1. A 32-year-old female presented with progressive weakness of limbs over 3 months. Neurological examination found reduced motor power and absent deep tendon reflexes. Laboratory tests showed proteinuria and red blood cell casts. The leading diagnoses were transverse myelitis, Guillain-Barré syndrome, myasthenia gravis, and neurosyphilis.
2. A 35-year-old female presented with chest pain and dyspnea. EKG showed diffuse ST-T changes and low voltage. Physical examination found neck vein engorgement and hepatomegaly. The leading diagnoses were restrictive pericarditis, beriberi heart disease, cardiac tamponade, and dilated cardiomyopathy
แนวทางการดูแลรักษาผู้ป่วยไวรัสตับอักเสบ ซี เรื้อรัง
ในประเทศไทย ปี พ.ศ. 2559
Thailand Practice Guideline for Management of
Chronic Hepatitis C 2016
http://www.thasl.org/files/31.Hep%20C%20Guideline%202016.pdf
แนวทางการดูแลรักษาผู้ป่วยไวรัสตับอักเสบ ซี เรื้อรัง
ในประเทศไทย ปี พ.ศ. 2559
Thailand Practice Guideline for Management of
Chronic Hepatitis C 2016
http://www.thasl.org/files/31.Hep%20C%20Guideline%202016.pdf
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Chiangmai Medical School
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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