USMLE 2 ชุด 8 Flashcards
คลอด Fat neonate Erb Ducheene
5th 6th waiter tip
TX?
massage PT
prevent contact
80% หายได้ลงใน 3 mo
หลังชนมี epigastric pain 20 after + coliky
Duodenal hematoma
ในเด็ก less abdominal tissue
IX CT scan
phynylketoneuria
- hypo pigmented blue eye fair hair seziure musty urine
IX?
AA analysis - AR fail chang ePHEN > tyrosin
tandem mass spectrometry
aldolase B
Fructose intolerance
condylomata acuminata
alot HPV 6+11
condylomata lata
2nd syphilis = grey white
late 2 nd
lower lip encrusted ulcer
DX?
SQ Ca= keratin peral
TX resection most no met @
hyperplasia นม
s/p reduction OR
now 3x3 spiculated mass + course calcified
TX?
reassure
foamy fat > benign breast mass = fat necrosis
from trauma/surgery/
no skin nipple retraction
fibrocystic change
multiple nodulocystic
fibroadenoma
1 mass
neuroblastoma ไม่จำเป็นต้องแสดงตั้งแต่เกิด 2 yo start intermittent fever periorbital ecchymoses paravertebral mass +Droop 1 side face flush constrict pupil opoclonus myoclonus IX?
VMA
NMYC gene small O blue cell
Rape
suicide idea
patellofemoral pain
worse when sitting
infiltated after OR - aspirated gastric acid
TX?
supportibe
Aute Otitis Media 6-18 mo child
narrow straighter
chronic supperative 6 wk
serous otitis media no bulge no fever
dd
teenage 17 yo
no eat, picky eater not sleep well
+ erythema nasal mucosa
+ wt loss
DX?
Coccain _ avoid /restrict food
blunt abdominal trauma >8th rib โดน
MCC bleed =
hepatic laceration + rebound + gen guarding
APAS presentation
TX?
DVT
PR
TIA
STROKE
TX: ligfe loing anti coag +- hydroxycholoquine
neurosyphilis
artheritis CVS abnormal CSF inc lymp
post partum depression
TX when
+2 wk
ovarian failure
FSH
LH
inc FSH
inc LH
สามารถเกิดได้จาก chemo 5ปี ค่อยๆเป็น
henoch schonlein ?
IGA vasculitis ผื่น ข้อ abdominal intuss, renal +CAST
TX supportive + hospitalized + steroid
pccasional dizziness + palpation
dec PLT
IX?
HIV test 10% อาจจะมี
ITP
HEp C
Depression + suicide dont want SSRI?
TX?
dialectical behaviour therapy = psychotherapy first
BAT L ab pain
splenic injuty
FAST normal but high risk
IX?
CT scan
vaginal Ca + malorder vaginal discharge bleeding mass
risk 60yo + HPVm tobacco DES
TX?
biopsy
TX sx
TOF
brain abscess
pancreatic ca
TX?
stop smoking
pancreatitis
stop alcohol
NEC
เด็กไม่จำเป็นต้องมีไข้
foot ball sign
hypothermia
preterm formula milk blood in stool
TOF dec blood supply
ureter stone cut off
-1 cm dec discharge + stain + drink 2L/day
+1cm med alpha blocker, pain , strain, hydro neph
Quad chromosome AFP BHCG INHIBIN trisomy down NT platau
trisomy- dec all except inhibin
down- inc BHCG + inhibin
NT - inc AFP
platau- in AFP
conduct HL female
otosclerosis - abnormal remodel ของ otic capsule from autoimmune
lithium toxic
NV diarrhea ataxia confuse tremer
risperidone
galactorrhea orthostasis
extrapyramidal
ITP splenectomy when
+1 y
PLT <100,000
ทำBM Bx เมื่อ
1)แก่ อายุ>60ปี อันนี้เป็นแบบrelative 2)มีseries อื่นที่ผิดปกติด้วย หรือมีอาการอื่นที่ไม่อธิบายด้วยplt.ต่ำ 3)เจอunexplained organomegaly. 4)ไม่ตอบสนองต่อ steroid. 5)ก่อนsplenectomy
ITP
แบ่งเป็นprimary(ส่วนใหญ่ประมาณ80%) คือไม่มีสาเหตุร่วม กับsecondary คือมีสาเหตุร่วม เช่น Autoimmune disease(SLE, Graves’, Evans syndrome, APS), infection(3H = HIV, HCV, H. Pylori) และviral infectionอื่นๆ เช่นCMV VZV, malignancy อย่าง lymphoproliferative disorderต่างๆ, สุดท้ายก็ยาที่ต้องหา(Rifampicin, quinine, abciximab, vancomycin, valproic acid)
-Lab เบื้องต้นที่ควรส่งทุกคนคือ CBC&Pbs, UA, LFT, antiHIV/antiHCV. อื่นๆ ที่อาจพิจารณาส่งเป็นรายๆ ไป เช่น ถ้าซีด/PbsแบบAIHA อาจต้องส่งdirect coombs test/reticulocyte countเพิ่ม, ถ้ามีdyspepsiaก็ต้องหาH.pylori, สงสัยAutoimm.ก็ ANA และต่างๆนานาตามที่สงสัย
pregnancy hypothyroid
drug?
inc levothyroxine
sheehan
FSH
TSH
dec FSH
dec TSH
แต่ adhesion = normal
aortic dissection
IX?
CT i contrast - type A = emergency Sx
unstable = TE echo
hypersensitivity
1 2 3 4
1-igE
2- IgA- good pasteure, AIHA
3 - AB AG PSGN lupus nephritis
4- T cell contact derm TB
Gambling disorder
TX
CBT + naltrexone opiod antagonist
acute diver
IX
abdomen CT i contrast LLQ fever ileus
Preterm premature rupture of membrane
<34 wk infect? atb corticosteroid Mg
>34 wk ATB cortico delivery
IV penicillin - GBS
Thyroid strome
s/p OR @@@
fever tachycardia AF hypotension agitate seizure guiter n/v
malignant hypertnermia= inc crea, in K, muscle rigid
Iron poisoning
NV shock hypotension met acidosis hematemesis
IX: radioplaque
TX: whole bowel irregation
CC
2D- hepatic necerosis
2-8wk pyloric stenosis
Aspirin
tinnitus fever met acidosis hyperapnea, inc depth + rate inspiration
BCA then biopsy now purple papule firm
+R arm edema
DX?
angisarcoma
IX biopsy again
lining blood vessel lymph
mittle schemerz
mid cycle pain
somatic symptom
+1 problem +6 months
coversion disorder
neuro symptom
brown macule
cafe spot
NF 1
Lish nodule
CC nerve shelf tumor
cluster freckles axillary groin
down
brushfield spot =ALL
tuberous sclerosis
hypopigmented facial angiofibroma
CPPD
meniscial calcified
Rhomboid shape
+ bifringence
chrondrocalcinosis
PEEP
inc intra thoracic pressure
dec right preload
2 MDS drug
apriprazole quetapine
Bupropion = NE d reuptake inhibitor
Gen AD TX
Buspirone
baby blue
+ holosystolic
LAD
P pulmonale ‘
DX?
Tricuspid atresia hyperplastic RV = ASD VSD
TOF
RAD
TAPVR
RAD + right vent hypertrophy
TA
normal EEG
inc pulmonary marking
child infraorbital ecchymosis jerky movement flank mass dumbbel tremor - spinal cord compression opsclonus myoclonus
DX?
neuroblastoma - adrenal medulla sympathetic
NMYC
withdrawal alcohol heroin opioid coccain + amph nicotine
alcohol - delirium heroin - yawn dilate pupil lacrimation opioid - dilate pupil, myalgia, hyperactive bowel coccain + amph- dlow crash vivid dream nicotine - inc appetite
normal PP
uterine at umbilicus + - 2 cm
TOA
TX?
emperic Azithro + ceftri
gonococcal
intrauterine synechiae
ashermas syndrome > cut out basalis
vaginal Ca
smoking most important
age +60 HPV DES
gartnerduct cyst
lateral to anterior vagina (wolffian duct)
skene gland
bilat paraurethral in anterior vaginal vestibule
valvular excoriation + erythema + abnormal pap
intermittant bleeding dyspareunia
vulvular CA
endometrial hyperplasia
from peripheral aromatization of androgen to estrogen
androstenedine > estrone
neonatal thyrotoxicosis from
transplancental TSH receptor AB _ bind to TSH receptor
low birth wt, tachy, warm skin,
TX: self resolving 3 mo
symptomatic : MMZ, bblocker
hyperandrogen
ovarian cyst , inc BHCG- leuteomas bilateral
tx expectant
virilization inc testosterone = sertoli- leydig
chronic HT in preg
MCC complication
preterm labor , oligo
PPROM
chorioamnionitis UTI
placenta precia
prior CS
valvular firm white plaque + excoriation
IX
candida = white discharge + symmetric
biopsy
lichen sclerosis
risk for vulvular CA
Benigh tx steroid
malignant : imiquimode laser
microenceph + hypotonia baby
travel + mosquito
+ multiple intracranial cal + close anteriro frantanelle
ZIKA syndrome = flavivirus, transplacental
IX RNA detection, ADES
Lysteric
intracranial cal + hydrocephalus
alcohol
micro encep แต่ไม่มี craniosynosis
endometriosis
IX
laparoscopy
ดูว่ามีที่ uterosacral ligament ?
if yes = sacral pain