All practice questions

A 24-year-old man comes to the clinic due to a sore on his penis that he noticed 5 days ago. He reports no pain, itching, or penile discharge. He is sexually active with a new male partner and does not use condoms consistently. Vital signs are within normal limits. Physical examination reveals a single, 1.5-cm, sharply circumscribed, indurated, and painless ulcer on the penile shaft. Bilateral, non-tender inguinal lymphadenopathy is present. Which of the following is the most appropriate pharmacotherapy for this patient?

A 68-year-old female presents to the outpatient clinic reporting progressive fatigue and shortness of breath with minimal exertion over the past three months. Her past medical history includes chronic obstructive pulmonary disease and primary hypothyroidism. Her current medications include inhaled tiotropium and oral levothyroxine. Vital signs are within normal limits. Pulse oximetry is $96\%$ on room air. Physical examination reveals marked conjunctival pallor. Lung fields are clear to auscultation bilaterally, and there is no jugular venous distention or peripheral edema.

Laboratory studies reveal the following:
Hemoglobin: $7.1\text{ g/dL}$
Mean corpuscular volume: $115\text{ fL}$
White blood cell count: $4,500/\text{mm}^3$
Platelet count: $160,000/\text{mm}^3$
Thyroid-stimulating hormone: $2.4\text{ }\mu\text{U/mL}$ (normal: $0.4-4.0\text{ }\mu\text{U/mL}$)

Which of the following is the most appropriate next step in management?

A 65-year-old man with a history of metastatic prostate cancer presents to the emergency department with a 2-day history of progressive lower extremity weakness, sensory loss below the umbilicus, and new-onset urinary retention. Physical examination reveals paraparesis, hyperreflexia in both lower extremities, and decreased rectal sphincter tone. Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient's condition.

Match each pediatric patient presenting for a clinical visit with the most appropriate next step in their preventive care or immunization management.

Macrosomic neonates are at increased risk for birth trauma, particularly during difficult or operative vaginal deliveries. Match each characteristic clinical presentation observed during the newborn physical examination with its most likely traumatic etiology.

Review the following physical examination findings of skin lesions in newborn infants. Associate each dermatologic presentation with its corresponding diagnosis.

A 9-month-old boy is brought to the clinic by his parents for a pre-travel consultation. The family will be traveling next week to a country experiencing an ongoing measles outbreak and plans to stay for two months. The patient was born at term, has no significant medical history, and is developing normally. He has received all routine childhood immunizations recommended for his age in the United States. His vital signs are within normal limits, and physical examination is unremarkable. Which of the following is the most appropriate recommendation regarding measles immunization for this patient?

An $8$-day-old newborn is evaluated in the pediatric clinic for a routine well-child visit. The mother is concerned about a skin eruption that appeared on the infant's face three days ago, which seemed to worsen after they sat in a sunlit room. The infant was born at $39$ weeks gestation via an uncomplicated vaginal delivery and is exclusively breastfeeding well. The mother is a $28$-year-old primigravida who has a history of episodic joint stiffness and cold-induced finger discoloration, for which she has not sought medical care. The infant's vital signs include a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure of $65/40 \text{ mmHg}$, respiratory rate of $36/\text{min}$, and a heart rate of $72/\text{min}$. Physical examination of the infant reveals erythematous, annular plaques with slightly raised and scaly borders concentrated around the periorbital regions and scalp. The anterior fontanelle is flat and soft, and the lungs are clear to auscultation. Which of the following is the most appropriate next step in the management of this patient?

A pediatric clinic is auditing patient records to ensure adherence to specialized immunization guidelines for high-risk patients. Match each pediatric patient scenario with the most appropriate vaccine indication, absolute contraindication, or management step.

A 39-week gestation male neonate is born via spontaneous vaginal delivery to a 28-year-old primigravida. The pregnancy was uncomplicated. At birth, the neonate is limp, apneic, and cyanotic. Place the following steps of neonatal resuscitation in the correct chronological order of execution according to standard neonatal resuscitation guidelines, assuming the neonate's clinical status does not improve and the heart rate remains consistently below 60/min despite each successive intervention.

A $58$-year-old man is evaluated in the intensive care unit for worsening respiratory status. Eight days ago, he was intubated following a severe motor vehicle collision. Over the past $24$ hours, his oxygen requirements have increased, and he has developed a fever of $38.9^\circ\text{C}$ ($102.0^\circ\text{F}$). Copious thick, purulent secretions are noted in the endotracheal tube. Physical examination reveals coarse rhonchi over the right lung field. Laboratory studies show a leukocyte count of $16,500/\text{mm}^3$ with $85\%$ neutrophils. A chest radiograph demonstrates a new dense consolidation in the right lower lobe. The patient was empirically started on intravenous vancomycin, piperacillin-tazobactam, and amikacin.

Today, the quantitative endotracheal aspirate culture returns positive for $>10^5\text{ CFU/mL}$ of *Pseudomonas aeruginosa*. The isolate is susceptible to piperacillin-tazobactam, cefepime, meropenem, and amikacin. Blood cultures show no growth. His serum creatinine has increased from $1.0\text{ mg/dL}$ on admission to $2.3\text{ mg/dL}$ today.

Which of the following is the most appropriate next step in pharmacotherapy?

Match each inpatient clinical scenario with the most appropriate targeted pharmacologic intervention based on current clinical guidelines.

Evaluate the following neonatal clinical presentations characterized by gastrointestinal obstruction or feeding intolerance. Match each specific presentation to its precise underlying embryologic or pathophysiologic etiology.

In the management of systemic autoimmune and inflammatory diseases, disease-modifying antirheumatic drugs (DMARDs) and biologic therapies are mainstays of treatment. However, their use is associated with unique adverse effects that require specific screening and monitoring strategies. Match each medication below with its most characteristic adverse effect profile or required screening parameter.

A 35-year-old woman is evaluated in the clinic for progressively worsening pain and color changes in her fingers. She has a known history of diffuse cutaneous systemic sclerosis. She describes her fingers turning white, then blue, and finally red upon exposure to cold. These episodes are now occurring even in mildly cool environments and are severely impacting her daily activities. Physical examination reveals thickened skin over her hands and forearms, as well as tiny, pitted scars on the distal fingertips. She asks about the therapeutic options available for her condition as it progresses.

Arrange the following interventions in the standard stepwise order of therapeutic escalation for the management of Raynaud phenomenon, from the initial approach to the final option for medically refractory, critical ischemia.

During a routine evaluation in the newborn nursery, a physician examines a 48-hour-old female infant due to a newly developed skin eruption. The infant was born at 39 weeks of gestation via an uncomplicated vaginal delivery to a healthy mother who received standard prenatal care. Vital signs are within normal limits for age, and the infant is feeding vigorously at the breast. Physical examination reveals multiple erythematous macules, some containing central 1- to 2-millimeter yellowish pustules, scattered across the chest, abdomen, and bilateral thighs. The palms and soles are completely spared. Which of the following is the most appropriate next step in management?

A 32-year-old woman brings her 8-week-old daughter to the outpatient clinic for a scheduled preventive care encounter. The mother has a history of severe ulcerative colitis, which was managed with continuous intravenous infliximab therapy throughout her pregnancy; her most recent infusion occurred at 38 weeks gestation. The infant has been exclusively breastfed and demonstrates appropriate weight gain. Developmental assessment reveals that the infant coos, exhibits a social smile, and successfully tracks objects past the midline. Vital signs are within normal limits. Skin examination reveals a scattered eruption of small, firm, yellow-white papules surrounded by an erythematous halo over the trunk. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in the management of this patient?

A 65-year-old man is hospitalized for community-acquired pneumonia. Upon admission, he was empirically started on intravenous ceftriaxone and azithromycin. Two days later, his clinical condition has significantly improved. He is now afebrile, his oxygen saturation is 96% on room air, and his cough has decreased. He is eating well and tolerating oral intake. Sputum culture results return positive for Streptococcus pneumoniae. Susceptibility testing shows the organism is highly sensitive to penicillin, amoxicillin, ceftriaxone, and levofloxacin. Which of the following is the most appropriate next step in pharmacotherapy?

A 54-year-old woman is evaluated on the general medical ward for new-onset chills and a temperature of 38.8°C (101.8°F). She recently completed her second cycle of systemic chemotherapy for invasive ductal carcinoma. Laboratory studies demonstrate a white blood cell count of 900/mm³ and an absolute neutrophil count of 250/mm³. Her blood pressure is 110/70 mm Hg, pulse is 105/min, and respiratory rate is 18/min. Physical examination reveals an indwelling central venous port in the right upper chest with no overlying erythema, fluctuance, or tenderness. The remainder of the examination is unremarkable.

Arrange the following steps in the most appropriate chronological order for the acute diagnostic and therapeutic management of this patient.

A 72-year-old male with a history of metastatic prostate cancer is admitted directly to the inpatient medical ward from his oncologist's clinic due to rapidly progressive lower extremity weakness. He reports a two-week history of worsening thoracic back pain that frequently awakens him from sleep. Over the last 24 hours, he has become entirely unable to stand or walk. He also mentions an inability to urinate since early this morning. Vital signs are within normal limits. Neurologic examination shows symmetric 2/5 motor strength in the lower extremities, diminished pinprick sensation below the T10 dermatome, and bilateral Babinski signs. A distended, palpable bladder is noted on abdominal examination. Complete blood count and basic metabolic panel, including serum calcium, are unremarkable.

Which of the following is the most appropriate initial step in the management of this patient?