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

USMLE step 2 ชุด 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

82 yo epigastric pain hyperlipidemia DM
PMX cholelithiasis
smoker TB positive
Do ECG

A

Atypical MI in DM women elder

epigastric vomitng nausea

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2
Q

38 to DOB mocoid sputum 6 mo bulging frontanelle prominant saclp vein (+99% percentile)
IX อะไร

A

CT scan brain

hydrocephalous

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3
Q

Post opt atelectasis most severe during 2 nd night

low PaO2, increase hypervent

A

Respi alkalosis

decrease PaCO2

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4
Q

25 hr baby vomit green
mom มี CFTR F 508
BP 80/50 NGT placed CXR: dilate loop

Next step what

A

do contrast Enema หา CF CC คือ ,icrocolon: meconium ileus gastrografen, r/o hirshprung if dilate biopsy anorectal monometry

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5
Q

suicidal ideation hearing voice mute motionless resist all instruction to move
= catatonia

Tx อะไร

A

Benzo (lorazepam) or ECT

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6
Q

43 yo knee pain chrondocalcinosis + effusion DM mild hepatomegaly

= pseudogout need to check whatt

A

Ironstudy = hemochromatosis = bronze skin DM hyperthyroid listeria vibrio yersinia

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7
Q

Cluster HA
awake at night

what TX

A

Iithium
varapamil
if acute 100% O2

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8
Q

DOB dysphagia
blurr vison จาก cured fish

what TX

A

give equine antitoxin therapy

= botulism

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9
Q 
75 yo back pain 
diff walking urination
prostate CA 
hyper reflexia
weak Lower extremity

T10-11 worse at night

A

IV steroid spinal cord compression next do MRI

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10
Q

19 yo มี 6 mo amenorrhea menarch 11, atop 9 months ago
soccer player no men after medroxyprogesterone challange

risk of what

A

Bone fracture

functional hypothalamic

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11
Q

children lymphadinitis

MCC คือ?

A

staph A.

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12
Q

Methyl phenidate common side effect

A

dec appetite > wt loss> insomnia

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13
Q

PAD give Aspirin, reduce stroke MI

indication of given simvastatin

A

40 year
DM
HPN
LDL 190

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14
Q

33 yo SOB pounding(water hammer, corrigan upstroke rapid collapse of peripheral pulse) heart aware of heart beat when lying left side BP 150/45, HR 73
what DX

A

AR
จาก RF
Decrescendo + diastolic wide pulse pressure

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15
Q

16 mo old baby cnat stand hypertonic LE UE babinski absent

DX

A

cerebral palsy non progressive motor dysfunction splastic diplegia premature

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16
Q

Myopathy normal CK ESR

what

A

steroid, cushing , painless

Muscle atropy by stroid , AKT-1 X no insulin growth factor

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17
Q

Myopathy increase ESR
normal CK

what

A

Polymyalgia rheumatica pain stiff

temporal arteritisด้วยความที่หลอดเลือดนี้ส่งแขนงไปเลี้ยงกล้ามเนื้อและอวัยวะบนศีรษะและใบหน้านอกกระโหลก อาการที่เกิดจึงเกิดกับศีรษะและใบหน้า คือ อาการปวดศีรษะรุนแรง มักจะเกิดเฉียบพลันรุนแรง ปวดกราม ปวดลิ้น อาการรุนแรง เรื้อรัง ไม่หาย บางคนอาจคลำหลอดเลือดที่ว่าได้ชัดเจน
อาจมีอาการปวดไหล่ ปวดสะโพก ปวดร้าวตามตัวที่เรียกว่า

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18
Q

Myopathy increase CK
increase ESR

what?

A

inflame arthritis

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19
Q

myopathy increase CK

normal ESR

A

statin induce hypothyroid

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20
Q

preeclampsia 36 wk AOG +1 protein

do what

A

urine protein to creatinin ratio test

gold standard for qualift the proteinuria >0.3 or 24 hr 300mg

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21
Q

32 yo progressive SOB no chest pain
มี viral 2 ek
bibasal crackle inc JVP +2 edema
EKG- dilate ventricle with diffuse hypokinesia

A

suggest CHF dilate จาก viral myocarditis COXB> parvo > HHS> Adeno> Entero

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22
Q

VitB 12 loss what

A

loss propioperception of LE จาก dorsal column

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23
Q

in baby hypovolumia, hypernatremia tx

A

NSS 0.9% use fluid resus

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24
Q

Deliruim flutuation cognitive poor attention disorient

high dose steroid

A

induce psychosis evil children จาก steroid

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25
Q

53 yo homeless men DOB candida lung bilat crackle = consolidation pneymonia

IX:?

A

ventilation/ perfusion mismatch cause hypoxemia R>L intrapulmonary shunting

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26
Q

66 yo skin wound shiungle hx skin change oozing crust

IX:

A

skin biopsy r/o SCC ( chronic wound burn scar)

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27
Q

34 yo BOV goes blind when stand up enlarge blind spot

what dx

A

papilledem a swelling of optic nerve head

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28
Q

i never feel good and have low self esteem eversince college 5 year ago my low energy always feel down

DX

A

dysthymia

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29
Q

PCP HIV on ppt SIADH

serum 2Na+g/18+Bun/2.8 osm 275(low)-295(high)

A

normal paraprotein, hyperlipid

high = hypergly

low -
hypovolumic- UNa <40 vomit diarrhea dehydrate
UNa >40 diuretic adrenal insuff

euvolumic - u osmole <100 bronchogenic polydipsia
> 100 osm- SIADH

hypervolumic CHF nephrotic

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30
Q

Pregnancy appendectomy

cute

A

use mid line vertical laparotomy

not laparoscopic

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31
Q

34 yo cough blood + wheeze right side + dense opacity in right upper lobe

ทำไรต่อ

A

place patient on isolation respi

ถ้า 600ml/24hr , 100ml/hr do CT bronchoscope if persistent embolized

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32
Q

22 yo knee pain catching while walking unabel to extend swell
PE no pain or crepitus no varus or valgus
IX อะไร

A

Do MRI meniscal tear

from soccer tournament (rotational on plantar foot)

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33
Q

Depress 2 mo + evil saying
shout spoke rapidly standing up all night writting letter suicide attempt

TX ?

A

lithium calporate > 2nd quitapine lamotrigine

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34
Q

underweight pregnancy

A

growth restriction

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35
Q

17 yo adnexal fullness + ovarian cyst, calcified hyperechoic

A

cystic teratoma dermoid
CC ischemic necrosis, จาก torsion,
rupture + free fluid

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36
Q

PRegnancy 20-30 min- moderate insensity excercise??

A

waking jogging no gymnastic

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37
Q

TOF crescendo decresendo systolic murmur

manuver

A

knee chest position will increase
systemic vascular resistance
kink femoral A.

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38
Q

68 yo COPD SOB without relieve
กิน methylprednisolone ipratropium albuteral
E tube insert when <7.1, PaCo2 60

tx อะไร

A

non invasive PEEP also pulmonary edema ARDS early extubate

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39
Q

Schizo

A

lateral enlarge of ventricular

40
Q

15 yo sexually active get chlamydia + gonorrhea swap

IX ?

A

NAAT gold standard

not urine marijuana

41
Q

HIV chest pain diaphoresis nausea recurrent vomiting coccain injected conjuntivae dilate pupil
widen mediastinum effusion

DX:

A

esophageal perforation

42
Q

mallory weiss

A

mucosal tear EDG heal spontaneous

43
Q

Boerhaave transmural tear

A

gever dyspnea odynophagia subcutaneous emphysema CT exophagography with gastrografin pleural effusion

44
Q

เห็น meta myelocyte + myelocyte ดู LAP Leukocyte alkaline phosphatase

A 
high = leukemoid reaction = infection
Low = CML
45
Q

24 yo + CKD transplant + immune supression
burning pain at wrist at night
DX TX

A

carpal tunnel

TX: wrist splint at night

46
Q

Febrile seizure at 2 yo

A

tx reassure do not hospitalized for observation send home from emergency

47
Q

BP 220/120 treat next morning confuse seizure normal breath

what TX?

A

look out nitroprusside

48
Q

intensive glycemic control prevent

A

microvascular retinopathy / not macrovascular MI STROKE

49
Q

32 yo both hand tingling
BOV HA Dizzi
touch pain sense dec on upper extremity optic neuritis papilledema disc hypermic swollen

IX?

A

MRI periventricular supial

50
Q

72 yo s/p shingle difficulty urination palpable lower ab mass
cough /diphenhydramine, hydroxyzine, chlopheniramine
tx ?

A

First gen H

anticholinergic -> M of para symp - detruser hypocontract

51
Q 
SLE in pregnancy 
Edema mimic preeclampsia 
arthritis hematuria 
proteinuria 
Hypertension 
WBC + RBC cast on UA

IX อะไร

A

Renal Biopsy

52
Q

3 days old cyanosis right hand 96% o2
right feet 85% o2 sat
lactic acidosis

etiology

A

thickening of tunica media in aortic arch
coarctation
dec femoral pulse 4 sec capillary fill

53
Q

Hyponat ดู serum osm

A

290 + = hypergly renal failure DI high NA central DI
Low Na Nephrogenic DI

  • 290 ดู urine osm
    -100 คือ primary poly dipsia both low malnutrition
    +100 ดู urina NA +25 SIADH adrenal insuff hypothyroid
    -25 volume depression CHF Cirrhosis
54
Q

Fall incident coin 4.5 cm in lung

previous CXR

A

STABLE no work up

New - do CT chest benign= serial CT
suspect = PET biopsy
highly suspect - excision

55
Q

47 yo coffee ground emesis

black tarry stool weakness pale conjunctivae

A

inc BUN/CR
Upper GI bleed tachy cardia = volume depletion
inc urea form Break down hemoglobin urea reabsorption in proximal tube

56
Q

inevitable abortion

A

vaginal bleeding
dilate cervix
product of conception see felt above os
UTZ show sac in lower segment

57
Q

34 yo HA given pain killer, new Ht 185/105 irregular S4 continuous murmur thoughtout thorax
CXR ?

A

erosion of inferior costal surface

Cocarctation of aorta = systolic murmur blood flow pass narrow aorta at left infraclavicular interscapular
notching erosion of 3-8 rib steonotic signs

58
Q

Pan hypopituitary will have whatttt

to aldosterone

A

normal

secrete depend on renin

59
Q

4 wk s/p rhinoplasty wheezing nostril

what cause

A

nasal septal perforation

other can cause this is coccain syphilis TB sarcoid wegener

60
Q

PTx CHF left vent dysfunction holosystolic murmur MR occur due to left ventricular dilate

A

increase renin norepi ADH will inc SVR
inc blood volume will inc preload and LEDVคือ wedge pressure นั่นเอง
dec contractility dec cardiac index

volume loss dec LEVDV, dec CI, inc SVR sympathetic
MI will dec CI inc SVR and normal LVEDV

61
Q

syccinylcholine cardiac arrhythmia dur to

A

electrolyte
influx Na and efflux L

severe hyperkalemia

62
Q

16 yo facial hair BMI 20

A

inc 17 hydroxyprogesterone
inc testosterone
inc DHT

non classical adrenal hyperplasia = dec 21 hydroxylase

63
Q

Vagina lesion not painful

A

Klep granulation no lymph
syphilis
chlamydia is painful node

64
Q

loud snoring depression

A

mood disorder due to another medication condition

osa = low mood irritability

65
Q

8 yo fever cough paroxysmal ppt by eating subcutaneous emphysema

IX?

A

do CXR to r/o pneumothorax

66
Q

8 yo boy maroon colored stool well cooperative + painless

IX?

A

tecnetium 99 pertechnetate scan for meckel diverticulum

67
Q

36 yo AB distend flatus loss wt sweat arthralgia enlarge non tender inguinal node ulcer on buccal IX อะไร

A

HIV testing

68
Q

45 yo HIV GI + B symptom splenomegally CMV igG (-), CD 4,22 AKP 412
3mm TB test

A

Azithromycin MAC

69
Q

80 yo PHX DM MI stroke
BP 78/48 HR 124 DM sacral ulcer
venous statis FBS 250 inc mix venous O2 sat

คือจากอะไร

A

Reduce cardiac afterload

from sepsis shock

70
Q

RA pressure + PCWP

A

preload

71
Q

SVR

A

After load

72
Q

Asper staph avscess lymphadenitis

A

chronic granulomatous
test dihydroorhamine
nitroblue tetrazolium

73
Q

54 yo fever chill dysphagia drooling 38.8 c, muffle voice tongue displace posterier superior bilateral crepitus submandibular

A

ludwig angina teeth root

molar mandibular

74
Q

68 yo DM hypothyroid hypercholesteral on dialysis crea 3.2-3.5 platelet dysfunction normal pt count

A

uremic tx BT only

tx DDAVP

75
Q

23 yo motor accident give fluid 2.5 L
BP 70/30 multiple bruise extremly cold neck vein flat
small left vent cavity + EF 75%

A

hypovolumic shock

76
Q

32 yo 3 days fever cough sputum clear crackle on right vase occasional wheeze

IX

A

CXR - CAP

CXR needed for diagnosis then give AB

77
Q

inferior MI

A

papillary muscle displacement MR blood leak back to left atriu, increase diastolic overload inc LVEDP + left vent filling pressure

78
Q

AF origin is pulmonary vein

A

mcc ectopic foci cardiac tissue extend to pulomo vein มี elctrical

79
Q

67 yo forgetful fear of demential like now i feel low useless teary lose sleep

A

MDS

pseudo dementia

80
Q

4 mo poorfeeding pallor web neck shield chest triplephalangeal thumb tachy systolic murmur anemia
Macrocytic anemia low Rt count
defect in programmed cell death in progenitor cell
AD

A

diamon black fan anemia

81
Q

Fanconi

A

AR pancytopenia
macrocytosis cafe
micro eye short shoe kidney
no thumb

82
Q

inferior MI

A

2 3 avf

83
Q

lateral MI

A

23 avf + 1 avl V5 V6

84
Q

bed wetting 7 yo tx?

A

demopressin

imipramine ( due to SE suicide cardio toxi)

85
Q

died this is painful loss i amhere to help you though it

A

advise

86
Q

valgus abduct

A

medial collateral ligament

tx ice rest compress elevation

87
Q

mesenteric ischemia and atherosclerosis met acidosis abrupt when cardiac emboli

A

AF
infective
endocarditis IV staph

88
Q

52 yo black stool ab discomfort food help with pain
gain wt drink beer

PT ab tender right side + bruit

A

PUD

89
Q

pregnancy clear fluid leak when stand up tx chlamydia at 10 wk all normal

A

urinary incontinence stress inc abdominal pressure

90
Q

HIV diarrhea

A

<180 low grade fever = crypto acid fasting
<100 no fever - isosporidium + crampy pain
<50 FEVER = MAC, hematochezia ab pain = CMV

91
Q

12 yo boy right groin pain knee pain limping 90% for weight 60% for height hip movement limited right food outword excertional movement of thight on flex hip

slipped capital femoral epiphysis displace femoral head loss abduction internal rotation

A

tx surgical pinning of femoral head

92
Q

phenelzine

A

MAOi prevent deamination of Dopamine, Norepi, S

93
Q

micrognathia

A

edward

94
Q

microopthalmia + cutis plasia

A

platau

95
Q

3yo sickle fever no cough no cold no thing no DOB

ptx plenic sequest crisis

organism?

A

s pneumonia - dispite vaccination cause of non typable MCC SEPSIS
meningiococcal

Usmle กู อย่างละ 100ข้อ (10 decks)

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