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Usmle กู อย่างละ 100ข้อ > USMLE 2 ชุด 7 > Flashcards

USMLE 2 ชุด 7 Flashcards

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USMLE® Step 1 flashcards
1
Q

MG induced by what atb

A

fluoro macrolide aminoglycoside

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2
Q

brain blood supply

A

ACA caudate, internal capsule (pure motor)
MCA putamen, globus pallidum
PCA thalamus = lacunar stroke

basal ganglia involve = athetosis ballistic hemiparesos

s/p improve thalamic pain syndrome
dejerine roussy
allodynia

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3
Q

opioid withdrawal

A

ab cramp vomiting diarrhea inc pulse in bp diaphoresis yawn sad altheralgia piloerect mydriasis

TX methadone , clonidine

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4
Q 
CC of MI 
acute
3-5d
5-2wk
\+++later
A

acute - right vent failure - (RCA) hypotension kussmaul
3-5d -
1. papillary muscle rupture (RCA) pulmonary edema , DOB, holosystolic% murmur
2. interseptum rupture (LAD) , ((RCA (basal septal) holosystolic% , biventricular shock inc O2 in RA comfirm by PA catheter on TEE
5-2wk - free wall rupture (LAD) distal heart sound
+++later - left vent aneurysm (LAD) stable angina

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5
Q

CC nephrotic what wil occur

A

loss AT3 hypercoag renal vein thrombosis

membranous glomerulopathy

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6
Q

SLE on pred

SE?

A

osteonecrosis of femoral head
reduce range of motion

IX MRI

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7
Q

Hypothyroid myopathy

A

weak proximal muscle

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8
Q

cant walk on heel

A

fibular N.

no dorsiflex

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9
Q

Penumonia jivoreci

A

IX? inc LDH diffuse reticular CXR
TX: TMP SMX(15,75 kg/day แบ่ง 3เวลา) second line pentamidine + prednisolone 21 days if dec O2 72, 90

dose pred
40mg x2 for 5 วัน
40mg x 1 for 5 วัน
20mg x1 for 10วัน

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10
Q

CI breast feeding

A 
Active TB
HIV
active varicella at breast
chemo
substance abuse
baby galactosemia
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11
Q

adult lactose intolerance

A

IX by hydrogen breath test low stool ph

inc stool osmotic gap

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12
Q

toilet training yo?

A

2-5 yo

if +5 = need investigate

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13
Q

choanal atresia presentation

A

cyanosis but ok when cry
narrow pterygoid at posterior nasal
cant pass catheter

IX CT$

COLOBOMA
HEART
ATRESIA CHOANAL
RETARD GROWTH
GENITAL
EAR ABNORMAL

Charge @@@@

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14
Q

s/p operation เจอ dilate loop on xray

+ yhpotension DX?

A

bacterial peritonitis
fever inc PMN protein <1g, SAAG >1.1g, mental changes

TX cefo

prophylaxis fluoroquinolone

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15
Q

friedreich ataxia

A 
14 yo girl progressive lower back weak dorsal cord atrophy
GAA - AR frataxin gene 
CC = hypertrophy heart 
IX : genetic 
TX: physical therapy
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16
Q

HIV diarrhea

A

watery
<180 + fever = crypto
<100 no fever + cramp = microsporidium
<50 + high fever MAC

<50 CMV bloody small frequence AB pain

IC colonoscopy biopsy eosinophilic basophilic intracytoplasm

do eye r/o retinitis

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17
Q

cherry angiomat a

A

old ppl 30-40 sharp capillary in dermis benigh

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18
Q

strawberry angioma

A

young inc then regress by 8 yo in epidermis

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19
Q

Pronator drift while closing eye

A

pyrimidal

corticospinal track

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20
Q

Evaluation precocious puberty

IX?

A

bone age evaluation
inc do LH ถ้า high =central ถ้า lo peripheral inc GNRH

normal -มี breast pubic ไหม?

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21
Q

estrogen progestin OCP risk

A
  1. hypertension stroke , MI? inc angiotensin synthesis by estrogen
  2. thromboembolic
  3. hepatic adenoma
  4. cervic Ca
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22
Q

Mg inhibit

A

K renal excretion at outer medullar

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23
Q

amyloidosis presentation

A

inflammation RA TB OSTEOMYELITI LYMPHOMA VASCULITIS ANYrecurrent infection

  1. nephrotic hepatomeg peripheral senseless bleeding bruise skin

IX: abdominal fat pad biopsy

TX colchicine preventative

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24
Q

pt with cirrhosis should under goes

A

screening endoscopy to exclude varices

TX nadolol

ammonia when encephalopathy only

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25
Q

ascitis fluid

examination

A

1 color- bloody(TB CA), milky( panrea), turbid, straw
2 neutrophil - 250+ peritonitis
3 protein 2.5 less - cirrhosis, nephrotic
2.5 more CHF, Bud chiari, fungal, TB
4 SAAG
less 1.1 - TB peritoneal pancreatic nephrotic
more 1.1 portal HT, cirrhosis bud chiari

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26
Q

heriditary spherocytosis

IX?

A

eosin malemide binding = flow test

acidify glycerol lysistest

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27
Q

young kid
hyperreflex

DX?

A

1 mental = hemocystinuria(AR) + thrombosis TX vit B anticoag

AA vent dilate = marfan (AD)

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28
Q

evaluate secondary amenorrhea

IX

A
  1. BHCG
    2 prolactin TSH FSH
    3 ถ้ามี procedure = hysteroscopy
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29
Q

AFIB HT >
leg ischemia

IX ?
TX?

A

echo เพราะ เป็น arterial ไม่ไช้ doppler นะ

prevent by apixaban

ถ้า venous Ddimer + veno doppler - warm erythematous swell tender

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30
Q

Hyper ca

A

dec vit D = dec phosphorus

MCC prarthyroid def !@@@

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31
Q

pregnant UTI caused by?

A

progesterone ureteral dilation UTI

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32
Q

TCA - ECG?

A

prolong QRS

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33
Q

MG - ECG?

A

prolong QT

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34
Q

menupause indication for HRT =

A

vasomotor
hot flash
sleep disturbance

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35
Q

simple renal cyst

TX?

A

reassure only

if large painful > aspirate

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36
Q

55
hyperplasia of smooth muscle intimal layer
normal FEV FVC
DX?

A

pulmonary hypertension

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37
Q

pseudocyst

TX?

A

endoscopic drainage ถ้ามี NV ABpain

supportive ถ้า asymptomatic

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38
Q

MI then PCI then hypotension tachy flat neck vein

DX?

A

retroperitoneal hematoma

ื CT abdomen non contrast

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39
Q

TB

TX

A

place on respi isolation

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40
Q

hemoptysis
600/24hr
or stable

tx?

A

hemoptysis
600/24hr - ABC unstable - bronchoscopy- emboli resect
or stable - LAB CT scan + bronchoscope

41
Q

Blunt chest trauma
dec breath sound rales bruise wall pulmonary contusion

IX patchy infiltrate irregular alveolar ถ้า hematoma จะขาวเลยwithout lung marking
TX?

A

supportive - neb

42
Q

succinyl choline

A

depolarizing NM block at post synaptic L out

arrythmia from Hypo K

43
Q

Rhinoplasty

MCC complication

A

Nasal septal perforation

44
Q

Pneumothorax

TX?

A

small - observe O2 supportive

unstable tube thoracostomy or needle decompression

45
Q

trochanteric bursitis presentation

A

cant lie on right hip when sleeping

46
Q

seminoma lab

A

Inc BHCG

normal AFP

47
Q

teratoma

A

inc BHCG

inc AFP

48
Q

penetrating trauma
even neg FAST แต่มี rebound guarding
tx?

A

urgent explor lap

49
Q

psoas abscess
fever
pain that look like PID แต่จะมี psoas sign
Abpain if extend

IX

A

CT scan leukocyte

TX ATB + Drain

50
Q

fever skinlesion + spread pain crep hypotension

fluid given ok

A

NEC

TX? debrid

51
Q

meniscal tear

A

popping catching provocative test โดย twisting foot + effusion

IX MRI
TX Echo cardiac marker CXR

52
Q

anterior dislocated shoulder what n damg

A

axillary N injury weak abduct

blow when externally rotated + abduct arm

53
Q

Emphysema cholecystitis risk= DM immune, vascular เหมือน cholang แต่ไม่เหลือง
arifluid level ที่ GB = echoli clostridium

TX?

A

emergent cholecystectomy

54
Q

Female on OCP strp on warfarin

RLQ pain

what happen

A

ovarian cyst rupture

55
Q

Acute M CI <2
what will happen on
PCWP
LA pressure CO

A

dec PCWP
increase LA pressure
dec CO

56
Q

pilonidal disease

A

young male obese intergluteal region mass 4-5 cm ตรงตูด mucoid purulent discharge

57
Q

central venous cath

what to do next

A

CXR

58
Q

varicocele

suping / standing

IX?
TX?

A

dec in supine
inc when standing atrophy testical

IX retrograde venous flow = tortous
TX gonodal vein ligation/ supportive

59
Q

bladder Ca

screening

A

need no screening

60
Q 
DM เดิม ตอนนี้มี
DOB palpitation
poor sleep wt loss inc glucose 
normal elyte 
VS: inc BP, inc Temp, tachy

DX?

A

thyrotoxicosis

61
Q

Dermatomyositis associated with

A

malignancy- ovarian, lung. pancrea, stomach, non hodgkin

proximal weakness , rash,
$periorbital edema
$ joint gottron, heliotrope rash

+- lung interstitial, dysphagia, myocarditis

62
Q

osteoid osteoma

TX:

A

left thigh pain at night

improve with NSAID observe lot ดำๆกลมๆ

63
Q

Legg calve perthes

presentation
IX
TX

A 
ach knee limp 
normal xray(flat femoral head> avascular) มี URI + fever 
age 3-12yo restricted hip AB IR + tredenlenburg

TX: night splint

64
Q

AIHA

what cold hot?what

A

cold: ยา URI SLE CLL = กินยาแล้ว weak DOB spleenomegaly > direct IgG coomb
TX steroid splenectomy CC: Venous thrombosis, lymphadenopathy

HOT: mycoplasma, IM, Lymph- anti igM, livedoreticularis
TX: avoid hot, Rituximab, Fludarabine
CC ischemia gangrene lymph

65
Q

Pedia

Age + Gross fine language cognitive

A

2 mo lift head, track, coo,smile recognition

4 mo sit/roll hand open , laugh, twin voice

6mo sit unsupport, transfer object, response time, stranger anxiety

6 mo pull to stand 3 finger hold bottle say mama dada wave bye

12mo stand walk throw 2 finger grip seperation anxiety come when call

66
Q

CV% inc

ทำอะไร ไห้อะไร

A

rosuvastatin 5-10g

ก่อน lifestyle modification

67
Q

HA + warning

A 
neuro(seizure, AOC), 
inc intensity,
inc frequency,
more than 40yo,
new onset,
trauma,
in the morning

do MRI

68
Q

lower back pain

TX?

A

NSAID MOD activity
ถ้าไม่มี redflag
= wt loss fever ca neuro def

69
Q

recent URI now middle mediatinal mass

DX?

A

bronchogenic cyst

70
Q

5days breast pain

breast engorgement

A

galactocele= subareolar mobile, circumscribe mass

71
Q

thin irregular painful mass

A

primary dysmenorrhea

72
Q

social anxiety disorder citeria

A

1+ situation + 6 mo

propanolol SSRI CBT

73
Q

Atrial myxoma

A

L atrium intracardiac tumor อาจะ มี wt loss

murmur by position

74
Q

multiple joint stiff in the morning mild swell no red no tender

from what organisms?

A

parvovirus B19

if RA = swelling + morning stiffness

75
Q

normal movement deliver fetal 4 crease L thigh, 1 crease R thigh
blue grey macule sacrum

IX?

A

ultrasound hip - Dysplasia hip

=Breech, fx,
+ ortholani, dislocated hip
barlow limit hip

<4 mo UTZ,
>4mo radiograph palvik support

76
Q

obese

ไตเป็นอะไร จาก อะไร

A

insulin resist inc lipolysis

NAFLD

77
Q

variceal UGIB

TX?

A 
1 IV fluid 
2 keep HB +7
3  Endoscopic to stop
bleed - balloon TIP SHUNT
no bleed- B block + band + 2 wk later
78
Q

Acute pancreatitis IX LAB?

A

ALT +150 biliary pancreatitis

IX UTZ RUQ

79
Q

Clavical fracture
neuro?

IX?

A

neurovascular - subclavian A+ brachial plexsus

IX angiogram

80
Q

reduce post opt atelect. pneumonia

A

incentive spirometry

81
Q

poenumoperitoneum
perforated GU
even take war INR 2.1 ok
ต้องไห้ ?

A

FFP ก่อ operate เสมอ

82
Q

Gut obstruction inc temp dec bp

tachy met acidosis 4 วัน

A

Explore lap

83
Q

patellar dislocation fell มีเสียง pop knee flex dec range of motion มี ?

A

lateral dislocated deformity (medial patello femoral ligament )

84
Q

R leg ติด dash board initial ?

A

measure compartment pressure
pain on stretch pain out of proportion
paresthesia early
delta pressure <30 mmHg

tx: urgent fasciaotomy

85
Q

gymnastic

stress fracture wheere?

A

tibial

86
Q 
child proximal thigh  no ROM
high fever 3 days 
femoral proximal tenderness
DX?
TX?
A

osteomyelitis
inc ESR inc CRP normal x ray

TX Vanco

87
Q

ไม่บอกเมียว่าผัวมาคลีนิก

A

ห้ามบอกนะ

88
Q

hepatitis cirus window period ทำ IX?

A

AntiHBC IgM

HBSAG

89
Q

asymptomatic bacterial UTI

TX?

A

+100,0100 CFU
Ecoli Kleb Enero GBstrep

TXamoxicillin clavulanic ,ต้อง treat นะ ไม่งั้นจะ pyelonephritis

90
Q

TMPSMX

SE?

A

kernicterus

91
Q

neonatal sepsis เด็ก

A

เด็กไม่จำเป็นต้องมีfever สามารถ hypothermia ได้ (<36)

work up ได้เลย ควรได้ Ampi + Genta

LP ถ้า shock, epilepsy$$$

92
Q

Heat stroke

citeria

A

AOC +40c

cc Rhabdo RF DIC

93
Q

Trichomoniasis

A

flagellated motile organism

94
Q

umbilical hernia

surgery when ?

A

SX 5 ปี
SX ถ้า +1.5 CM mass

also watch out for hypothyroid ehler beck down

95
Q

คนแก่ๆ osteop
orosis trauma acute pain เดิน นอน ยืนไม่ได้

ไอ เก็บของ bend หลังได้

A

vertebral compression fracture

tx corticosteroid

96
Q

old สามารถมี absent ankle reflex ได้

A

d

97
Q

binge eating disorder weight ยัง OVER 20BMI

TX CBT

A

Bulimea ต้อง BMI -20

98
Q

Male 13-16 yo
มี CXR metaphysis proximal humerus tibial distal femur

inc AKP
inc LDH

อาจะไม่มี B symptom

A

Osteosarcoma

Usmle กู อย่างละ 100ข้อ (10 decks)

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