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Usmle กู อย่างละ 100ข้อ > USMLE 2 ชุด 6 > Flashcards

USMLE 2 ชุด 6 Flashcards

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USMLE® Step 1 flashcards
1
Q

3yo strep throat nontender UA blood +2

wilms tumor IX?

A

CT scan for met pulmo

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2
Q

25to SOB sue accessory muscle intubate next morning extubate + albuterol now tremor when lift hand with muscle
IX?weakness

A

check electrolyte

albuterol - hypok

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3
Q

56 yo DOB
work for home insulation plumbing now inc BP, digital clubbing bibasal crackle pleural calcifiation
caused

A

dec diffuse lung capacity

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4
Q

67yo forgetfulness sad concerned
pseudodementia cognitive impair
tx?

A

SSRI

alzheimer = no concerned no worry no distress

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5
Q

65yo worsen memory board base gait carotid bruit enlarge ventricle
urinary incontinence

A

normal pressure hydrocephalous

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6
Q

baby sitter burn baby spare what

A

flexor

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7
Q

35yo edema at the end of the day hypoalbuminemia dec Na UA fatty cast = nephrotic

cc?

A

hypercoag los protein C s anti thrombin
anemia loss transferrin
Vit D los calciferal binding protein
dec thyroxin dec TBG

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8
Q

lung nodule

malignancy

A

+2 cm 60yo smoking speculated = surgical
+8mm fine needle biopsy
-4mm - no risk just FU

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9
Q

COPD tx

A

stop smoking

spo2 88 need O2 therapy

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10
Q

Heparin induce thrombocytopenia

IX TX

A

serotonin release assay

stop heparin give agratoban foundaparinus

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11
Q

25yo transient LOV bruit on mandibular angle inc renin inc aldosterone
IX?

A

CT scan angio fibromuscular dysplasia

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12
Q

24yo dyspareunia no thinging no pain no external pain but internal exam intolerance DX?

A

genitopelvic pain/ penetration disorder

TX? kegel

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13
Q

trigerminal neural gia

A

demyelination of nerve nuclei = jawpain V2 V3 unilateral in MS bilateral

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14
Q

48yo UTI PID given ceftri IV culture ecoli sensitive to ceftri genito cipro tmpsmx

ไห้ยายังไง PID

A

uncomplicated nonpregnancy healthy = fluoroquinolone + TMP SMX oral

complicated: DM CKD immune hospital aquired vomit sepsis = IV fluoroquinolone aminoglycoside cephalosporin

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15
Q

42 yo RA treated with infliximab now erupt papule painful

DX?

A

herpes

valacyclovir

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16
Q

74yo POP prolapse, tx

?

A

passary fitting = poor surgical candidate (HF OBESE DM)
if symptomatic
1pelvic pressure 2 bowel bladder problem 3 sexual 4 erosion

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17
Q

withdrawal symptom?
heroine
cocain, amph
serotonin

A

heroine= dilate pupil lacrimation hyperactive bowel crampy diarrhea normal temp piloerect

Coccain, amph= inc appetitie insomnia severe depress

serotonin= erectric shock neuro + paresthesia

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18
Q 
7yo 
1 wk cook outside and eat + prior diarrhea 
2 days prior bloody diarrhea 
diffuse abdominal pain
icteric +2edema

LAB will show ? CBC

A

dec platelet
HUS
microangiopathic hemolytic anemia
schistocyte

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19
Q

acute intermittent porphyria

A

psychic
neuropathic tingling finger
urinary porphobilinigen

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20
Q

squat

A

inc after load

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21
Q

30yo sob swell lower extremity
+ d dimer
risk factor?

A

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

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22
Q

Asian newborn

dec UGT activity until 2 wk

A

20-25 exchange transfusion

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23
Q

reoutine testing colon
sigmoidoscopy
colonoscopy
FOBT

A

colon at 50yo
sigmoidoscopy Q5y
colonoscopy Q10
FOBT yearly

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24
Q

Thiazide hyperglycemia watch out ?

A

chlorthalidone

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25
Q

Bartonella ?

A

<100 CD4
vascular cutaneous lesion
B symptom
hyperspleenomegaly

TX? doxy erythromycin first then antiretroviral

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26
Q

Cancer related Anorexia

TX?

A

Progesterone Analog

Megestrol

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27
Q

Sepsis

TX?

A

PNSS FIRST@@if fail use dopamine

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28
Q

Prostate met

tx

A

orchiectomy then radiation therapy

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29
Q

Cystic fibrosis kid recurrent URTI

use AB?

A

Vancomycin both methicillin resistance staph+ pseudo

if cefepine = staph methicillin sensitive + pseudo

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30
Q

45yo Recurrent sinusitis otitis joint back pain on ibuprofen aspirin otoscopy tympanic rupture UA protein +2 blood +2

DO

A

Qualitative antibody in serum granulomatous + poly angitis
C-ANCA PR MPO skin livedoreticularis
non healing ulcer

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31
Q

TX

dialectic
biofeedback
supportive

A

dialectic - boarderline
biofeedback- pain disorder
supportive- psychotic + in crisis

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32
Q

Recommended vaccine
influenza
TD/Tdap
Pneumococcus

A

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

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33
Q

15 yo breast lump tender
mom die of breast Ca
tx?

A

schedule follow up affter next month
- Fibroadenoma estrogen progesterone = premens tenderness @@@
should be examine at least one mens cycle

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34
Q

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?

A

Ditiazem= vasospastic angina
intimal hyperreactive during sleep ,
Smoking TX: CCB dihydropyridone amlo, felodipine

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35
Q

penetrate trauma LUQ spleen colon + tender rebound

even FAST - do what?

A

OPEN LAP

hemodynamic instability peritonitis blood from NG or rectal exam

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36
Q

38yo homeless muscle pain stiffness alcoholic injection use high blood unable to open jaw spasm nect

?? cause by

A

toxin mediate neuropathy?

tetanus > block release on inhibitory GABA door health excess no vaccine or booster

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37
Q

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?

A

necrotizing fascitis strep O staph A clostridium pain out of porportion erythema swelling air in CT black dot == crepitus

38
Q

therapy not work i can see that your lack of improvement has been fustrating

A

les focus on a small goal we can agree on

39
Q

RA = difficulty gripping coffee cup in the morning

involve what?

A

cevical spine spine subluxation cord compression rheumatoid nodule subcutaneous

40
Q

Pneumothorax spontaneous- size

A

small -2 cm= observe supplement O2

+2CM needle thoracostomy = 14-18 –> 2,3 ICS mid clavicular line

41
Q

23yo 38 wk AOG
rupture + Epidermal
-8 cm dilate cervix unchange after 4 hr

tx?

A

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

42
Q

Boy 10yo

HA visual disturb vomiting bilat eyelid retraction limit upward gaze preferdownwardgaze pupil sluggish to light ??

A

pinealoma
block CSF, compress tectum
associated GERM CELL tumor
Precocious male + BHCG 9yo- BIG penis

43
Q

Craniopharyngioma presentation

A

only visual disturbance

44
Q

54 yo difficulty walking proximal weakness pain fall hyporeflex
HT on thiazide metropolol + bruid carotid premature vent contraction
IX?

A

electrolyte disturbance

low K cause cramp weak hyporeflex arrhythmia Premature ventricular beat

45
Q

Risk for breast Cancer

A

Hormone replace
nulliparity
increase age at first time birth
alcohol consumption (done dependent <1day)

46
Q

Pagent

A

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

47
Q

MM

LAB?

A

inc Ca
inc P
inc AKP
inc hydroxyproline

48
Q

primary hyperparathyroid

A

inc CA
dec P
inc AKP

49
Q

neonatal polycythemia

A

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

50
Q

HT cause IUGR placental insufficiency
inc spiral A resistance

from coccain tobbaco alcohol

A

head sparring 2/3rd trimester

51
Q

OSA relax pharyngeal muscle

A

intermittent upper airway collapse

52
Q 
32yo tick bite
myalgia, confuse, HA, non lymphadenopathy
inc lymphocyte
inc ARP
inc ALT
low WBC
low Plt
TX?
A

Doxy

DX: Ehelichiosis

53
Q

45yo dyspnea - Abdominal distand - farmer edema
inc JVP, dec heart sound
CXR Ring calcified heart prominent X+ y descent

A

TB constrictive pericarditis

54
Q

Chikungunya

A

macular rash wrist pain
dec WBC
HA conjunctivitis
TX: supportive metrotrexate for joint chronic

55
Q 
4mo 
pneumocystis jirovecii + oral thrush
leukocyte 18000
lymphocyte 45
neutrophil 50%
no ADA def

WHAT from

A

Dec CD4**** lymphocyte count

HIV infection

56
Q

Phagocytosis what organism

chronic granulomatous :#

A

Aspergilous staph A

serratia CAT +

57
Q

Low PH urine

A

uric acid stone
TX :
potassium citrate
allopurinol

58
Q

Ca stone

A 
TX : 
thizaide
oxalate restriction 
allopurinol 
potassium citrate
59
Q

32 yo SOB at night liver enlarge ankle edema 3rd heart sound enlarge cardiac sihouette pleural effusion non st changes texas travel ??

A

viral infection

viral myocarditis

60
Q

PEdiatric
3yo
constipation small fissure at anal verge
tx?

A

begin oral alxative

limit cow milk inc diet fiber

61
Q

variceal hemorrhage

tx

A

1 fluid
2 ocreotide
3 ceftriaxone

endoscopy within 12 hr
band ligation sclerotherapy
uncontrol balloon tamponad for recurrent TIP shunt

62
Q

Boarderline personality

A

depress easily angry paranoid cut wrist

associated child abuse

63
Q

riluzole

A

glutamate inhibitor

64
Q

orthostatic proteinuria in 14 yo boy

what next step

A

repeat urine dipstick

65
Q

egg shell liver cyst

A

hydatid cyst

66
Q

stroke ptx can have weakness fall alot lead to

A

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

67
Q

Alzheimer can develop

A

incontinence in later stage

68
Q

ABO incompatibility mother o baby AB,a,b

A

mild jaundice only

69
Q

HELLP

A

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

70
Q

male
seminoma
non seminoma

A

seminoma + BHCG

Non seminoma - large mediastinal mass + BHCG, +AFP

71
Q

smudge center of eye enlarge color wash out , eye pain, 1 side
what dx

A

optic neuritis associated MS acute in 2 wk
afferent pupil defect
IX MRI @@@@

72
Q

60 yo scrotal pain dysuria pain during urination

A

Ecoli acute epidydymis
+35 coliform bac > UA culture

-35 sexually transmitted NAAT chlamydia gonorrhea

73
Q

Turett
citeria
DX?
TX?

A

1 motor + 1 tic throat clearing
grimance blink jerk shrugging

TX
anti dopamine - tetrabenzine > most effective
Anti psycho
A2 agonist clonidine

74
Q

Jaundice + pancreatitis

IX?

A

CT

NOT UTZZZZZ

75
Q

Risperidone

A

2nd gen antipsy block D2 inc prolactin galactorrhea irregular mass infertility

76
Q 
Screening
BCA
Cervical pap
Colon Ca
HIC
Hyper lipid
HT
OSteoporosis
A 
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
77
Q 
68yo HT 
dizziness 
BP 140/90 right arm
BP 100/76 left arm
4th heart sound  
systolic carotid bruit เป็น ?
A

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 @@@@

78
Q

joint replacement infect

A

<3mo staph A pseudomonas

>3mo propioni Bac staph epidermidis no fever no inc WBC แต่ ,u impair gait sinus tract formation

79
Q

Diff lifting swallowing (choking)

DX ได้อะไรบ้าง

A

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

80
Q

Chylothorax etiology ?

A

cardiac surgery / down syndrome / noonan

81
Q

slip capital femoral epiphysis

etiology
IX ?

A

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

82
Q

leg calve perthes ?

A

Boy 5-7 yo ( younger)

AVN hip

83
Q

Vasoapsatic angina

A

<50 yo smoking occur at night < 15mins resolved
IX: ambu ECG ST elevation/ no coronary angio defect #
TX: CC blocker to prevent
nitroglycerin treat

84
Q

TB can cause adrenal ?

A

Adrenal insufficiency
retain K + H, normal Anion gap met acidosis
hypotension

85
Q

Obturator N.

A

sensory ข้างๆ ไข่ + Adductor

86
Q

sup peroneal

A

เท้า นิ้ว 2 ถึง 5

87
Q

deep peroneal

A

ระหว่าง 1-2

88
Q

37 yo RF

heart??? cause

A

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

89
Q

atopic dermatitis

ร่างกายสร้าง อะไรไม่ได้

A

ร่างกายสร้าง corneum ไม่ได้ allergen เลยเข้าไปได้ inc risk dry env stress over heat detergent

90
Q

Eczematous

A

เริ่มด้วยแดงก่อนแล้วค่อยแข็ง

ฺbaby face scalp extensor
adult flexor

Usmle กู อย่างละ 100ข้อ (10 decks)

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