 at 35wk AOG
due to leiomyoma now contact ! 2min 45sec each mod variability variable deceleration

TX?

A

Abdominal myomectomy with uterine cavity entery done
do not do vaginal labor

do CS in intramural or submucosal

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21
Q

Stable Angina Med

A

B blocker
nitrite
Ranolazine dec myocardial Ca influx
Dihydro CCB dec afterload

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22
Q

HIV bilat infiltration O2 80% CD4 160 tx ?

A

TMP SMX corticosteroid(PaO2 <70mmHg, A-a gradient >35 mmhg)
pneumocystis pneumonia

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23
Q

Abortus + mum engorge breast

tx

A

NSAID

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24
Q

DM + Ht ( 144/87)
+3 UA protein

tx?

A

intensive BP control to reduce Nephro complication

no glycemic intense = hypoglycemia > heart cc

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25
Q 
25 yo
G2P1 32 AOG 
\+ PID + Abruption placenta + weak pedia pulse 
low cardiac output dec wedge 
inc systemic
low BP

DX?

A

hypovolumic shock

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26
Q

Central retinal artery occlusion embolism
painless LOV
tx?

A

ocular massage = anterior chamber paracentesis, hyper O2 chamber

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27
Q

SLE

low what

A

LOW C3 C4

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28
Q

ขาดำๆ เสก็ดๆ

A

venous hypertension = stasis dermatitis

== xerosis lipodermatosclerosis

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29
Q

Glaucogonoma - skin central clearing crusting scaling boarder
DX?

A

Necrolytic migratory erythema

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30
Q

4yo

squirt L eye proptosis ( left tumor unilateral eye) esotropia optic disc pallor ( optic n atropy) cafe aulait

A

optic glioma

NF1 Lish nodule

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31
Q

Chronic illness + pericholecystic fluid involve infection ischemia

DX
TX

A

acalculus cholevystic

tx percutaneous cholecystectomy

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32
Q

Schizoaffective ?

A

MDS manic schizo/ time of delusion hallucination

แต่ต้องมี 2wk with out MDS

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33
Q

HIV diarrhea

IX

A

stool examination for ova parasite

possible non bloody= crypto > MAC> microspora> giardia

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34
Q

bipolar 1

tx

A

life long lithum

inhibit phosphoinositol cascade
CC tremor hyponatremia

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35
Q

13yo
abscess with appreanace
i pull my hair when i get anxious + broken hair

DX?

A

trichotiollomania

OCD

TX CBT

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36
Q

Preterm labor <32 give what

A

beta met toco MGsulfate

even without preeclampsia + penicillin

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37
Q

Scaphoid fracture = osteonecrosis - IX?

A

do CT MRI to confirm

retrograde blood supply

38
Q

31 yo G1P0 8wkAOG
presistent vomiting
BP 90/50 tachycardia
do urinalysis for Ketone

what PH ?

A

hypok hypocl
met alkalosis

hyperemesis gravidarum

39
Q

water deprive test if +600 uring osm

A

primary polydipsia

40
Q

Epiglottis

IX confirm ?

A

ET should be perform dot delay CXR

41
Q

64yo
HA nausea
phx: Dialysis erythropoietin _ BP 210/121 retinal hemorrhage จาก ?

A

Erythropoietin therapy

42
Q

44yo dyspareunia
chronic dry eye
dry vagina
cause?

A

inadequate lubricant

sjogren

  1. raynaud, RO LA + lymphocyte in salivary gland
  2. non hodgkin RA parotid enlarge MALT
43
Q

6yo congen deaf
suddendrop
no confusion

from what?

A

QT prolong syndrome JERVELL potassium channel defect

propanolol + pace maker maintaining CA K MG

44
Q

5yo
diff walking + purplish non blanching rash + abdomen diffuse tender
PHX viral 1wk
UA blood trace protein

DX?

A

intussusception = henoch

tx NSAID supportive steroid

IGA nephropathy

45
Q

Craniopharyngiomas

A

calcified cholesterol motoroil 3 component solid cystic

46
Q

Trichinellosis ??

A

Muscle abdominal pain fever ungual hemorrhage splinter hemorrhage retinal hemorrhage weak muscle periorbital edema eosinophillia

47
Q

Leydig cell tumor ?

A 
in testosterone inc estrogen inc aromatase 
Peinke crystal (eosinophil inclusion) gynecomastia precocious boy
48
Q

Down syndrome infanity

10 w AOG do what test

A

plasma free fetal DNA testing

49
Q

chronic alcoholism + unconsciousness
31 c prolong QT
TX?

A

Active rewarming

50
Q

Acute Mania attempt to scale fence at white house
terrorism HX

TX?

A

lithium ( avoid in kidney), vlaporate (avoid in liver)

  1. antipsychotic
  2. olanzapine
51
Q

5mo poor weight gain
inc feeding
K3 urine pH7.9

low Bicarb inc CL normal Anion gap

A

RTA type 1

52
Q

CBC target
thalassemia B inc hemoglobin A2

tx?

A

reassurance

53
Q

23yo nasal breathing stuffy nose dry cough
no wheeze rash
boggy mucosa
post nasal drip + dry cough

tx?

A

topical intranasal glucocorticoid

non allergic rhinitis

antihistamine H1 no H2 have no Anti Ach

54
Q

42yo DOB + wheezing med aspirin diltiazam atorvas albuterol NSAID block COX 1+2 shift to lipo inc LTC4

DX?

A

pseudoallerfic drug reaction known asthma rhinisinusitis polyp

tx use leukotriene zileuton or leuko antagonist lukast avoid aspirin

55
Q

inc BP Ha Bruit Right ear

?

A

fibromuscular dysplasia

Renal ICA

56
Q

65yo
RA acetaminophen thiazide
general edema +4 protein normal BP enlarge kidney

kidney biopsy?

A

glomerular deposition after staining ciongo apple green

AA amyloidosis associated with chronic RA IBD TB OSTEOMYELITIS fold wrong V microglobulin

57
Q

Zenker

IX?

A

Barium esophagram

upper sphincter dysfunction

58
Q

alcoholic mallry weiss

patho

A

tear at GE junction also hiatal hernia

IX endoscopy

59
Q

tardive dyskinesia -

tx

A

switch to quetiapine clozapine

VALBENAZINE

60
Q 
23yo 29AOG SOB 
tried
excercise intolerance normal BP 
AF
rapid ventricular response 
recent tonsillectomy from sore throat
DX?
A

mitral stenosis from RF

recent

61
Q

48yo TABSO cervical cancer -
now with clear watery discharge

DX?

A

vesicovaginal fistula

62
Q

Duchenne

A

no dysctophin
onset 20to
X link + kyphosis
becker 5yo

63
Q

osteophyte diff walking DM1
hypoercholesterol

DX?

A

Nerve DMg charcot joint
B12 def DM
syphilis spinal cord injury
syringo myelin

64
Q

hyper emesis gravidarum

elyte?

A

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
65
Q

HX pancreatitis now abnormal mass

what tx?

A

Endocopic drainage

pancreatic pseudocyst

66
Q

target rash raise edge itchy tinea use?

A

clotrimazole + terbinafine

> oral griseofluvin

67
Q

viral sinusitis lead to

A

bacterial sinusitis

-purulent swelling turbinate

68
Q

blastomycosis 3mo fever night sweat produce bough
lytic bone lesion + skin verrocous crusted
biopsy ?

A

granuloma nodule

69
Q

23yo ulcerated non painful genital ulcer nontender lymph VDRL + HIV neg
IX?

A

fluorescence treponemal AB absorption not biopsy @@@@@@

possible VRDL pos cdue to early infeciton

70
Q

SLE first test

A

ANA

cost effective than DsDNA smith to confirm

71
Q

42 yo
fever sore throat HA maculopapular Rash trunk to entire body
3 sexual female
lymphphadenopathy

DX?

A

syphilis
secondary sore throat systemic
1 dose IM PEG

72
Q

TX hyper calcemia

A

severe +14 = NSS + cal tanin, loop diuretic, bisphosphonate
Mode 12-14 = same
asymptomatic -10= avoid thiazide lithium

73
Q

@@@ high yield

metabolic syndrome 3/5

A

waist male 40 women 35
FBS 100-110
TG 150
HDL male -40 women -50

central obesity DM2

74
Q

64yo
double vision downout
HT DM2
cause?

A

nerve damage - contral infract - ischemic

ok pupil dilate

75
Q

Cat bite-
tetanus vaccination
3 yo ago
deep puncture wound

tx?

A

prescribed amoxi + clavulanic

- booster tetanus who last vaccinated + 5 years

76
Q

Post partum Endometritis = DOB after 24 hr
diffuse bilat crackle

?DX

A

ARDS from sepsis from Endometritis

77
Q

Ankylosing spondlitis
restrictive luung dz
from what>

A

chestwall motion restricted (enthesitis)

78
Q

Daughter become vegetarian

A

reassure normal behaviour

79
Q

42yo
fever Hepc HIV Alcoholic hypertrophy thrush palpitate
given moxifloxacin fluconazole
ECG like torsad de point

tx?

A

Mg Sulfate

adenosine -supravent tachy
Amiodarone - V tach A tachy for normal baseline QT
Atropin- AV block bradycardia
Sodium Bicarb- Quinedine torsad

80
Q

Aspirin

Elyte?PH

A

metabolic alkalosis then aniongap met acidosis
dec PaCO2
dec HCO3
near normal PH mix both = acidosis alkalosis

81
Q

29yo vomiting abdominal pain crampy s/p appendectomy 6mo small bowel obstruction

A

Adhesion ladd bands

proximal - early morning vomiting
distal - coliky delay vomiting constipation obstipation hyperactive BS dilate loop

82
Q

HIV Eye pain conjunctivitis keratitis fundoscopy = central necrosis widespread pale peripheral

A

herpes simples

83
Q

HIV eye CMV?

A

no pain@ fluffly granular retinal hemorrhage conjunctivitis

84
Q

sphincter of oddi dysfunctional

IX?

A

manometry

85
Q

73yo fall hip pain dec breath sound crackle
palpitation canbe arrhythmia
next best step?

A

ECG cardiac marker CXR

surgical withing 72hr but have to stabilized ptx first

86
Q

Neuroleptic malignant
confuse stiff inc BP inc temp from antipsy
TX?

A

Bromocriptine
amantadine
reverse D antagonist

87
Q

dystonia

tx?

A

benztropine

88
Q

shoulder dystochia

A

Mc robert

flex hiip thigh against abdomen

89
Q

Sheehan triad

BP85/55 anemia low pulse

A

ishemic necrosis

90
Q

60yo OA cervical spondylosis

A

bony spur limit rotation lateral bonding narrow disk space hypertrophy vetebral body

91
Q

4yo boy
vesicoureteral reflux
HX UTI leukocyte esterase nitrite
MCC complication

A

Renal scar
if first UTI withing 2yo DO UTZ not cystoureteralgram
but cystoureterogram = gold standard

92
Q

focal segmented glomerular in

A

HIV
OBESE
Heroin

Usmle กู อย่างละ 100ข้อ (10 decks)

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