F                  F              .          2        1                    9                2551
                 F       ...
Internal Medicine
1.     F                          32               F                                                 mot...
11. F                      18 กF              F                         F ก                  F        1) Polymyositis 2) D...
1)   inhale salbutamol prn + inhale corticosteroid             29. F               18        ก           F ก F            ...
1) Propanolol                            2) Lugol solution                  1) Eczema                              2) Lipo...
3) Chondrocalcinosis              4) Bone ankylosis              5) Acute MI
    5) Lumpy soft tissue                     ...
3) Drug interaction                  4) Volume depletion             1)   Methanol                    2) Ethylene glycol
 ...
68. F                                        F ก                           73.                 30           F             ...
78. F                  50                  F              ก          F      83. F           F penicillin         F diarrhe...
3) Cloxa                                                               1) Piroxicam                  2) Propanolol
92.    ...
1) Sepsis                             2) Prematurity                 14. ก               4 RUQ pain with mass urine: RBC 1...
21. F                           TB AFB 2+ CXR cavity ก 6                        29. F newborn preterm GA 32 wk            ...
35. ก           7        F     F                  F                         F         1)   IV dopamine
                2  ...
5) Hirchsprung disease                                                                1) Early feeding                  2)...
60. ก        9           ก      F ก F                      3                 3 cm below RCM, EXT : mild pitting edema     ...
3) Observe and plan admit 4) Surgery                                                 4) Torsion of appendix testis
   5) R...
11. F               35        F                                       6          3) CT chest                              ...
19. F                   52                    F ก F F                                    2) Nasotracheal intubations
     ...
5) surgery                                                       4) Mammogram F ก                ก2
31.                22 ...
7.          F        30       F term           F       F F          1) 300                                2) 500
      man...
21.           F F 7                F 3 ก 2            ก                           3) Metronidazole                       4...
1)                F F         F             ก                                         1) Vulva CA                         ...
1)  Expectant + Manage             NST                          1) Hemorrhagic cyst          2) Endometriotic cyst
     2)...
ศรว 51 By Cmu
ศรว 51 By Cmu
ศรว 51 By Cmu
ศรว 51 By Cmu
ศรว 51 By Cmu
ศรว 51 By Cmu
ศรว 51 By Cmu
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ศรว 51 By Cmu

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  1. 1. F F . 2 1 9 2551 F 4 กF F F F ก . F ก . F F F . F ก F Fก F Fก F FF Fก ก ( F ) ก ก . F F F ก ก F F F ^__^ ก 4707xxx Chiangmai Medical School
  2. 2. Internal Medicine 1. F 32 F motor power 4/5, lower 1/5, absent DTR F ก F ก F ก Urine protein 1+, F red blood cell cast ก F F F 1) Transverse myelitis 2) GBS specific ก F ก 3) MG 4) Neurosyphilis 1) Rheumatoid factor 2) ANA 6. F 30 1 F ก F ก 3) Anti-histone antibody 4) Anti-dsDNA antibody F neck vein engorgement, hepatomegaly 2. F 35 F F F F F ก กก EKG F diffuse ST-T change, 4 กF F F low voltage F ก F F F F wbc = 89000, PMN = 90%, G/S: gram negative diplococci 1) Restrictive pericarditis 2) Cardiac beriberi intracellular ก ก F F 3) Cardiac tamponade 4) DCM 1) Cloxacillin 2) Gentamicin 7. F 50 ก F 5 F F 3) Ceftriazone 4) Doxycycline F F ก F ก F 5) Metronidazole tenderness and guarding at epigastrium, liver dullness 3. F ก ก Generalized tonic clonic +ve F ก F ก F F F F 1) acute pancreatitis ก ก กF F F กก F ก F 8. 60 F กF F F neurological deficit F F papilledema F F ก ก CT scan: multiple calcified cystic lesions กF F 1) Cellulitis 2) Contact dermatitis F F Fก ก F ก 3) Dermatitis herpetiformis 4) Herpes simplex infection 1) Taenia solium 2) Taenia saginata 5) Varicella zoster infection 3) Toxocara 4) Toxoplasma 9. F 40 ก F F F 5) Gnathostoma F ก F ก F BT = 39 °C, erythema 4. F 55 F ก F and tender at left upper thigh F F กF ก 4ก ก 1 ก AFB F F F F Fก ก F ก negative 3 Fก CXR F reticulonodular 1) S. aureus 2) S. pyogenes infiltration with thickening cavity ก F F 3) H. influenzae 4) P. aeruginosa F ก F ก 10. F DM, HT 1) culture for TB 2) Start anti-TB drug F ก F 1 F 10 3) Bronchoscopy 4) Aspiration ก ก F ก F 5) PCR for TB 5. F 18 ก 2 1) TIA 2) Temporal lobe ischemia FกF F ก F 3) Cerebella ischemia 4) Bell s palsy ก F ก F ก F Upper
  3. 3. 11. F 18 กF F F ก F 1) Polymyositis 2) Dermatomyositis ก Upper respiratory tract 3) Psoriasis 4) Mixed connective tissue disease infection F F F กก CXR 5) SLE F Interstitial infiltration 17. F 40 ก F 1 กF F ก ก ก 1) Ampicillin 2) Ciprofloxacin F F ก ก ก 3) Roxithromycin 4) Gentamicin CXR F WNL ก F F F 5) Augmentin ก F ก 12. ก F F F F FF F ก F 1) Skin test 2) CT chest F ก ก F ก 3) Sputum AFB 4) Bronchoscopy F F F F Fก ก 5) PFT F ก ( ก F ก F 18. F 50 ก F 25 ก ก F F กก 5 ก) 1 กF F F ก 1) Hypokalemia 2) Hyperkalemia F ก F BP = 120/70 mmHg, fine crepitation 3) Hyponatremia 4) Hypernatremia both lower lungs, PMI 6th ICS 1 cm lateral to MCL, S3 5) Hypocalcemia 5) Acute gastric dilation gallop ก ก F F 6) SIADH 1) Digoxin 2) Thiamine 13. F F ก ก peripheral 3) Atropine neuropathy (wrist drop) 19. F กก ก ก F 14. F CKD K = 7, EKG change กก ก ( ) กF F F F Fก ก F F ก 15. F 40 F 3 1) Chigger mite 2) Louse F F F ก F F F ก 3) Aedes egypti 4) Tick ก F ก F ก F ก F BP = 5) Flea 120/80 mmHg, PR = 110 /min, RR = 24 /min, BT = 39 °C, 20. F F ก F mild jaundice, lung clear, liver 2 cm BRCM F ก F ก F ก F BP 60/30 mmHg F F sacral reflex F ก F 1) Enteric fever 2) Dengue fever 3) Leptospirosis 4) Scrub typhus 1) Cardiogenic shock 2) Spinal shock 5) Murine typhus 3) Neurogenic shock 4) Hypovolemic shock 16. F 50 F ก 5) Obstructive shock ก ก ก กF ก4 FกF 21. F 18 ก ก F ก F ก F tenderness of กก ก ก ก 2-3 quadriceps muscle, purple-red discoloration over the F F ก F ก F F F upper forehead, eyelids and cheeks F ก ก ก ก F F F
  4. 4. 1) inhale salbutamol prn + inhale corticosteroid 29. F 18 ก F ก F F F 2) alpha-agonist as need ก PE: lung clear, rub chest F 3) steroid 4) β2 agonist as need + steroid 1) Endocarditis 2) Pancarditis 5) Oral bronchodilator 3) Myocarditis 4) Pneumonia 6) Salbutamol inhalation as needed 30. F 16 homozygous β-thal F 7) Long acting β2 agonist + corticosteroid ก F 1 F 8) Inhaled corticosteroid ก F ก F BP drop, irregular heart rate & 22. F subacute thyroiditis F ก rhythm, hepatosplenomegaly F F heart 1) ASA + propanolol complication ก 23. T4 ก TSH ก Dx? 1) Cardiac siderosis 1) Simple Goiter 2) Iodine deficiency 2) Cardiac hypertrophy 3) Thyroid CA 4) Subacute thyroiditis 3) Immune cardiomyositis 5) Hashimoto thyroiditis 4) Extramedullary hematopoiesis at heart 24. F 28 F ก F F 2 F 31. Clinical rheumatoid arthritis F PE : DTR 3+ , loss of 1) Ibuprofen 2) Paracetamol sphincter tone F lesion F 3) MTX 4) Sulfazalazine 1) Parasagital sinus 2) Basal pons 5) Chloroquine 3) Thoracic area 4) Lumbosacral area 32. F DM with HT F ก 5) Conus medularis F ก F Costovertebral angle tenderness 25. EKG : bradycardia F vital sign F F ก ก F F ก (80/50 mmHg, HR = 30) ก ก 1) Ceftriaxone IV 2) Ceftriaxone ก F F 3) Ofloxacin ก 1) Atropine 2) Dobutamine 33. 22 F F F F ก PR 26. F 27 2 F PE: white patch RR miosis ก ก F F F F F F 1) Atropine 2) Naloxone 1) anti-HIV 3) Diazepam 27. F F EKG F ( Mobitz II) F 34. F 40 ก 80 kg 160 cm. Dx. DM, FBG 1) Atropine 2) Lidocaine 180 ก ก F F 3) Digitalis 4) Cardioversion 1) 2) Metformin 28. F 68 F ก F ก F ก 3) Acarbose 4) Glibenclamide F ก F 35. F 25 ก . 1 , PE: mild 1) Rabies vaccine 2) Tetanus vaccine exophthalmos, generalized enlarged thyroid both lobe, 3) HBV vaccine 4) Influenza vaccine .(Graves ), T4..,T3 400, TSH < 0.001 ก ก 5) HPV vaccine F F
  5. 5. 1) Propanolol 2) Lugol solution 1) Eczema 2) Lipoma 3) PTU 4) Radioactive iodine 3) Xanthelasma 4) Seborrheic dermatitis 5) Subtotal thyroidectomy 42. 15 F ก F 4 36. 32 ก ก BP 150/100 mmHg PR ก 2-3 F Prophylaxis 120/min PE: neuro sensory normal, muscle weak gr. 1/5 1) Propanolol 2) Sumatriptan both upper and lower, reflex 2+ all Lab: Na 136 mmol/l, 3) Flunazine 4) 1), 2) K 2.5 mmol/l, Cl 102 mmol/l, CO2 22 mmol/l F F 5) 1), 3) ก ก F 43. F 30 yr ก F 1) Free T4 2) Plasma glucose drowsiness, BP 150/110, PR 80, RR 22, stiffness of neck, 3) CT brain 5) CSF exam Babinski s sign - neg, Retinal a. - absence of pulse, no 37. 30 bus F F ก papilledema F F ก , AFB 3+, F F TB F 1) Migraine 2) Viral encephalitis F 3) Subarachnoid hemorrhage 4) Bacterial meningitis 1) 2 wk. 2) 1 mo. 44. 35 yr ก 4 wk ก F 3) 2 mo. 4) 1 wk ก F AFB neg F ptosis mild proximal muscle weakness, normal 5) F F DTR, normal sensory Dx 38. 40 Asthma 2 PTA 1) Polymyositis 2) Horner s syndrome F F ก F F ก F ก F T 3) Hyperthyroidism 4) Myasthenia gravis 37.4 °C BP 110/90 mmHg PR 100 bpm RR 28 /min Lung: 5) CN III palsy wheezing at both lower lung with accessory muscle 45. F 21 yr F 2 F F F used ก ก F F 3 , Total ophthalmoplegia, bilateral facial 1) Terbutaline sc 2) IV steroid palsy, paradoxical breathing, generalized decrease 3) IV dexamethasone 4) IV Theophyline motor power gr II-III/V, areflexia, loss of vibration sense 5) NB salbutamol all toe and fingers F ก ก 39. F hyperkeratosis onycholysis ก ก 1) Azathiopine 2) Interferon beta 1A F F 3) Cyclophosphamide 4) Methylprednisolone 1) Topical cotrimoxazole 2) Topical itraconazole 5) Intravenous immunoglobulin 3) Topical ketoconazole 4) Oral itraconazole 46. F 70 yr F F EKG ( 40. F F ก ก F F ST elevate) F ก ก กF F กก F ก ก ก ก ก F 1) Aspirin 2) Enoxaparin F F ก 3) Clopidogrel 4) Warfarin 1) Psoriasis 2) Lichen planus 5) Dipyramidamole 3) Discoid lupus erythematosus 47. ก ก F F 41. Pt 50 yr F F ก F ก F F F WBC 20,000 Needle shaped crystal X- 1 wk, Cholesterol 350, TG 250 ก ray finding 1) Osteoporosis 2) Osteophyte
  6. 6. 3) Chondrocalcinosis 4) Bone ankylosis 5) Acute MI 5) Lumpy soft tissue 52. 40 F 3-4 /wk F F F 48. F 50 F 2 F F F F ก F F F F F ก ก ก PE: BT 38.5°C, ก F Rt. knee swelling and marked tender. Lab 1) 2) F ก 3) fiber 4) Alcohol 1) Serum uric acid 2) Rheumatoid factor 5) ก F F Fก ก 3) Joint fluid analysis 4) ESR 53. F 45 F 1 25 F 5) Knee plain film X-ray 3-4 /d 2 F ก 49. F 70 F 3 F diclofenac F F F ก V/S ก scaling lesion F F F F turbid yellow, WBC 20,000 (PMN 50 2 F Dx %, L 20 %), ESR 50%, gram stain negative (X-ray : no 1) Pellagra 2) Subdural hematoma joint space narrowing, sclerotic rim? no fracture, no 3) Wernickes encephalopathy 4) Electrolyte imbalance osteolytic lesion) F F ก 5) Delirium tremens 1) Septic arthritis 2) Pseudogout 54. F 33 dyspnea, engorged neck vein, no 3) Gout 4) Rheumatoid arthritis murmur, EKG: low voltage, generalized ST change with 5) Osteoarthritis inverted T F F ก 50. 49 F F F F 1) Constrictive pericarditis 2) Cardiac tamponade F 3 กF ก F 3) RBBB 4) Lateral wall infarction ก PE: Rt lobe liver enlarged with mild 5) Pulmonary embolism tenderness, HBsAg positive 55. F 18 ก LFT: TB/DB = 1.0/0.2, AST = 60, ALT = 70, ALP = F ก F ก F ก F pink 112, Total protein = 5.0, Albumin = 2.3 frothy sputum, crepitation both lower lungs, BP 160/100 U/S: Hyperechoic mass at right lobe liver diameter 6 mmHg F F furosemide O2 ก ก cm, no intrahepatic duct dilatation F F ก 1) Digoxin 2) Propanolol 1) Metastatic CA 3) Dobutamine 4) Nitropusside 2) Amoebic liver abscess 5) Morphine 6) Mg 3) Hepatocellular carcinoma 56. F 32 Underlying Rheumatic heart disease 4) Peripheral Cholangiocarcinoma with mitral valve stenosis F Digoxin (0.25mg) 1 5) Postnecrotic cirrhosis with hepatic adenoma tab OD, Furosemide (40 mg) 1 tab OD 3 กF 51. 52 ก F F ก . F ก ก F ก PE: profused sweating, decrease breath ก PE: BP 100/70 mmHg, HR 50 bpm, Lung sound Lt. lung, Abd: tender with guarding Dx fine crepitation both lung, Heart loud S1, diastolic 1) Hiatal hernia 2) Ruptured esophagus murmur at apex Fก ก ก 3) Mallory-Weiss syndrome 4) Tension pneumothorax 1) Hypokalemia 2) Hyponatremia
  7. 7. 3) Drug interaction 4) Volume depletion 1) Methanol 2) Ethylene glycol 5) Metabolic alkalosis 3) Salicylate 4) Paraquat 57. F 32 Underlying Rheumatic heart disease 63. F ER ก EKG (VF) with Mitral valve stenosis F Digoxin (0.25mg) 1 ก ก F F tab OD , Furosemide (40 mg) 1 tab OD 3 กF 1) Defibrillation 2) Atropine injection . F ก ก F 3) Adenosine injection 4) Adrenaline injection ก PE: BP 100/70 mmHg, HR 50 bpm, Lung 64. 35 ER Fก F F ก fine crepitation both lung, Heart loud S1, diastolic 10 ก 2 ก ก F murmur at apex ก ก F F ก ก ก F ก F PE: BT 37°C , BP F 140/90, HR 120, RR 14/min with shallow breathing, motor 1) Atropine 2) beta Blocker grade II/V, reflex 1+ F ก ก 3) Digoxin 4) Steroid 1) Saxitoxin 2) Tetradotoxin 5) Furosemide 3) Botulinum toxin 4) Sialotoxin 58. F 60 30 ก X-ray Right 65. F ICU Subarachnoid hemorrhage F ET tube upper lung mass Na (urine osm 50) ก Foley s cath 1 wk F F F ก Candida albican ก ก F 1) SIADH 2) Polydipsia F 59. Patient CHF Bx: lymphocyte infiltration, most common 1) Itraconazole 2) Clotrimazole virus? 3) Fluconazole 4) Amphoterin B 1) Adenovirus 2) Coxsackie B 5) Foley s cath 3) EBV 4) CMV 66. ก F กก ก F ก ก 60. 65 U/D AAA PE: multiple F ก F ก F BT 41.1 °C , BP 80/60 ecchymoses, ก , CBC: Hb 10, WBC 7,200 (N 75, L mmHg , PR 140 /min RR 25/min F F 25), Plt 30,000, PT, PTT, TT: prolong, fibrinogen ↓, ก F ก ก ? 1) Heat stroke 2) Subdural hematoma 1) D-dimer 2) Euglobulin lysis time 3) Dehydrate 4) Encephalitis 3) Blood smear 67. F 75 bed sore F F ก2 61. F F ก ก HbH disease ก Stupor, mild pale, no Jx, no hepatosplenomegaly, Hb 9, Hct MCV RC MCV 98, WBC 14000, N90, L10, Plt 20000, PT 18, aPTT F 38 72 1 36, PBS MAHA Blood picture F F F 37 87 0.5 ก Hb F F 1) primary fibrinolysis 2) Vit K def 1) F --/αα 2) F αα/αα 3) Thalassemia with sepsis 4) DIC 3) F -α/-α 4) F β/β0 5) TTP 5) F β/β+ 62. ก F F ก Na? K?
  8. 8. 68. F F ก 73. 30 F 3 cachexia, muscular wasting F TG = 210, LDL = 200, HDL = 30 F F F (Capillaria philipinensis) F ก F ก ก ก F 1) Gemfibrozil 2) Simvastatin 1) ก 2) ก 3) Fibric acid 4) Niacin 3) ก ก 4) ก 5) Cholestyramine 5) F F F 69. F 56 F F F ก F F 2 6) F F F ก F ก DM & HT 10 yrs F EKG STEMI, V1-V4 74. 42 ก FU F ก F ASA Fก ก F .ก ก ก F ก ก 1) Enoxaparin 2) Warfarin F PE: PR 128 /min RR 30 3) Streptokinase 4) Balloon /min lung clear, Rt leg swollen & tenderness F ก 5) PCI ก 70. 56 2 F 3-4 F 1) Pleurodynia 2) Pneumonia 3 กF . BT= 37.3°C, PR = 98, RR = 18, 3) Pulmonary embolism 4) Acute coronary syndrome BP 104/80 mmHg, stupor, mild jaundice, mild ascites, 5) Dissected aortic aneurism spider nevi + palmar erythema F Investigation 75. 18 F 3 day moderate F ก ก pale, mild jaundice, liver 2 cm below costal margin, 1) CBC 2) Stool exam spleen 3 cm below costal margin, Hb 7.9, Hct 28, MCV 3) Coagulogram 4) LFT 65, WBC 9500, N 80%, L 20%, Plt 450,000 F 5) Abdominal paracentesis F ก 71. F 42 2 F 20 1) AIHA 2) HbH with crisis cyanosis at finger tips, radial pulse 1+, brachial 3) PNH 4) G6PD deficiency pulse normal Dx? 5) DIC 1) Raynaud s disease 76. F 45 ก1 ก 2) Takayasu s disease 1-2 ก 1-2 3) Polyarteritis nodosa F F 200/120 mmHg F F 4) Thromboangiitis obliterans F F 210/130 mmHg PR 120 5) Systemic lupus erythematosus /min RR 22/min Fundus Flame shape 72. F 60 F F 1 F hemorrhage with early papilledema ก ก Furosemide F F F F WBC 50,000 , F F PMN 80%, sugar 22 (plasma glucose 105) F crystal , 1) Enalapril 2) Propanolol G/S & AFB negative ก ก 3) Prazosin 4) Nitroprusside 1) Colchicine 2) Ceftriaxone 5) Spironolactone 3) Indomethacin 4) Intraarticular steroid injection 77. F anaphylaxis shock F treatment F 5) Anti-TB drug 1) IM adrenaline 2) Subcutaneous adrenaline
  9. 9. 78. F 50 F ก F 83. F F penicillin F diarrhea ก PE : pupil 1 mm F proctoscope ก F Fก AAC ก ก lesion F F 1) Pontine hemorrhage 1) Metronidazole 2) Cellebellar hemorrhage 84. pt pale + jx F F F : 3) Subarachnoid hemorrhage 1) Hb typing 2) Inclusion body 4) Basal ganglion hemorrhage 3) BMA 4) G-6 PD screening 5) Intraventricular hemorrhage 5) Coomb s test 79. F 30 F F ก 85. F Clinical DKA ก ก F F ก F F F ก F F F ก 1) i.v. insulin 2) i.v. fluid 1) Vitiligo 2) Pityriasis versicolor 86. F clinical DIC ก ก F 3) Tinea corporis 4) Leprosy F 5) Syphilis 1) ATB 2) Plt. 80. 45 F 2 F ก PR 3) FFP heaving, totally irregular, pitting edema, JVP up to 87. EKG PVC 3 ก F F mandible, tapping apex, tapping parasternum, loud P2 ก ( F ก กF loud S1 ???), opening snap 1) Ventricular tachycardia , Diastolic rumbling murmur apex F F 88. EKG complete heart block ก ก ก F F 1) Rheumatic carditis 1) Atropine 2) Mitral valve prolapsed 89. 55 Hx smoking ve, Dx HT 6 mo on enalapril & 3) Infective endocarditis amlodipine F F 2 wk BP 130/70 F 4) Mitral annulus calcification 1) Off enalapril 2) amlodipine 5) Rupture chordate tendinae 3) On dextrometrophan 4) Inhaled hydrocortisone 81. ก F ก CXR: 5) LFT cavitary lesion with air fluid level F F 90. F 65 F 2 F 2 ก , ก , ก , F ก F 1) Lung abscess F mild tenderness, crepitus F swelling 82. Pt. ก HT Na 140, K deformities Dx 3.0, HT 1) Pseudogout 2) OA 1) Pheochromocytoma 3) RA 4) Reactive arthropathy 2) Primary hyperaldosteronism 5) Seronegative arthritis 3) Renal a. stenosis 91. F 25 F F UA: wbc = 10-20, rbc = 0-1 F 1) Ofloxacin 2) Cef-3
  10. 10. 3) Cloxa 1) Piroxicam 2) Propanolol 92. 50 dx. Bronchogenic CA N/V 3) Sumatriptan 4) Indomethacin F F V/S stable PE F ก lethargy BUN = 30, 5) Acetaminophen Cr = 2, Ca = 14 ก ก IV fluid 94. ก 2 F VSD F pulse F F BP 1) Steroid 2) Bisphosphanate F F F Ambu F tube F Amiodarone F 3) Peritoneal dialysis 4) Furosemide EKG ventricular tachycardia management 5) Corticosteroid 1) Defibillation 2) Ca gluconate 93. 15 ก กF 4 hr ก 3) NaHCO3 4) Adenosine ก กF F ก ก 5) Direct-current synchronized cardioversion ก F ก ก 3 F F Fก ก F Pediatrics 1. ก 5 F F F ก cervical 1)Oral 10% D/W 10 ml/kg lymphadenopathy, Splenomegaly and grayish patch at 2)IV 10% D/W 2 ml/kg tonsil F กF F 3)IV 10% D/W 4 ml/kg 1) EBV 2) Diptheria 4)IV fluid with GPR 4-6 mg/kg/min 3) GAS 4) Measles 5)IV fluid with GPR 6-8 mg/kg/min 2. ก 6 ก F F 6)IV hydrocortisone 10 mg/kg/day F 3 F PE: Multiple ill-defined, fine 5. ก F F ก webbed neck, scaly patches, hypopigmented macules and patches wide nipple distance and low hair line ก F KOH: negative Fก F F F 1) Vitiligo 2) Pityriasis alba 1) Decrease Insulin 2) Decrease GH 3) Pityriasis vesicolor 4) Tinea facialis 3) Increase estrogen 4) Increase GnRH 5) Contact leukoderm 5) Decrease PTH 3. F ก 3 F ก 6. ก 5 F F F Lung: rhonchi right lung F investigation ก F F F F ก 1) AP, lateral prognosis ก 2) PA, lateral 1) CBC 2) ESR 3) Inspiration and expiration 3) Skin biopsy 4) UA 4) Right lateral decubitus 7. F ก F F F Fก 5) Left lateral decubitus 4. Term newborn BW = 4000 g DM ก ก 8. NB 35 wk, 2700 g F Blood group O, Rh positive F Blood sugar = 26 mg% Fก ก F 4 Hct 40% TB = 10 กF F F F ก
  11. 11. 1) Sepsis 2) Prematurity 14. ก 4 RUQ pain with mass urine: RBC 10- 3) Thalassemia 4) G6PD deficiency 20, WBC 1-2 Fก 5) ABO incompatibility 1) Wilm s tumor 2) Neuroblastoma 9. ก 2 1 F 3) Lymphoma 4) Hydronephrosis F 1-2 F F 3-5 15. ก 3 F 3 F PE : Moderately pale , F mild icteric sclera , No hepatosplenomegaly + 1) Pneumococcal vaccine F ก F ก Lab : Hb 7.7, WBC 4,800, Lym F , 2) ก ก ก plt 380,000, RC 7.5, MCV 87 F 3) Fก antihistamine ก ก 1) Coomb s test 2) Inclusion test 4) skin test 3) Hemoglobin typing 4) G6PD screening 5) F normal ก 5) Bone marrow aspiration 10. ก 2 F 1 wk ก F ก 16. กก wheeze retraction, greenish patch at posterior pharynx and anaphylaxis F first med tonsils ก F 17. ก 1 F 1 F V/S T 39.8 , PR 140, RR 40, BP 1) Croup 2) Diphtheria 90/60, CBC : Hb 11, WBC 20,000 N 93% , Plt 50,000 3) Candidiasis 4) Streptococcus tonsillitis Coagulogram : PT, PTT prolong Petechiae and 5) Infectious mononucleosis necrotic purpura at legs F ก manage 11. ก 6 U/D Asthma F ก 2d ก PE: 1) Fluid therapy 2) Antimicrobial F suprasternal, intercostal, subcostal retraction, 3) Plt concentration 4) FFP inspiratory and exspiratory wheezing, RR 40/min F 5) Vasopressin salbutamol 3 dose ก 20 min F F exp. 18. ก F ก F F ecchymosis wheezing F Fก ก Vit K deficiency 1) Oral mucolytic 2) Oral antibiotic 19. F ก 2 3) IV Aminophylline 4) IV Dexamethasone F ก Ascites, UA : Proteinuria 3+, RBC 0-1/HPF, Fine 5) NB. Ipratropium bromide granular cast 0-1, Fat oval cast 0-1 Fก ก 12. ก 10 U/D β thal/Hb H F ก F 1) Decrease Plasma oncotic pressure splenectomy กF Sx F Vaccine 2) Increase Plasma Hydrostatic pressure prophylaxis 3) Oncotic pressure cavity 1) Typhoid vaccine 2) Influenza vaccine 4) Hydrostatic pressure cavity 3) Pneumococcal vaccine 4) Meningococal vaccine 5) Increase Vascular permeability 13. 2 F F PE: mild pale, no Jx 20. ก 12 F ก F 1 nodule กF F 6x8 cm cross midline hard ก ก F F F ก F ก consistency Dx , neurologic exam normal F F F 1) Neuroblastoma 2) Wilm s tumor 1) EKG 2) Blood sugar 3) ANLL 4) Non-Hodgkin lymphoma 3) 24hr Holter monitor 4) EEG 5) Retroperitoneal teratoma 5) F F
  12. 12. 21. F TB AFB 2+ CXR cavity ก 6 29. F newborn preterm GA 32 wk ก ก 1,500 PPD 4 mm F manage ก F gm 12 F ก ก F 22. ก 8 F F F 3 F BP 90/70, PR 120, RR 30, poor perfusion, Lab: 1) Spyringomyelin 2) Lecithin Na 145 Cl 110 HCO3 10, urine ketone 4+ 3) Phosphatidyl inositol 4) Phosphatidyl glycerol Management F ก 30. F ก 4 F 39 C PE: milky patch at tonsil, 1) Insulin 2) 0.9% NaCl cervical LN 1-2 node 2 cm 2 F , ก 3) Potassium 4) HCO3 ก liver 2 cm BRCM, spleen 2 cm BLCM F 23. F newborn F F 41 wk with meconium ก stain AF + fetal distress F 1) Infectious mononucleosis 1) + F 2) ET tube + suction 2) TB lymphadenitis 24. ก term 2 F BW 4,600 gm PE: BT = 3) Streptococcal pharyngitis 37, PR = 150 AF bulging, mod pale, no jx, CBC: WBC 4) Diphtheria 8,500 platelet 190,000 F 5) Lymphoma 1) Sepsis 2) SDH 31. F ก 4 TB F ก F BCG scar 3) Idiopathic vitamin K deficiency of infant CXR ก tuberculin test 13 mm F F 25. F newborn F ก heart murmur, cataract, 1) INH prophylaxis F F congenital infection (Rubella) 2) start TB 26. F ก 6 ก F 4 3) repeat tuberculin test ก 3 F ก F F PE: tachycardia, tachypnea, 4) BCG pansystolic murmur 2/6 at left parasternal border, 5) AFB from gastric larvage cyanosis F 32. F ก 9 ก F F F para, 1) Hypoxic spell 2) Asthma amoxy 3 F F PE: sunken eyeball, 3) Pulmonary embolism 4) Breath holding spell dry lips, perianal redness F F ก ก ก 27. F ก 2 4 PTA F 38 PE: drooling ก ก, posterior pharynx Dx 1) Salmonella 2) Shigella 1) Acute tracheitis 2) Acute epiglottitis 3) Rotavirus 4) Lactase deficiency 3) Viral croup 4) Laryngitis 5) Antibiotic-related diarrhea 5) Retropharyngeal abscess 33. ก 1 ก barking cough, inspiratory 28. F ก 3 1 stridor, expiratory rhonchi F ก ก F IV ก F F ก F visit 1) Ampicilin IV 2) Cloxacilin IV 1) OPV, DPT 2) Hib 3) F beta-agonist 4) F adrenaline 3) MMR, OPV, DPT 4) HBV 5) ETT 5) OPV, DPT, JE 34. ก 3 Barking cough Mx 1) Adrenaline NB stat 2) Salbutamol NB stat 3) Dexamethasone IV 4) Prednisolone po
  13. 13. 35. ก 7 F F F F 1) IV dopamine 2 ก ก , PE: lethargy, moderate 2) Nebulized adrenaline jaundice, erythematous indurated mass at Rt. Breast, 3) Nebulized bronchodilator F ATB? 4) On O2 mask with bag 10 LPM 1) Ceftriaxone 5) Positive pressure ventilation 2) Ampicillin + Gentamicin 41. ก 11 , 1 กF F , CBC: Plt 3) Cloxacillin + Gentamicin F , Dx? (ITP) 4) Fortum + Amikacin 42. ก 15 กกก 2 F ก 5) Fortum + Vancomycin Upper/Lower motor weak gr IV/II DTR no impaired pain 36. F ก F Ampicillin 14 ก F and touch, glottic stroking pattern F F endoscope F hyperemia, Tx? 1) Beri Beri 2) GBS 1) Metronidazole 2) Ceftriaxone 43. ก F ก Drooling, miosis, dysphoresis, profuse 37. ก 8 กF 1 PTA, sweating F ก ก ก 2 wk PTA, vital 1) Ethanol 2) Organophosphate sign ก , PE: Oozing per gum, petichiae & ecchymosis 3) Opioid 4) Ephedrine trunk & extremities, no lymphadenopathy, no 5) Cocaine hepatosplenomegaly, Dx? 44. ก 6 ก F 1) Hemophilia 2) Acute leukemia Breath sound F F F F X- 3) DHF 4) ITP ray heart Rt. chest F Dx. 5) APDE 1) Situs inversus 2) TE fistula 38. ก 5 hr ก ก 30 sec ก 3) Diaphragmatic hernia F C/S APGAR 1 = 8, 45. ก 10 ก ก F F 5 = 9, 52 cm, HC = 35 cm F Ix ก ก F F ก 3 F F ก Dx ก F F ก 2 1) Plasma glucose 2) Urine ketone F PE: central cyanosis, clubbing finger, Loud 3) E lyte 4) CBC P2, diastolic rumbing murmur 3/6 at Lt upper parasternal 5) Serum ammonia border lung: clear F F ก 39. Case preterm 32 wk. BW 1,500 g F ก ก ก 1) Pulmonary embolism 2) Aortic regurgitation 1) Respiratory distress syndrome 3) Hypoxic spell 4) Eisenmenger complex 40. ก 4 F ก resuscitation 5) Congestive heart failure F F F F F Fก F ER P.E. : T = 46. ก 7 ก ก 2,800 gm ก F 36.5 , PR = 140 , RR = 55 ,BP = 90/60 , drowsy , mild ก F ก cyanosis , diffuse fine crepitation and expiratory 2,400 gm Dx. F wheezing , capillary refill 4 sec , O2 sat 85% On O2 mask 1) Duodenal atresia 2) Pyloric stenosis with bag 5 LPM frothy pink 3) Inborn error metabolism 4) Sepsis
  14. 14. 5) Hirchsprung disease 1) Early feeding 2) Bolus 10% D/W 2 ml/kg 47. F ก 9 ก F ก ก 3) Plasma exchange PE: Thyroid diffuse enlarged, exophthalmos, 54. ก 4 mo WBC 18000 (N 80%), Hct 6.9%, smooth skin. PR 120 FT4 TSH Antityroglobulin Dx (Subdural hematoma) 1:1,600 ก F 55. ก 4-5 ก ก ก F Amoxy 2 1) Iodized oil 2) Iodized salt ก F F F ก ก 3) Lugol solution 4) Methimazole F 48. ก 7 F F 1 Dx F Chickenpox 1) F X-ray PNS FF F ก F 2) F nasal speculum ก 1) ก F 3) Amoxicillin/Clavulinic acid 2) ก ก 4) F Amoxycillin F 3) F F ก 5) Consult ก F 4) ก Acyclovir 48 hr 56. ก F ก F 5) F F F F 1) 10 F F 49. ก ก hyperpnea, +ve urine 2) 12 F ketone 4+ Dx 3) 2 กF F F F 1) DKA 2) Sepsis 4) 3 F 10-20 3) meningitis 5) 5 F 50. F ก 9 mo F otitis media 57. ก UTI ก F Ampicillin 14 ก F 3 mo กF ก pneumonia, F F WBC = 1-5, RBC > 100 S.pneumo, Hib, F F defect F ก F scope Patch? F 1) B cell 2) T cell 1) Cotrimoxazole 2) Norfloxacin 3) Phagocytic defect 4) Complement 3) Metronidazole 51. ก 4 F F BP = 90/60 mmHg, PR = 58. ก 6 F ก F truncal obesity , 120 /min F ก Stiff neck positive Buffalo hump , moon face c acne , ก ก F ก 1) Salmonella 2) N. meningitides 1) Hypocalcemia 2) Hyperkalemia 3) L. monocytogenes 4) S. pneumonia 3) Advance bone age 4) Increase serum cortisol 5) H. influenza 5) Increase activity of rennin 52. ก 10 mo F ก 3 mo ก 59. ก 4 yr 2 wk กF F ก PE: Pallor, inspiratory stridor, chest drawning F petichiae CBC Hb 7, Hct 22, WBC 3200 (N epinephrine F epinephrine F 35, E 3, L 62), Platelet 26000, MCV 90 F Investigation 1) 2) ก 3) F 4) 1) Serum ferritin 2) Bleeding time 53. DM ก ก ก sign 3) Reticulocyte count 4) Screening coagulogram hypoglycemia DTX 30 Hct 63 Management 5) Bone marrow aspiration
  15. 15. 60. ก 9 ก F ก F 3 3 cm below RCM, EXT : mild pitting edema Fก BW 7 kg PR 120 lung: wheezing both lung, CXR: ก ก perihilar infiltration, PPD 4 mm F brochodilator F 1) Lanoxin 2) Prednisolone Dx 3) Furosemide 4) Restrict sodium 1) Retained FB 2) Diaphragmatic hernia 5) Hydralazine 3) TB 4) GERD 66. ก 8 F ก 2 5) Asthma กก F F ก BT = 38.2°C, PR = 61. ก 6 ก ก F 2 F ก 110/min, RR = 52/min, BP = 90/60 mmHg, O2sat = 92%, ก กF F F ก Lung : expiratory wheezing both lung, CXR : generalized 62. ก 19 F ก ก hyperinflation both lung กก ก F F F F F F PTT 50 sec (control 30 sec), PT 13 sec (control 14 1) O2 2) IV fluid sec), no prolonged bleeding time ก ก 3) IV adrenaline 4) NB salbutamol 5) ET tube 1) Lupus coagulopathy 67. ก 9 F F 2) Factor VII deficiency F ก F ก F BT= 39.0°C, 3) Factor VIII deficiency PR= 120 /min, RR = 40 /min, crepitation both lungs, 4) von Willebrand factor deficiency decreased breath sound left lung F F 5) Hereditary platelet dysfunction cellulitis F กF F F F F 63. ก 3 F mild pale other WNL ก 13.5 kg , ก ก F ก blood smear : hypochromic microcytic anemia 1) Salmonella spp. 2) S. aureus 1) Iron deficiency 3) H. influenzae 4) M. pneumoniae 64. Vacuum extraction F 5) M. tuberculosis ก F F F ก 68. ก 6 1 PE: 1) Cephalhematoma 2) Epidural hematoma generalized ecchymosis CBC: Hb 12, Hct 36, WBC = 3) Subdural hematoma 4) Subgaleal hematoma 8,500, PMN = 55%, Lym = 30%, Eo = 15%, Plt = 5) Caput succedaneum 154,000 with pale stain LAB ก 65. ก 5 F F 1) PT 2) aPTT 2 ก 100 cc/day PE : BP 150/100 , Heart 3) Bleeding time 4) VCT : S3 gallop, Lungs : fine crepitation both lower lung, Liver 5) TT Surgery 1. F 47 กF F5 กF ก F 3 F F F F กF ก ก ก กF ก F F 1) Analgesic 2) Try reducing
  16. 16. 3) Observe and plan admit 4) Surgery 4) Torsion of appendix testis 5) Reassure and plan discharge 7. F F ก ก F 2. F ก F epigastrium F ก ก F F F ก F F 2 กF F pseudocyst at the front of pancreas F4 F F ก F ก Abdomen : generalized FกF กF F ก F guarding, absent bowel sound ก F F F F 1) Partial Pancreatectomy 2) Total Pancreatectomy 1) Plain abdomen 2) CT abdomen 3) Excision of pseudocyst 4) Internal drainage 3) Ultrasound 4) Abdomen series 5) Percutaneous drainage 5) MRI 8. F ก ก 3. F 22 FกF F 3 กF F ก F กก ก 30 กF F ก กF 2 cm oval shape, firm, smooth F ก ก ก F , and movable ก F F ก F 86/70 mmHg F 1) Fat necrosis 2) Fibroadenoma laceration 3 cm anterior to sternocleidomastoid 3) Fibrocystic disease 4) Intraductal carcinoma ก F F 5) Intraductal papilloma 1) Explore wound at ER 2) Explore wound at OR 4. F 56 F 3) CT 4) MRI F F F ก colonoscopy 5) Angiography polyps at descending colon F polypectomy ก 9. 16 กF F F กF 2 F ก ก cm. Fก F F ก F 1) Villous adenoma well define 2.5 centimeter mass, firm consistency at the 2) Tubulovillous adenoma right breast ก F F 3) Tubulous adenoma 1) F F F 5. F hernia testis F 1 กF 2) F F F ก F F 3) Fine needle aspiration 1) Reduction 2) Ultrasound 4) Ultrasound ก ก 6 3) Surgery 4) Radiation 5) Mammogram ก ก 12 5) Reassure 10. F 35 F Fก 5 ก F 6. F 30 ก ก 2 F F F ก F F F 5 กF ก F ก F ก F ก Abdomen - tender at F F ก ก ก epigastrium, liver dullness, decreased bowel sound ก F F FF Ultrasound F F ก increase vascular blood flow ก F F 1) Alcoholic gastritis 2) Bowel perforation ก 3) Acute pancreatitis 4) SBP 1) Orchitis 2) Epididymitis 5) Cholecystitis 3) Incarcerated hernia 4) Acute torsion testis
  17. 17. 11. F 35 F 6 3) CT chest 4) MRI chest 3 กF . กF F F F 5) Observe vital sign and clinical sign and symptom ก F Fก F F 15. F 13 F ก F F F F F ก ก F ก F 1) Injected 5% phenol 2) Rubber band ligation stupor F ก CT scan F crescent 3) Hemorrhoidectomy 4) Cryosurgery shape hemorrhage hyperdensity area ก 5) Reassure and follow up F F ก 12. F 65 F ก F Colorectal 1) acute epidural hemorrhage Cancer 1 กF F F 2) acute subdural hemorrhage ก F 3 กF F 3) subacute epidural hemorrhage ก F ก F restless, body temperature = 4) subacute subdural hemorrhage 39°C, Blood Pressure =100/70 mmHg, Pulse Rate 5) subacute intradural hemorrhage =110/min , Respiratory Rate = 26/min generalized 16. F 14 F ก F F abdominal tenderness, guarding, rebound tenderness, F F F ก ก F ก F absent bowel sound กก F Acute abdominal Blood pressure drop Glasgow Coma Score = 8 series F generalized bowel dilatation with ก F F intraabdominal free air F F F F 1) Cervical Collar 2) ET intubations F F กF ก F F F 3) CT and MRI 1) Ceftriazone + Metronidazole 4) IV fluid and dopamine if necessary 2) Clindamycin + Gentamicin 5) Refer to the nearest hospital immediately 3) Clindamycin +Ceftazidime 17. F F ก F 2 4) Ampicillin + Gentamicin F F F ก F F 5) Ceftazidime + Gentamicin ก F ก F ก 13. F 35 F ก ก F Loose sphincter tone, areflexia both legs F ก ก ก F F F ก F ก F ก F trachea shift F F , Right 1) Parasagittal 2) Basal pons pneumothorax ( F F tension pneumothorax) 3) Thoracic cord 4) Lumbosacral nerve root ก F F 5) Conus medullaris 1) Pleural tapping 2) Observe vital sign 18. F 14 ก F ก FF F ก 3) Oxygen mask with bag 4) Emergency ORIF burn 1st degree burn = 4% F , 2nd degree 14. F 31 F กก ก left burn= 27% 15 กF F inhalation injury F F parasternal border 5 กF Blood ก F Parkland s formula Pressure drop F F ก ก 1) 200 ml/hr 2) 250 ml/hr F ก F distant heart sound ก F 3) 290 ml/hr 4) 340 ml/hr F 5) 390 ml/hr 1) Echocardiogram 2) Pericardiocentesis
  18. 18. 19. F 52 F ก F F 2) Nasotracheal intubations F F ก ก F ก F 3) Nasal Orotracheal intubations Leftt lung decrease breath sound, Abdomen: tender with 4) Tracheostomy guarding ก F F ก 5) Cricothyroidotomy 1) Hiatal hernia 2) Esophageal rupture 24. Pt. cholangitis ก 3 U/S: gallbladder 3) Tension pneumothorax 4) Mallory-Weiss syndrome thickening acute cholangitis F supportive 5) Deep neck infection NPO + ATB F ก F 20. 24 Intracranial bruise, chemosis F , 2 กF severe head injury F ก ก 1) F ATB F 14 2) LC ก F F ก 3) F ก 6 wk 1) Intraorbital abscess 25. Pt. ก F 6 hr tender at RLQ , + rebound 2) Carotid cavernous fistula tenderness F 3) Chronic subdural hematoma 1) Observe abdominal sign 4) Posttraumatic hydrocephalus 2) Emergency surgery 5) Ruptured ophthalmic aneurysm 26. X-ray mediastinal shift, bowel thorax 21. 18 ก ก F F 1) diaphragmatic herhernia 2x1 cm ( F F F ก ก ) ก F 27. bedsore ก sacral bone granulation F tetanus toxoid ก F F manage F F 1) Wound healing 2) Local flap 1) Rabies vaccine 3) Distant flap 4) Full thick graft 2) Rabies Ig 5) Partial graft 3) ก 1 F 28. 64 6 mild jaundice, soft scaphoid, 4) F TB = 16, DB = 10, ALP = 300 Ix F 5) Rabies vaccine Rabies Ig 1) CT abdomen 2) U/S 22. 70 F F กF 3) Radionucleotide scan 4) PTC ก F F ก 5) ERCP PR: firm, slightly enlarged and firm prostate gland, 29. 19 BP 90/60 PR 120 UA: normal ก F F ก RR 24 Abd: distention ก 1) Urethral stricture 2) Acute prostatitis 1) CT brain 2) Blood transfusion 3) Prostate cancer 4) Neurogenic bladder 3) C-spine protection 4) ET-tube 5) BPH 5) DPL 23. 20 F F 30. 40 กF 10 ก BP 110/70 F ก loss of laryngeal F F F 1 . prominence subcutaneous emphysema cervical ก F F 1) reduction 2) acute abdomen series 1) Orotracheal intubations 3) abdominal ultrasound 4) IV antibiotic
  19. 19. 5) surgery 4) Mammogram F ก ก2 31. 22 F ก F 5) Ultrasound F ก F ก1 F ก ก F ก x-ray 33. ก 6 yr F vaccine 5 yr ก F 2 cm absent breath sounds, tracheal shift ก F F vaccine F F (Tension pneumothrorax) 1) Rabies vaccine 2) TT 32. F 18 F F กF F 3) Rabies vaccine + Tetanus toxoid 2 ก F กF ก 4) Rabies vaccine Rabies Ig F F กF 5) TT + Rabies vaccine Rabies Ig ก PE: well-defined mass 2 cm in diameter 34. Motorcycle accident lesion T2 Foley Catheter , firm consistency , mild tenderness at UOQ manage ก F F ก ก ก BP 180/110 RR 1) self-breast examination F 2) F ก3 1) off F/C 2) Hydralazine 3) ก F 3) FNA 4) BP 5) ADVICE Ob & Gyn 1. 32 G2P1 GA 24 wk 4. F 28 mitral stenosis F F8 ก ก F F F F F ก กก ก 1) Fasting blood sugar 2) 50 g OGTT F F ก Fก F F 3) 100 g OGTT 4) Random glucose F 5) Urine sugar 1) F F F ก 2. F G1P0 GA 34 wk ก กF ก 2) F F F F F กF F F F sterile speculum fluid posterior 3) F F F F F tertiary center fornix fern test: positive F F F F 4) ก F ก ก ก 5) ก F F ก 1) Tocolytic drug 2) Dexamethasone 5. 26 GA 8 week ก Ultrasound GA 3) IV prophylactic ATB F F 4) Observe sign of chorioamnionitis 1) Femur length 2) BPD 5) PV progression F F 3) CRL 4) Abdominal circumference 3. F G2P1 GA 38 wk uterine contraction ก 3 5) Head circumference 30 Cervix dilate 3 cm, 50% effacement, station 0, 6. 24 G1P1 . Hydramnios F oxytocin membrane intact PV F ก ก Vaginal delivery bleed 1500 ml ก ก ก ก F F bleed PE : Uterus ½ FH > umbilical F 1) Amniotomy 2) Syntocinon post partum hemorrhage 3) U/S 4) Observe 1) F ก 2) Hydramnios 5) C/S 3) ก ก 4) F oxytocin
  20. 20. 7. F 30 F term F F F 1) 300 2) 500 maneuver 3) 800 4) 1000 1) McRobert maneuver 2) Modified crede 5) 2000 3) Zillneuing . 15. F F IUD 6 8. F G4P3 GA 38 wk true labor PV: OS open 7cm F F F cord Fetus Normal Most approp Mx ( F C/S) 1) Ultrasound 2) X-ray 9. F F Vulva Herpes F F 3) F urine pregnancy test (NL, C/S, ) 4) F hook F ก IUD ก 10. 28 G1P0 GA 38 wk F กF .2 . 5) F IUD F FH 3/4 > FHR 150 at RLQ Cervical os closed , 16. F 39 ก 65 kg 152 cm ANC USG at 3 trimester mass 8 cm @ anterolateral ก ก ก ก 4200 gm F lower uterine segment ? risk F DM F ก 1) Normal delivery 1) F 2) 2) Cesarean section 3) 4) ก macrosomia 3) Cesarean section with myomectomy 5) > 25 4) Cesarean section with hysterectomy 17. 18 GA 5 wks กF spina bifida 11. F ก ก F ก ก ก ก 1) wet smear 2) G/S 1) Iron 2) Zinc 3) C/S 3) Ca 4) Folic acid 12. ก F F F ก ก 5) B6 18. Female 18 yr GA 12 wk G1P0 ก F ( 1) perineum ก 2) F F ก suprapubic ) F ก F F F 3) F F ก fundus 4) flex hip F F PE: F F ก ก 5) F ก F F ก ก ก 8 wk ก ก F ก ก F 13. 28 S/P C/S Day 2 F F ก F mens cervix F Diagnosis? F F F กF ก 1) Threatened abortion 2) Complete abortion ก PE: T 38°C, Breast marked engorge 3) Inevitable abortion 4) Imminent abortion and tenderness, Abd mild tenderness, F oozing 5) Incomplete abortion F F bleed mild tenderness, MIUB: WNL, Cx: tender 19. GA 20 wk ก LMP F F F on motion, lochia rubra, no mass, Ut: mild tender, 20 wk fundal height ก F umbilicus ¼ F size, Adx: tenderness both sides Dx 1) ultrasound 1) Mastitis 2) Breast Abscess 2) F void กF F F 3) Pelvic infection 4) TOA 20. Pt. pregnancy BP 140/90 mmHg, urine alb 1+ Fก 5) C/S wound infection (Mild preclamsia) 14. F 52 F F menopause F ก F
  21. 21. 21. F F 7 F 3 ก 2 ก 3) Metronidazole 4) Ceftriaxone Asthma F F ก ก ก ก F F 5) Ofloxacin Asthma F 27. GA 38 wk term F mucous bloody 1) ก F F shown, cervix dilate 3 cm. Vx, ก FHR 144/min 2) ก soy formular milk ( ก Rt labia major 3) ก Hydrolysated extend casein formular lesion ulcer ก discharge F 4) F F Fก F ก vagina) Mx. 5) ก F Serum IgE ก ก 1) F ก 2) podophyline F NL F 3) TCA F NL 4) Silver nitrate F NL 22. F TB ก F F ก F ก Tuberculin test 5) Cesarean section F 4 mm F ? 28. 30 F3 ก EGD 1) ก TB 2) INH prophylaxis 1 month DU F 3) Observe chest X ray ก 6 1) Omeprazole 2) Misoprostal 23. 21 LMP 6 wk. F ก vagina F 3) Sucralfate 4) Ranitidine ก F F PV: uterine normal size, soft, no adnexal 5) Cimetidine mass, not tender, TVS: no intrauterine sac, no mass, 29. 30 GP1021 GA 38 wk in labor Drip Mx? Syntocinon F BP F 80/50 mmHg Fetal 1) D&C 2) Serun ß-hCG part F F Fetal heart sound F F Dx. 3) Exploratory laparotomy 4) Diagnostic laparotomy 1) Abruptio placentae 2) Placenta previa 5) MTX injection 3) Uterine rupture 4) Vasa previa 24. F 28 ก F 5) Prolapse cord 3 , F swelling, tender, red 30. F 40 G2P1 GA 8 wk ก Down labia minora 2.5 cm ก Tx? syndrome F 1) Incision biopsy 2) Excision biopsy 1) 1/50 2) 1/100 3) Masupialization 4) I&D 3) 1/200 4) 1/300 5) Needle aspiration 5) 1/400 25. 24 G1P0 GA 6 wk bleeding PV 31. F 38 G4P3 GA 39 wk, no ANC, 2hr PTA ก ก ก Ut. ก F U/S Double decidual sac ก กF . , contraction sign 5 30 , PV: 7cm,station -2 FกF F 1) Demise embryo 2) Implant bleed Management 3) Ectopic pregnancy 4) Intrauterine pregnancy 1) Observe 2) F syntocinon 5) Anembryonic pregnancy 3) Partial breech extraction 4) Total breech extraction 26. 30 F ก ก F F ก 5) Emergency C/S Wet smear 10%KOH F ( epithelium = 32. F F 8 wk Mitral stenosis clue cell) . F ก ก F F กก ก 1) Amoxicillin 2) Doxycycline F F
  22. 22. 1) F F F ก 1) Vulva CA 2) Ovarian tumor 2) F F 3) Imperforated anus 4) Sarcoid boterioides 3) F F F F ก F Tertiary care 5) Foreign Body in Vulva 4) F ก F F 39. 35 P1021 G4 F Oxytocin drip F F 5) F ก F ก BP 130/100 FHS F F 2/3 33. 28 G6P5005 F ก F F F ก ก F F transverse lie ก ก 4 cm. 1) Myoma uteri 2) Full bladder F 3) Theated Ut. Rupture 4) Hypertonic UC 1) F cytotec 2) external version 40. 28 กก ก F 3) C/S 3 ก ก ก F2 4) F Cx Internal version F F F 5) F Voohees กF ก ก 1) ก 34. F 60 2) ก ก 9 ก ก ก ก 2 vital 3) Conjugated estrogens 0.625 mg sign stable F F 21 1) F/U 6 mo 2) Colposcopy 4) ก ก ก ก ก ก ก 3) Endometrial ablation 4) Endometrial sampling ก3 F 5) OCP 41. Pt. severe preclamsia GA 33 wk F cervical change 35. F . G1P0 GA 32 wk PROM 1 hr 1) induction with oxytocin Contraindication . F ก F ก refer 2) induction + painless labor 1) F steroid 2) F O2 42. pt 14 primary amenorrhea mass 3) F Antibiotics suprapubic 10 week size firm PV normal 4) Progression cervix labia major bulging vagina : Imperforate hymen 36. risk factor uterine atony: Polyhydramnios 43. ก F F ก F ก กก ก 37. F 40 G1P0 GA 16 wk amniocentesis F 1) 10 2) 12 increased AFP ก risk 3) 14 1) Cleft lip 2) Bilary atresia 44. F 20 F 5 F 3) Duodenal atresia 4) Neural tube defect cervical F ก U/S ก F F : serum hCG 5) Esophageal stenosis 45. 28 ก 6 wk F F 38. ก 14 3 F F ก Fก F F F ก ก 2-3 Hx dysmenorrhea ก F F F F ก F F F F F 2 1) Condom 2) IUD F ก abdominal : tense cystic mass , 1/3 > 3) Combined pill 4) Progesterone suprapubic , labia majora : normal , Gaping labia minor 46. F 28 G1P0 GA 33 ก F BP with purple tissue , PR : pelvic mass 12 cm , cystic 170/120 P 90 FH 2/4 > O FHR 140 albumin 2+ F consistency MgSO4 F
  23. 23. 1) Expectant + Manage NST 1) Hemorrhagic cyst 2) Endometriotic cyst 2) Induction of labour Oxytocin 3) CA ovary 4) Fuctional ovarian cyst 3) Induction of labour PGE2 5) Polycystic ovarian syndrome 4) Induction of labour + painless labour 49. ก 14 F 8 F กF 5) Urgent C/S F / ก ก ก 47. 36 F 4 F ก F ก F F ก กก F ก ก F PV: fixed F ก F ก progesterone challenge cystic mass 5cm at Rt. Adnexa, nodular at cul-de-sac Dx test: negative estrogen-progesterone challenge test: 1) Follicular cyst 2) Dermoid cyst negative ก 3) Endometriotic cyst 4) TOA 1) Ovarian failure 2) PCOS 5) Corpus luteal cyst 3) Exercise amenorrhea 4) Asherman s syndrome 48. 30 PV mass ก ก F Pt. F ก U/S 3 cm homogenous hypoechogenic cyst F F content Rt.adnexa Dx Ortho & Rehabilitation 1. F RA F ก F swan neck modality 4) Displaced lateral condylar fracture 5) Displaced medial condylar fracture 1) block exercise 4. F 59 Biceps F 2) tension-gliding exercise reflex F ก 3) low-load, high repetitive resistant exercise 1) C5 2) C6 4) high load, high repetitive resistant exercise 3) C7 4) C8 2. F 22 ก F ก 5) T1 flexion, abduction, internal rotation 5. F 20 ก F F F diagnosis X-ray fracture neck of humerus ก F ก 1) Fx pelvic 2) Fx acetabulum ก F F 3) Fx neck of femur 4) Intertrochanteric Fx 1) Deltoid 2) Brachialis 5) Posterior hip dislocation 3) Biceps 4) Triceps 3. F ก 10 ก F 5) Coracobrachialis ก F ก F F ก F F PE: 6. F 52 yr ก ก F swelling at Rt elbow, triangle landmark at Rt elbow F PE: sensory intact, no thenar atrophy, Phalen test +ve ก Tx 1) Dislocation elbow 1) Observation 2) NSAIDS 2) Displaced olecranon fracture 3) Epidural steroid injection 4) Long arm cast 3) Displaced supracondylar fracture 5) A1 pulley release

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