USMLE step 2 ชุด 2 Flashcards
82 yo epigastric pain hyperlipidemia DM
PMX cholelithiasis
smoker TB positive
Do ECG
Atypical MI in DM women elder
epigastric vomitng nausea
38 to DOB mocoid sputum 6 mo bulging frontanelle prominant saclp vein (+99% percentile)
IX อะไร
CT scan brain
hydrocephalous
Post opt atelectasis most severe during 2 nd night
low PaO2, increase hypervent
Respi alkalosis
decrease PaCO2
25 hr baby vomit green
mom มี CFTR F 508
BP 80/50 NGT placed CXR: dilate loop
Next step what
do contrast Enema หา CF CC คือ ,icrocolon: meconium ileus gastrografen, r/o hirshprung if dilate biopsy anorectal monometry
suicidal ideation hearing voice mute motionless resist all instruction to move
= catatonia
Tx อะไร
Benzo (lorazepam) or ECT
43 yo knee pain chrondocalcinosis + effusion DM mild hepatomegaly
= pseudogout need to check whatt
Ironstudy = hemochromatosis = bronze skin DM hyperthyroid listeria vibrio yersinia
Cluster HA
awake at night
what TX
Iithium
varapamil
if acute 100% O2
DOB dysphagia
blurr vison จาก cured fish
what TX
give equine antitoxin therapy
= botulism
75 yo back pain diff walking urination prostate CA hyper reflexia weak Lower extremity
T10-11 worse at night
IV steroid spinal cord compression next do MRI
19 yo มี 6 mo amenorrhea menarch 11, atop 9 months ago
soccer player no men after medroxyprogesterone challange
risk of what
Bone fracture
functional hypothalamic
children lymphadinitis
MCC คือ?
staph A.
Methyl phenidate common side effect
dec appetite > wt loss> insomnia
PAD give Aspirin, reduce stroke MI
indication of given simvastatin
40 year
DM
HPN
LDL 190
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
AR
จาก RF
Decrescendo + diastolic wide pulse pressure
16 mo old baby cnat stand hypertonic LE UE babinski absent
DX
cerebral palsy non progressive motor dysfunction splastic diplegia premature
Myopathy normal CK ESR
what
steroid, cushing , painless
Muscle atropy by stroid , AKT-1 X no insulin growth factor
Myopathy increase ESR
normal CK
what
Polymyalgia rheumatica pain stiff
temporal arteritisด้วยความที่หลอดเลือดนี้ส่งแขนงไปเลี้ยงกล้ามเนื้อและอวัยวะบนศีรษะและใบหน้านอกกระโหลก อาการที่เกิดจึงเกิดกับศีรษะและใบหน้า คือ อาการปวดศีรษะรุนแรง มักจะเกิดเฉียบพลันรุนแรง ปวดกราม ปวดลิ้น อาการรุนแรง เรื้อรัง ไม่หาย บางคนอาจคลำหลอดเลือดที่ว่าได้ชัดเจน
อาจมีอาการปวดไหล่ ปวดสะโพก ปวดร้าวตามตัวที่เรียกว่า
Myopathy increase CK
increase ESR
what?
inflame arthritis
myopathy increase CK
normal ESR
statin induce hypothyroid
preeclampsia 36 wk AOG +1 protein
do what
urine protein to creatinin ratio test
gold standard for qualift the proteinuria >0.3 or 24 hr 300mg
32 yo progressive SOB no chest pain
มี viral 2 ek
bibasal crackle inc JVP +2 edema
EKG- dilate ventricle with diffuse hypokinesia
suggest CHF dilate จาก viral myocarditis COXB> parvo > HHS> Adeno> Entero
VitB 12 loss what
loss propioperception of LE จาก dorsal column
in baby hypovolumia, hypernatremia tx
NSS 0.9% use fluid resus
Deliruim flutuation cognitive poor attention disorient
high dose steroid
induce psychosis evil children จาก steroid
53 yo homeless men DOB candida lung bilat crackle = consolidation pneymonia
IX:?
ventilation/ perfusion mismatch cause hypoxemia R>L intrapulmonary shunting
66 yo skin wound shiungle hx skin change oozing crust
IX:
skin biopsy r/o SCC ( chronic wound burn scar)
34 yo BOV goes blind when stand up enlarge blind spot
what dx
papilledem a swelling of optic nerve head
i never feel good and have low self esteem eversince college 5 year ago my low energy always feel down
DX
dysthymia
PCP HIV on ppt SIADH
serum 2Na+g/18+Bun/2.8 osm 275(low)-295(high)
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
Pregnancy appendectomy
cute
use mid line vertical laparotomy
not laparoscopic
34 yo cough blood + wheeze right side + dense opacity in right upper lobe
ทำไรต่อ
place patient on isolation respi
ถ้า 600ml/24hr , 100ml/hr do CT bronchoscope if persistent embolized
22 yo knee pain catching while walking unabel to extend swell
PE no pain or crepitus no varus or valgus
IX อะไร
Do MRI meniscal tear
from soccer tournament (rotational on plantar foot)
Depress 2 mo + evil saying
shout spoke rapidly standing up all night writting letter suicide attempt
TX ?
lithium calporate > 2nd quitapine lamotrigine
underweight pregnancy
growth restriction
17 yo adnexal fullness + ovarian cyst, calcified hyperechoic
cystic teratoma dermoid
CC ischemic necrosis, จาก torsion,
rupture + free fluid
PRegnancy 20-30 min- moderate insensity excercise??
waking jogging no gymnastic
TOF crescendo decresendo systolic murmur
manuver
knee chest position will increase
systemic vascular resistance
kink femoral A.
68 yo COPD SOB without relieve
กิน methylprednisolone ipratropium albuteral
E tube insert when <7.1, PaCo2 60
tx อะไร
non invasive PEEP also pulmonary edema ARDS early extubate
Schizo
lateral enlarge of ventricular
15 yo sexually active get chlamydia + gonorrhea swap
IX ?
NAAT gold standard
not urine marijuana
HIV chest pain diaphoresis nausea recurrent vomiting coccain injected conjuntivae dilate pupil
widen mediastinum effusion
DX:
esophageal perforation
mallory weiss
mucosal tear EDG heal spontaneous
Boerhaave transmural tear
gever dyspnea odynophagia subcutaneous emphysema CT exophagography with gastrografin pleural effusion
เห็น meta myelocyte + myelocyte ดู LAP Leukocyte alkaline phosphatase
high = leukemoid reaction = infection Low = CML
24 yo + CKD transplant + immune supression
burning pain at wrist at night
DX TX
carpal tunnel
TX: wrist splint at night
Febrile seizure at 2 yo
tx reassure do not hospitalized for observation send home from emergency
BP 220/120 treat next morning confuse seizure normal breath
what TX?
look out nitroprusside
intensive glycemic control prevent
microvascular retinopathy / not macrovascular MI STROKE
32 yo both hand tingling
BOV HA Dizzi
touch pain sense dec on upper extremity optic neuritis papilledema disc hypermic swollen
IX?
MRI periventricular supial
72 yo s/p shingle difficulty urination palpable lower ab mass
cough /diphenhydramine, hydroxyzine, chlopheniramine
tx ?
First gen H
anticholinergic -> M of para symp - detruser hypocontract
SLE in pregnancy Edema mimic preeclampsia arthritis hematuria proteinuria Hypertension WBC + RBC cast on UA
IX อะไร
Renal Biopsy
3 days old cyanosis right hand 96% o2
right feet 85% o2 sat
lactic acidosis
etiology
thickening of tunica media in aortic arch
coarctation
dec femoral pulse 4 sec capillary fill
Hyponat ดู serum osm
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
Fall incident coin 4.5 cm in lung
previous CXR
STABLE no work up
New - do CT chest benign= serial CT
suspect = PET biopsy
highly suspect - excision
47 yo coffee ground emesis
black tarry stool weakness pale conjunctivae
inc BUN/CR
Upper GI bleed tachy cardia = volume depletion
inc urea form Break down hemoglobin urea reabsorption in proximal tube
inevitable abortion
vaginal bleeding
dilate cervix
product of conception see felt above os
UTZ show sac in lower segment
34 yo HA given pain killer, new Ht 185/105 irregular S4 continuous murmur thoughtout thorax
CXR ?
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
Pan hypopituitary will have whatttt
to aldosterone
normal
secrete depend on renin
4 wk s/p rhinoplasty wheezing nostril
what cause
nasal septal perforation
other can cause this is coccain syphilis TB sarcoid wegener
PTx CHF left vent dysfunction holosystolic murmur MR occur due to left ventricular dilate
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
syccinylcholine cardiac arrhythmia dur to
electrolyte
influx Na and efflux L
severe hyperkalemia
16 yo facial hair BMI 20
inc 17 hydroxyprogesterone
inc testosterone
inc DHT
non classical adrenal hyperplasia = dec 21 hydroxylase
Vagina lesion not painful
Klep granulation no lymph
syphilis
chlamydia is painful node
loud snoring depression
mood disorder due to another medication condition
osa = low mood irritability
8 yo fever cough paroxysmal ppt by eating subcutaneous emphysema
IX?
do CXR to r/o pneumothorax
8 yo boy maroon colored stool well cooperative + painless
IX?
tecnetium 99 pertechnetate scan for meckel diverticulum
36 yo AB distend flatus loss wt sweat arthralgia enlarge non tender inguinal node ulcer on buccal IX อะไร
HIV testing
45 yo HIV GI + B symptom splenomegally CMV igG (-), CD 4,22 AKP 412
3mm TB test
Azithromycin MAC
80 yo PHX DM MI stroke
BP 78/48 HR 124 DM sacral ulcer
venous statis FBS 250 inc mix venous O2 sat
คือจากอะไร
Reduce cardiac afterload
from sepsis shock
RA pressure + PCWP
preload
SVR
After load
Asper staph avscess lymphadenitis
chronic granulomatous
test dihydroorhamine
nitroblue tetrazolium
54 yo fever chill dysphagia drooling 38.8 c, muffle voice tongue displace posterier superior bilateral crepitus submandibular
ludwig angina teeth root
molar mandibular
68 yo DM hypothyroid hypercholesteral on dialysis crea 3.2-3.5 platelet dysfunction normal pt count
uremic tx BT only
tx DDAVP
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%
hypovolumic shock
32 yo 3 days fever cough sputum clear crackle on right vase occasional wheeze
IX
CXR - CAP
CXR needed for diagnosis then give AB
inferior MI
papillary muscle displacement MR blood leak back to left atriu, increase diastolic overload inc LVEDP + left vent filling pressure
AF origin is pulmonary vein
mcc ectopic foci cardiac tissue extend to pulomo vein มี elctrical
67 yo forgetful fear of demential like now i feel low useless teary lose sleep
MDS
pseudo dementia
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
diamon black fan anemia
Fanconi
AR pancytopenia
macrocytosis cafe
micro eye short shoe kidney
no thumb
inferior MI
2 3 avf
lateral MI
23 avf + 1 avl V5 V6
bed wetting 7 yo tx?
demopressin
imipramine ( due to SE suicide cardio toxi)
died this is painful loss i amhere to help you though it
advise
valgus abduct
medial collateral ligament
tx ice rest compress elevation
mesenteric ischemia and atherosclerosis met acidosis abrupt when cardiac emboli
AF
infective
endocarditis IV staph
52 yo black stool ab discomfort food help with pain
gain wt drink beer
PT ab tender right side + bruit
PUD
pregnancy clear fluid leak when stand up tx chlamydia at 10 wk all normal
urinary incontinence stress inc abdominal pressure
HIV diarrhea
<180 low grade fever = crypto acid fasting
<100 no fever - isosporidium + crampy pain
<50 FEVER = MAC, hematochezia ab pain = CMV
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
tx surgical pinning of femoral head
phenelzine
MAOi prevent deamination of Dopamine, Norepi, S
micrognathia
edward
microopthalmia + cutis plasia
platau
3yo sickle fever no cough no cold no thing no DOB
ptx plenic sequest crisis
organism?
s pneumonia - dispite vaccination cause of non typable MCC SEPSIS
meningiococcal
