USMLE 2 ชุด 6 Flashcards
3yo strep throat nontender UA blood +2
wilms tumor IX?
CT scan for met pulmo
25to SOB sue accessory muscle intubate next morning extubate + albuterol now tremor when lift hand with muscle
IX?weakness
check electrolyte
albuterol - hypok
56 yo DOB
work for home insulation plumbing now inc BP, digital clubbing bibasal crackle pleural calcifiation
caused
dec diffuse lung capacity
67yo forgetfulness sad concerned
pseudodementia cognitive impair
tx?
SSRI
alzheimer = no concerned no worry no distress
65yo worsen memory board base gait carotid bruit enlarge ventricle
urinary incontinence
normal pressure hydrocephalous
baby sitter burn baby spare what
flexor
35yo edema at the end of the day hypoalbuminemia dec Na UA fatty cast = nephrotic
cc?
hypercoag los protein C s anti thrombin
anemia loss transferrin
Vit D los calciferal binding protein
dec thyroxin dec TBG
lung nodule
malignancy
+2 cm 60yo smoking speculated = surgical
+8mm fine needle biopsy
-4mm - no risk just FU
COPD tx
stop smoking
spo2 88 need O2 therapy
Heparin induce thrombocytopenia
IX TX
serotonin release assay
stop heparin give agratoban foundaparinus
25yo transient LOV bruit on mandibular angle inc renin inc aldosterone
IX?
CT scan angio fibromuscular dysplasia
24yo dyspareunia no thinging no pain no external pain but internal exam intolerance DX?
genitopelvic pain/ penetration disorder
TX? kegel
trigerminal neural gia
demyelination of nerve nuclei = jawpain V2 V3 unilateral in MS bilateral
48yo UTI PID given ceftri IV culture ecoli sensitive to ceftri genito cipro tmpsmx
ไห้ยายังไง PID
uncomplicated nonpregnancy healthy = fluoroquinolone + TMP SMX oral
complicated: DM CKD immune hospital aquired vomit sepsis = IV fluoroquinolone aminoglycoside cephalosporin
42 yo RA treated with infliximab now erupt papule painful
DX?
herpes
valacyclovir
74yo POP prolapse, tx
?
passary fitting = poor surgical candidate (HF OBESE DM)
if symptomatic
1pelvic pressure 2 bowel bladder problem 3 sexual 4 erosion
withdrawal symptom?
heroine
cocain, amph
serotonin
heroine= dilate pupil lacrimation hyperactive bowel crampy diarrhea normal temp piloerect
Coccain, amph= inc appetitie insomnia severe depress
serotonin= erectric shock neuro + paresthesia
7yo 1 wk cook outside and eat + prior diarrhea 2 days prior bloody diarrhea diffuse abdominal pain icteric +2edema
LAB will show ? CBC
dec platelet
HUS
microangiopathic hemolytic anemia
schistocyte
acute intermittent porphyria
psychic
neuropathic tingling finger
urinary porphobilinigen
squat
inc after load
30yo sob swell lower extremity
+ d dimer
risk factor?
activated protein C resistance
factor 5 leiden hyper coagubility
factor 5 not response to anticoag C slower degrade , normal PT PTT
DIC + Cirrhosis= antithrombin Def
Asian newborn
dec UGT activity until 2 wk
20-25 exchange transfusion
reoutine testing colon
sigmoidoscopy
colonoscopy
FOBT
colon at 50yo
sigmoidoscopy Q5y
colonoscopy Q10
FOBT yearly
Thiazide hyperglycemia watch out ?
chlorthalidone
Bartonella ?
<100 CD4
vascular cutaneous lesion
B symptom
hyperspleenomegaly
TX? doxy erythromycin first then antiretroviral
Cancer related Anorexia
TX?
Progesterone Analog
Megestrol
Sepsis
TX?
PNSS FIRST@@if fail use dopamine
Prostate met
tx
orchiectomy then radiation therapy
Cystic fibrosis kid recurrent URTI
use AB?
Vancomycin both methicillin resistance staph+ pseudo
if cefepine = staph methicillin sensitive + pseudo
45yo Recurrent sinusitis otitis joint back pain on ibuprofen aspirin otoscopy tympanic rupture UA protein +2 blood +2
DO
Qualitative antibody in serum granulomatous + poly angitis
C-ANCA PR MPO skin livedoreticularis
non healing ulcer
TX
dialectic
biofeedback
supportive
dialectic - boarderline
biofeedback- pain disorder
supportive- psychotic + in crisis
Recommended vaccine
influenza
TD/Tdap
Pneumococcus
influenza- from 19 ++ anually
TD/Tdap- Every 10 years
Pneumococcus- 19-64 - PPSV23 - lung liver heart smoker DM
PPSV23+13 - csf leak cochlear implant ,sickle, aspleia, HIV, malignant , CKD
65- dose PSV 13, then PPSV23 each year later
15 yo breast lump tender
mom die of breast Ca
tx?
schedule follow up affter next month
- Fibroadenoma estrogen progesterone = premens tenderness @@@
should be examine at least one mens cycle
37yo weak up cos sternal chest pain only climb2 flight before dyspnea ECG ambulatory st elevation at 1 aVL V4 V6 coronary angio = no obstruction
TX?
Ditiazem= vasospastic angina
intimal hyperreactive during sleep ,
Smoking TX: CCB dihydropyridone amlo, felodipine
penetrate trauma LUQ spleen colon + tender rebound
even FAST - do what?
OPEN LAP
hemodynamic instability peritonitis blood from NG or rectal exam
38yo homeless muscle pain stiffness alcoholic injection use high blood unable to open jaw spasm nect
?? cause by
toxin mediate neuropathy?
tetanus > block release on inhibitory GABA door health excess no vaccine or booster
38 yo
2 days abrasion thigh worsen spread to bottoch calf fever 39
BP 82/60 tender on palpate loss sensation to light touch
DX?
necrotizing fascitis strep O staph A clostridium pain out of porportion erythema swelling air in CT black dot == crepitus
therapy not work i can see that your lack of improvement has been fustrating
les focus on a small goal we can agree on
RA = difficulty gripping coffee cup in the morning
involve what?
cevical spine spine subluxation cord compression rheumatoid nodule subcutaneous
Pneumothorax spontaneous- size
small -2 cm= observe supplement O2
+2CM needle thoracostomy = 14-18 –> 2,3 ICS mid clavicular line
23yo 38 wk AOG
rupture + Epidermal
-8 cm dilate cervix unchange after 4 hr
tx?
CS
arrest 6hr inadequate contraction, 4hr adequate contraction = CS
second stage 2he multipara, 3hr nulli
note amino infusion if variable decel
induce at 41 wk AOG
36wk see fetal presentation
Active stage 6cm cervix <1.2,1.5cm/hr
latent nulli 20hr, multi 14hr
allow 24 hr + oxy 12-18hr then CS
Boy 10yo
HA visual disturb vomiting bilat eyelid retraction limit upward gaze preferdownwardgaze pupil sluggish to light ??
pinealoma
block CSF, compress tectum
associated GERM CELL tumor
Precocious male + BHCG 9yo- BIG penis
Craniopharyngioma presentation
only visual disturbance
54 yo difficulty walking proximal weakness pain fall hyporeflex
HT on thiazide metropolol + bruid carotid premature vent contraction
IX?
electrolyte disturbance
low K cause cramp weak hyporeflex arrhythmia Premature ventricular beat
Risk for breast Cancer
Hormone replace
nulliparity
increase age at first time birth
alcohol consumption (done dependent <1day)
Pagent
Bone resorption sclerosis cortical thickening bowing HA
normal CA@@@@@@
normal P@@@@@@@
inc alkaline phos
inc urine hydroxyproline - inc bone turn over
Bone scan focal inc uptae
TX bisphosphanate
MM
LAB?
inc Ca
inc P
inc AKP
inc hydroxyproline
primary hyperparathyroid
inc CA
dec P
inc AKP
neonatal polycythemia
HCT >65
from
1 hypoxia, DM, Ht, IUGR
2 Twin delay cord clamping 13,18,21
respi cyanosis apnea, red skin
TX IV fluid glucose partial exchange transfusion
HT cause IUGR placental insufficiency
inc spiral A resistance
from coccain tobbaco alcohol
head sparring 2/3rd trimester
OSA relax pharyngeal muscle
intermittent upper airway collapse
32yo tick bite myalgia, confuse, HA, non lymphadenopathy inc lymphocyte inc ARP inc ALT low WBC low Plt TX?
Doxy
DX: Ehelichiosis
45yo dyspnea - Abdominal distand - farmer edema
inc JVP, dec heart sound
CXR Ring calcified heart prominent X+ y descent
TB constrictive pericarditis
Chikungunya
macular rash wrist pain
dec WBC
HA conjunctivitis
TX: supportive metrotrexate for joint chronic
4mo pneumocystis jirovecii + oral thrush leukocyte 18000 lymphocyte 45 neutrophil 50% no ADA def
WHAT from
Dec CD4**** lymphocyte count
HIV infection
Phagocytosis what organism
chronic granulomatous :#
Aspergilous staph A
serratia CAT +
Low PH urine
uric acid stone
TX :
potassium citrate
allopurinol
Ca stone
TX : thizaide oxalate restriction allopurinol potassium citrate
32 yo SOB at night liver enlarge ankle edema 3rd heart sound enlarge cardiac sihouette pleural effusion non st changes texas travel ??
viral infection
viral myocarditis
PEdiatric
3yo
constipation small fissure at anal verge
tx?
begin oral alxative
limit cow milk inc diet fiber
variceal hemorrhage
tx
1 fluid
2 ocreotide
3 ceftriaxone
endoscopy within 12 hr
band ligation sclerotherapy
uncontrol balloon tamponad for recurrent TIP shunt
Boarderline personality
depress easily angry paranoid cut wrist
associated child abuse
riluzole
glutamate inhibitor
orthostatic proteinuria in 14 yo boy
what next step
repeat urine dipstick
egg shell liver cyst
hydatid cyst
stroke ptx can have weakness fall alot lead to
rhabdomyosis hyperkalemia
if +6.5 use Ca gluconate แล้วค่อยไห้ fluid diuretic resin hemodialysis kayexalate
other b blocker digoxin DM TN hemodialysis
Renal endstage dec, GFR normal but dec K secretion
normal aldosterone = CHF, cirrhosis
low aldosterone = DM nephropathy, NSAIDm inter nephritis
Alzheimer can develop
incontinence in later stage
ABO incompatibility mother o baby AB,a,b
mild jaundice only
HELLP
centrilobular necrosis hematoma thrombi in portal capillary system
distension of liver capsule
pulmonary edema by vasospasm of arterial inc after load inc capillary pulmonary pressure
male
seminoma
non seminoma
seminoma + BHCG
Non seminoma - large mediastinal mass + BHCG, +AFP
smudge center of eye enlarge color wash out , eye pain, 1 side
what dx
optic neuritis associated MS acute in 2 wk
afferent pupil defect
IX MRI @@@@
60 yo scrotal pain dysuria pain during urination
Ecoli acute epidydymis
+35 coliform bac > UA culture
-35 sexually transmitted NAAT chlamydia gonorrhea
Turett
citeria
DX?
TX?
1 motor + 1 tic throat clearing
grimance blink jerk shrugging
TX
anti dopamine - tetrabenzine > most effective
Anti psycho
A2 agonist clonidine
Jaundice + pancreatitis
IX?
CT
NOT UTZZZZZ
Risperidone
2nd gen antipsy block D2 inc prolactin galactorrhea irregular mass infertility
Screening BCA Cervical pap Colon Ca HIC Hyper lipid HT OSteoporosis
BCA -50yo (q2y) Cervical pap- 21-65 (Q3y) Colon Ca- 50 (FOB yearly, COLONO q10y) HIV - 15-65 (1 time) Hyper lipid- MEN 35lipid profile Q5year HT- +18year every 2 years OSteoporosis - 65 + dexa
68yo HT dizziness BP 140/90 right arm BP 100/76 left arm 4th heart sound systolic carotid bruit เป็น ?
subclavian A. occlusion MCC
sharp by curvature more tubulent flow
ไม่ไช่ AA arch narrowing
= subclavian steal syndrome
Mostly asymptomatic ถ้ามี symptom 1. ischemia B > pain fatigue paresthesia 2. vertebrobasilar ischemia - dizziness ataxia dysequilibrium > ถ้า excercise Dilate upper ext Artery blood not go to brain 3. bruit on affected side
IX: doppler UTZ or MRI Angiogram
if coarctation lower extremity affected more not each side arm @@@@
joint replacement infect
<3mo staph A pseudomonas
>3mo propioni Bac staph epidermidis no fever no inc WBC แต่ ,u impair gait sinus tract formation
Diff lifting swallowing (choking)
DX ได้อะไรบ้าง
polyomyositis - proximal weakness, difficulty climbing, inc muscle enzyme creatinine, AST, ANA , JO ,$endomyseal ต้อง screen cancer ด้วยนะ
Fibromyalgia 1 pain 2 women middle age 3 trigger trapezius 4 +3month 5 normal LAB
Polymyalgia rheumatica 1 age +50 2 stiff pain shoulder hip 3 temporal arteritis 4 inc ESR
Dermatomyositis = + skin lesion $Perimyseal $perivascular B cell CD$
IX biopsy
tx prednisolone MTX azathioprine
Chylothorax etiology ?
cardiac surgery / down syndrome / noonan
slip capital femoral epiphysis
etiology
IX ?
obese aldolescence boy
associated with hypothyroid
dec growth hormone 1 pain 2 fall off 3 dec range of motion
dec $internal rotation $abduction $flextion
IX: CXR
$$TX immediate screw fixation
leg calve perthes ?
Boy 5-7 yo ( younger)
AVN hip
Vasoapsatic angina
<50 yo smoking occur at night < 15mins resolved
IX: ambu ECG ST elevation/ no coronary angio defect #
TX: CC blocker to prevent
nitroglycerin treat
TB can cause adrenal ?
Adrenal insufficiency
retain K + H, normal Anion gap met acidosis
hypotension
Obturator N.
sensory ข้างๆ ไข่ + Adductor
sup peroneal
เท้า นิ้ว 2 ถึง 5
deep peroneal
ระหว่าง 1-2
37 yo RF
heart??? cause
mitral stenosis ไม่ไช่ AR&
dyspnea hemoptysis orthersyndrome > compress recurrent laryngeal , AF may + stroke
PE lough opening snap mid diastolic rumble > patches on face malar rashes @@ AV anastomosis
IX: ECG Pmitral RVH tall V1V2
TTE visualization
atopic dermatitis
ร่างกายสร้าง อะไรไม่ได้
ร่างกายสร้าง corneum ไม่ได้ allergen เลยเข้าไปได้ inc risk dry env stress over heat detergent
Eczematous
เริ่มด้วยแดงก่อนแล้วค่อยแข็ง
ฺbaby face scalp extensor
adult flexor
