USMLE 2 ชุด 7 Flashcards
MG induced by what atb
fluoro macrolide aminoglycoside
brain blood supply
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
opioid withdrawal
ab cramp vomiting diarrhea inc pulse in bp diaphoresis yawn sad altheralgia piloerect mydriasis
TX methadone , clonidine
CC of MI acute 3-5d 5-2wk \+++later
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
CC nephrotic what wil occur
loss AT3 hypercoag renal vein thrombosis
membranous glomerulopathy
SLE on pred
SE?
osteonecrosis of femoral head
reduce range of motion
IX MRI
Hypothyroid myopathy
weak proximal muscle
cant walk on heel
fibular N.
no dorsiflex
Penumonia jivoreci
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
CI breast feeding
Active TB HIV active varicella at breast chemo substance abuse baby galactosemia
adult lactose intolerance
IX by hydrogen breath test low stool ph
inc stool osmotic gap
toilet training yo?
2-5 yo
if +5 = need investigate
choanal atresia presentation
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 @@@@
s/p operation เจอ dilate loop on xray
+ yhpotension DX?
bacterial peritonitis
fever inc PMN protein <1g, SAAG >1.1g, mental changes
TX cefo
prophylaxis fluoroquinolone
friedreich ataxia
14 yo girl progressive lower back weak dorsal cord atrophy GAA - AR frataxin gene CC = hypertrophy heart IX : genetic TX: physical therapy
HIV diarrhea
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
cherry angiomat a
old ppl 30-40 sharp capillary in dermis benigh
strawberry angioma
young inc then regress by 8 yo in epidermis
Pronator drift while closing eye
pyrimidal
corticospinal track
Evaluation precocious puberty
IX?
bone age evaluation
inc do LH ถ้า high =central ถ้า lo peripheral inc GNRH
normal -มี breast pubic ไหม?
estrogen progestin OCP risk
- hypertension stroke , MI? inc angiotensin synthesis by estrogen
- thromboembolic
- hepatic adenoma
- cervic Ca
Mg inhibit
K renal excretion at outer medullar
amyloidosis presentation
inflammation RA TB OSTEOMYELITI LYMPHOMA VASCULITIS ANYrecurrent infection
- nephrotic hepatomeg peripheral senseless bleeding bruise skin
IX: abdominal fat pad biopsy
TX colchicine preventative
pt with cirrhosis should under goes
screening endoscopy to exclude varices
TX nadolol
ammonia when encephalopathy only
ascitis fluid
examination
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
heriditary spherocytosis
IX?
eosin malemide binding = flow test
acidify glycerol lysistest
young kid
hyperreflex
DX?
1 mental = hemocystinuria(AR) + thrombosis TX vit B anticoag
AA vent dilate = marfan (AD)
evaluate secondary amenorrhea
IX
- BHCG
2 prolactin TSH FSH
3 ถ้ามี procedure = hysteroscopy
AFIB HT >
leg ischemia
IX ?
TX?
echo เพราะ เป็น arterial ไม่ไช้ doppler นะ
prevent by apixaban
ถ้า venous Ddimer + veno doppler - warm erythematous swell tender
Hyper ca
dec vit D = dec phosphorus
MCC prarthyroid def !@@@
pregnant UTI caused by?
progesterone ureteral dilation UTI
TCA - ECG?
prolong QRS
MG - ECG?
prolong QT
menupause indication for HRT =
vasomotor
hot flash
sleep disturbance
simple renal cyst
TX?
reassure only
if large painful > aspirate
55
hyperplasia of smooth muscle intimal layer
normal FEV FVC
DX?
pulmonary hypertension
pseudocyst
TX?
endoscopic drainage ถ้ามี NV ABpain
supportive ถ้า asymptomatic
MI then PCI then hypotension tachy flat neck vein
DX?
retroperitoneal hematoma
ื CT abdomen non contrast
TB
TX
place on respi isolation
hemoptysis
600/24hr
or stable
tx?
hemoptysis
600/24hr - ABC unstable - bronchoscopy- emboli resect
or stable - LAB CT scan + bronchoscope
Blunt chest trauma
dec breath sound rales bruise wall pulmonary contusion
IX patchy infiltrate irregular alveolar ถ้า hematoma จะขาวเลยwithout lung marking
TX?
supportive - neb
succinyl choline
depolarizing NM block at post synaptic L out
arrythmia from Hypo K
Rhinoplasty
MCC complication
Nasal septal perforation
Pneumothorax
TX?
small - observe O2 supportive
unstable tube thoracostomy or needle decompression
trochanteric bursitis presentation
cant lie on right hip when sleeping
seminoma lab
Inc BHCG
normal AFP
teratoma
inc BHCG
inc AFP
penetrating trauma
even neg FAST แต่มี rebound guarding
tx?
urgent explor lap
psoas abscess
fever
pain that look like PID แต่จะมี psoas sign
Abpain if extend
IX
CT scan leukocyte
TX ATB + Drain
fever skinlesion + spread pain crep hypotension
fluid given ok
NEC
TX? debrid
meniscal tear
popping catching provocative test โดย twisting foot + effusion
IX MRI
TX Echo cardiac marker CXR
anterior dislocated shoulder what n damg
axillary N injury weak abduct
blow when externally rotated + abduct arm
Emphysema cholecystitis risk= DM immune, vascular เหมือน cholang แต่ไม่เหลือง
arifluid level ที่ GB = echoli clostridium
TX?
emergent cholecystectomy
Female on OCP strp on warfarin
RLQ pain
what happen
ovarian cyst rupture
Acute M CI <2
what will happen on
PCWP
LA pressure CO
dec PCWP
increase LA pressure
dec CO
pilonidal disease
young male obese intergluteal region mass 4-5 cm ตรงตูด mucoid purulent discharge
central venous cath
what to do next
CXR
varicocele
suping / standing
IX?
TX?
dec in supine
inc when standing atrophy testical
IX retrograde venous flow = tortous
TX gonodal vein ligation/ supportive
bladder Ca
screening
need no screening
DM เดิม ตอนนี้มี DOB palpitation poor sleep wt loss inc glucose normal elyte VS: inc BP, inc Temp, tachy
DX?
thyrotoxicosis
Dermatomyositis associated with
malignancy- ovarian, lung. pancrea, stomach, non hodgkin
proximal weakness , rash,
$periorbital edema
$ joint gottron, heliotrope rash
+- lung interstitial, dysphagia, myocarditis
osteoid osteoma
TX:
left thigh pain at night
improve with NSAID observe lot ดำๆกลมๆ
Legg calve perthes
presentation
IX
TX
ach knee limp normal xray(flat femoral head> avascular) มี URI + fever age 3-12yo restricted hip AB IR + tredenlenburg
TX: night splint
AIHA
what cold hot?what
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
Pedia
Age + Gross fine language cognitive
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
CV% inc
ทำอะไร ไห้อะไร
rosuvastatin 5-10g
ก่อน lifestyle modification
HA + warning
neuro(seizure, AOC), inc intensity, inc frequency, more than 40yo, new onset, trauma, in the morning
do MRI
lower back pain
TX?
NSAID MOD activity
ถ้าไม่มี redflag
= wt loss fever ca neuro def
recent URI now middle mediatinal mass
DX?
bronchogenic cyst
5days breast pain
breast engorgement
galactocele= subareolar mobile, circumscribe mass
thin irregular painful mass
primary dysmenorrhea
social anxiety disorder citeria
1+ situation + 6 mo
propanolol SSRI CBT
Atrial myxoma
L atrium intracardiac tumor อาจะ มี wt loss
murmur by position
multiple joint stiff in the morning mild swell no red no tender
from what organisms?
parvovirus B19
if RA = swelling + morning stiffness
normal movement deliver fetal 4 crease L thigh, 1 crease R thigh
blue grey macule sacrum
IX?
ultrasound hip - Dysplasia hip
=Breech, fx,
+ ortholani, dislocated hip
barlow limit hip
<4 mo UTZ,
>4mo radiograph palvik support
obese
ไตเป็นอะไร จาก อะไร
insulin resist inc lipolysis
NAFLD
variceal UGIB
TX?
1 IV fluid 2 keep HB +7 3 Endoscopic to stop bleed - balloon TIP SHUNT no bleed- B block + band + 2 wk later
Acute pancreatitis IX LAB?
ALT +150 biliary pancreatitis
IX UTZ RUQ
Clavical fracture
neuro?
IX?
neurovascular - subclavian A+ brachial plexsus
IX angiogram
reduce post opt atelect. pneumonia
incentive spirometry
poenumoperitoneum
perforated GU
even take war INR 2.1 ok
ต้องไห้ ?
FFP ก่อ operate เสมอ
Gut obstruction inc temp dec bp
tachy met acidosis 4 วัน
Explore lap
patellar dislocation fell มีเสียง pop knee flex dec range of motion มี ?
lateral dislocated deformity (medial patello femoral ligament )
R leg ติด dash board initial ?
measure compartment pressure
pain on stretch pain out of proportion
paresthesia early
delta pressure <30 mmHg
tx: urgent fasciaotomy
gymnastic
stress fracture wheere?
tibial
child proximal thigh no ROM high fever 3 days femoral proximal tenderness DX? TX?
osteomyelitis
inc ESR inc CRP normal x ray
TX Vanco
ไม่บอกเมียว่าผัวมาคลีนิก
ห้ามบอกนะ
hepatitis cirus window period ทำ IX?
AntiHBC IgM
HBSAG
asymptomatic bacterial UTI
TX?
+100,0100 CFU
Ecoli Kleb Enero GBstrep
TXamoxicillin clavulanic ,ต้อง treat นะ ไม่งั้นจะ pyelonephritis
TMPSMX
SE?
kernicterus
neonatal sepsis เด็ก
เด็กไม่จำเป็นต้องมีfever สามารถ hypothermia ได้ (<36)
work up ได้เลย ควรได้ Ampi + Genta
LP ถ้า shock, epilepsy$$$
Heat stroke
citeria
AOC +40c
cc Rhabdo RF DIC
Trichomoniasis
flagellated motile organism
umbilical hernia
surgery when ?
SX 5 ปี
SX ถ้า +1.5 CM mass
also watch out for hypothyroid ehler beck down
คนแก่ๆ osteop
orosis trauma acute pain เดิน นอน ยืนไม่ได้
ไอ เก็บของ bend หลังได้
vertebral compression fracture
tx corticosteroid
old สามารถมี absent ankle reflex ได้
d
binge eating disorder weight ยัง OVER 20BMI
TX CBT
Bulimea ต้อง BMI -20
Male 13-16 yo
มี CXR metaphysis proximal humerus tibial distal femur
inc AKP
inc LDH
อาจะไม่มี B symptom
Osteosarcoma
