All practice questions

A $12$-month-old boy and his $4$-year-old sister are brought to the clinic by their mother for routine well-child visits. The boy was diagnosed with perinatal HIV infection shortly after birth and is currently taking antiretroviral therapy. He has had no opportunistic infections. His laboratory studies from one week ago show an HIV viral load of $45,000$ copies/mL, a CD4+ T-lymphocyte percentage of $12\%$, and an absolute CD4+ count of $410$ cells/mm³. The $4$-year-old sister is healthy, takes no medications, and has a normal physical examination. Both children have received all age-appropriate vaccinations up to this point. The mother expresses concern about whether the children can safely receive their scheduled immunizations today, particularly the "live virus" vaccines, given the boy's HIV status. Which of the following is the most appropriate immunization plan for these siblings today?

Match each of the following pediatric clinical vignettes describing an acute osteoarticular presentation with the most likely responsible infectious agent.

A 15-month-old boy is brought to the clinic for a routine preventive care visit. He is previously healthy and has received all recommended immunizations up to 6 months of age. His 6-year-old sister was recently diagnosed with acute lymphoblastic leukemia and is currently undergoing induction chemotherapy. The parents are highly anxious about the 15-month-old receiving any vaccines that could potentially transmit an infection to his severely immunocompromised sister. When asked about the boy's development, the parents report that he walks independently, can drink from a cup, and has a vocabulary of four words, including "mama" and "dada". They express concern that his speech is delayed compared to his sister at this age. His physical examination today is unremarkable. Which of the following is the most appropriate next step in management?

An 86-year-old multiparous woman is brought to the emergency department due to a 3-day history of progressive abdominal distension, intractable vomiting, and failure to pass flatus or stool. She resides in an assisted living facility and has a history of severe chronic obstructive pulmonary disease and profound, unintentional weight loss over the past 6 months. She also complains of pain radiating down the medial aspect of her right thigh, which is exacerbated by extending and internally rotating the right hip. Her temperature is $38.4^{\circ}\text{C}$ ($101.1^{\circ}\text{F}$), pulse is $122/\text{min}$, respirations are $24/\text{min}$, and blood pressure is $88/55\text{ mm Hg}$. Physical examination reveals a tympanic, distended abdomen with marked right lower quadrant tenderness and involuntary guarding. Bowel sounds are high-pitched and tinkling. Laboratory studies show a leukocyte count of $18,500/\text{mm}^3$ with $15\%$ bands and a serum lactate level of $4.6\text{ mmol/L}$. An upright abdominal radiograph demonstrates multiple dilated loops of small bowel with prominent air-fluid levels, but no pneumoperitoneum. Which of the following is the most appropriate next step in management?

A term neonate born to a mother with blood type O, Rh-negative develops visible scleral and cutaneous icterus at 24 hours of life. Assuming the infant has confirmed ABO incompatibility and the clinical condition progressively worsens despite each preceding intervention, arrange the following diagnostic and therapeutic steps in the correct escalating chronological sequence.

A mother brings her 48-month-old daughter to the clinic for a medical evaluation before the child begins a pre-kindergarten program. The mother expresses significant concern regarding the child's fine motor progression and self-care independence. Specifically, she notes that the girl is unable to draw a triangle, struggles to use scissors to cut out complex shapes, and still requires assistance with tying her shoelaces and fastening small buttons. The mother mentions that her older son had mastered these tasks by this age. During the visit, the child speaks in complete, easily understood sentences and enthusiastically shares a detailed story about her pets. Clinical observation reveals she can successfully copy a cross, draw a person with three distinct body parts, and hop on one foot. She is noted to engage in cooperative, imaginative play with dolls in the examination room. Physical examination is unremarkable. Which of the following is the most appropriate next step in the management of this patient?

A male neonate is evaluated in the well-baby nursery at $16$ hours of life. He was delivered at $41$ weeks of gestation via an uncomplicated spontaneous vaginal delivery to a $29$-year-old primigravid woman. The maternal pregnancy course was routine, and all prenatal serologies were negative. The infant's vital signs are within normal limits, and he is breastfeeding vigorously. Physical examination reveals a widespread eruption of small, flaccid vesiculopustules on the forehead, chin, and lower back. Several of these lesions have already ruptured, leaving flat, hyperpigmented macules surrounded by a fine collarette of scale. A microscopic examination of the fluid obtained from an intact pustule using a Wright stain demonstrates a heavy predominance of neutrophils without any visible microorganisms. Which of the following is the most appropriate next step in the care of this patient?

An evaluation is requested for a $65$-year-old man in the intensive care unit who developed right calf swelling and tenderness this morning. $6$ days ago, he underwent an exploratory laparotomy with a small bowel resection for acute mesenteric ischemia. His postoperative course has been complicated by severe acute kidney injury secondary to prolonged intraoperative hypotension, though he remains nonoliguric. Since admission, he has been receiving subcutaneous unfractionated heparin for deep venous thrombosis prophylaxis.

His temperature is $37.7^\circ\text{C}$ ($99.9^\circ\text{F}$), blood pressure is $135/85$ mm Hg, pulse is $98$/min, and respirations are $16$/min. Physical examination reveals pitting edema and tenderness over the right calf. The laparotomy incision is clean, dry, and intact.

Laboratory results today:
Hemoglobin: $11.2$ g/dL
Platelet count: $85,000/\text{mm}^3$ (preoperative: $250,000/\text{mm}^3$)
Leukocyte count: $9,500/\text{mm}^3$
Blood urea nitrogen: $48$ mg/dL
Serum creatinine: $3.4$ mg/dL

A compression ultrasonography of the right lower extremity confirms a new deep venous thrombosis in the popliteal vein. Which of the following is the most appropriate next step in the management of this patient?

A 64-year-old man is brought to the emergency department due to a 2-day history of progressively worsening shortness of breath and coughing up blood-tinged sputum. His past medical history is significant for chronic rhinosinusitis that has been poorly responsive to multiple courses of antibiotics, and migrating joint pains for the past 6 months. His temperature is $37.6^\circ\text{C}$ ($99.7^\circ\text{F}$), blood pressure is $155/95\text{ mmHg}$, pulse is $108/\text{min}$, and respiratory rate is $26/\text{min}$. Oxygen saturation is 88% on room air. Physical examination reveals a mild collapse of the nasal bridge. Lung auscultation reveals diffuse bilateral crackles. Heart sounds are normal with no murmurs, gallops, or jugular venous distention. There is trace bilateral lower extremity edema. Laboratory results show:

Hemoglobin: $9.2\text{ g/dL}$
Leukocyte count: $14,000/\text{mm}^3$
Platelet count: $410,000/\text{mm}^3$
Blood urea nitrogen: $42\text{ mg/dL}$
Serum creatinine: $2.8\text{ mg/dL}$ (baseline $1.0\text{ mg/dL}$ 6 months ago)
Urinalysis: 2+ protein, large blood, 20-30 red blood cells/hpf, presence of red blood cell casts.

A portable chest radiograph shows bilateral, patchy, diffuse alveolar infiltrates. An electrocardiogram shows normal sinus rhythm. Which of the following is the most appropriate initial step in the management of this patient's acute condition?

Match the following classic peripheral blood smear findings with their most likely associated hematologic disorder.

A $38$-year-old woman is brought to the emergency department due to a $4$-day history of worsening fatigue, spontaneous bruising, and continuous oozing of blood from her gums. Her temperature is $37.9^\circ\text{C}$ ($100.2^\circ\text{F}$), blood pressure is $110/65 \text{ mm Hg}$, and pulse is $112/\text{min}$. Physical examination shows scattered petechiae and large ecchymoses over her extremities.

Laboratory studies reveal the following:

A peripheral blood smear demonstrates pancytopenia and atypical promyelocytes with abundant primary granules and multiple rod-like intracytoplasmic inclusions bundled together.

Arrange the following steps in the most appropriate chronological order for the diagnosis and management of this patient's condition:

A term newborn is delivered via emergency cesarean section due to fetal bradycardia. At birth, the infant is apneic, limp, and cyanotic. Assume the infant's condition continues to deteriorate and fails to respond to each successive intervention. Arrange the following neonatal resuscitation steps in the correct chronological order according to standard guidelines.

Zoonotic and vector-borne infections can present with diverse, overlapping systemic symptoms. Their management heavily depends on the specific pathogen, disease stage, and patient comorbidities. Based on the clinical features provided, which antimicrobial regimen is the most appropriate next step in management for each patient? Match each clinical scenario with its optimal targeted pharmacotherapy.

Autoantibodies serve as crucial diagnostic markers in evaluating systemic autoimmune conditions. Match each specific clinical manifestation profile with the autoantibody most characteristically associated with the underlying disease.

A 9-month-old girl is brought to the clinic in late December with a 3-day history of nasal congestion, low-grade fever, and a prominent cough. Her parents report that today she has been breathing faster than usual and they can hear a wheezing sound. Her temperature is 37.8°C (100.0°F), heart rate is 130/min, respiratory rate is 54/min, and oxygen saturation is 96% on room air. Physical examination reveals mild subcostal retractions and diffuse expiratory wheezes and crackles bilaterally. She is alert, interacting appropriately with her parents, and taking her formula without difficulty. Which of the following is the most appropriate next step in management?

Match each patient's clinical scenario with the most appropriate antimicrobial management strategy, reflecting current infectious disease and antimicrobial stewardship guidelines.

Match each pediatric patient presenting for a routine well-child visit with the age-appropriate universal screening intervention recommended by the American Academy of Pediatrics (AAP), regardless of their individual risk factors.

A 42-year-old man presents to the emergency department with a 4-week history of a persistent productive cough, subjective low-grade fevers, drenching night sweats, and an unintentional 5-kg (11-lb) weight loss. He immigrated to the United States from Southeast Asia five years ago. His vital signs are temperature 38.1°C (100.6°F), blood pressure 118/76 mmHg, heart rate 92/min, and respiratory rate 18/min. A portable chest radiograph performed in the emergency department demonstrates a 3-cm cavitary lesion in the apical segment of the right upper lobe. The patient is currently resting in a standard emergency department examination room with the door closed.

Arrange the following interventions in the most appropriate chronological sequence for the comprehensive management of this patient.

For each of the following patients, select the most appropriate targeted antimicrobial therapy based on current clinical guidelines and stewardship principles.

A 67-year-old female presents to an outpatient clinic complaining of progressively worsening shortness of breath over the last three days. She has a medical history of essential hypertension, hyperlipidemia, and a 45-pack-year smoking history. She reports increased chest tightness and wheezing but notes her daily cough remains productive of only minimal, clear sputum. She denies any fever, chills, orthopnea, or paroxysmal nocturnal dyspnea. Her medications include amlodipine, atorvastatin, and an albuterol inhaler. The temperature is 37.0°C (98.6°F), blood pressure is 154/90 mm Hg, pulse is 95/min, and respiratory rate is 22/min. Pulse oximetry reveals an oxygen saturation of 91% on room air. The jugular venous pressure is estimated at 5 cm H2O. Chest auscultation reveals a prolonged expiratory phase with widespread, high-pitched polyphonic wheezing bilaterally. No crackles or cardiac murmurs are heard. There is trace, chronic non-pitting edema of the lower extremities. Which of the following is the most appropriate next step in management?