All practice questions

Match each clinical presentation of an adverse transfusion event to its primary underlying pathophysiologic mechanism.

Evaluate the following pediatric patients presenting with signs and symptoms concerning for acute bacterial meningitis. Which initial empiric intravenous antimicrobial regimen is most appropriate for each patient's clinical presentation? Match each patient to the correct regimen.

A 68-year-old woman is brought to the emergency department by her daughter due to a high fever, severe diffuse headache, and progressive confusion over the past 24 hours. Her temperature is 39.2°C (102.6°F), blood pressure is 110/70 mm Hg, and heart rate is 115/min. She is lethargic but arouses to painful stimuli. Physical examination reveals marked nuchal rigidity. Ophthalmoscopic examination demonstrates bilateral blurring of the optic disc margins. Arrange the following steps in the most appropriate chronological order for the immediate management of this patient's condition.

A medical student is reviewing developmental screening tools used during routine well-child preventive care visits. To correctly administer screening questionnaires and identify potential delays, the student must know the normal progression of infant and toddler development. Arrange the following fine motor milestones in the chronological order in which they are typically achieved by a healthy neurotypical child, from earliest to latest.

Match the following clinical presentations of neonatal respiratory distress with their primary underlying pathophysiologic mechanism.

Systemic vasculitides often present with overlapping multi-organ involvement, but distinct clinicopathologic features and specific infectious associations can differentiate them. Match each patient's clinical presentation with the most likely specific systemic vasculitis diagnosis.

A 5-year-old girl presents to the clinic with her adoptive parents for an initial health assessment. The family recently immigrated, and the parents state that the child has no previous medical or vaccination records. The patient's past medical history is notable for severe persistent asthma. Three weeks prior to her arrival, she suffered a severe asthma exacerbation that required a pediatric intensive care unit admission. She was discharged on a regimen of oral prednisone 2 mg/kg daily, which she has continued taking for the past 21 days. Her other medications include high-dose inhaled fluticasone and as-needed albuterol. Vital signs are within normal limits. Physical examination reveals cushingoid features but is otherwise unremarkable, with clear breath sounds bilaterally. The physician is planning her catch-up immunization schedule. Which of the following is the most appropriate immunization management for this patient at today's visit?

Match each clinical presentation to the most appropriate, evidence-based therapeutic intervention, taking into account current clinical guidelines and antimicrobial stewardship principles.

A male infant is born at 39 weeks gestation via spontaneous vaginal delivery to a 28-year-old primigravida. The pregnancy was complicated by maternal preeclampsia and intrauterine growth restriction. Birth weight is 2100 g. APGAR scores are 8 and 9 at 1 and 5 minutes.

At 14 hours of life, the infant is evaluated for lethargy, jitteriness, and poor feeding. Vital signs show a temperature of 36.8°C (98.2°F), heart rate of 150/min, and respiratory rate of 64/min. Physical examination reveals a plethoric appearance, sluggish capillary refill, and scattered erythematous macules with central yellow-white papules on the infant's trunk.

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

A 68-year-old woman presents to the clinic for the management of right knee pain that has been progressively worsening over the last 3 years. The pain is exacerbated by prolonged standing or walking and is relieved by rest. She has no other medical conditions and currently takes no medications. Her body mass index is 31 kg/m². Examination of the right knee reveals bony hypertrophy, crepitus on active range of motion, and a minimal, cool effusion. X-rays demonstrate medial joint space narrowing and marginal osteophytes. She is highly motivated to improve her symptoms but wants to understand the step-by-step treatment approach. Arrange the following management steps in the most appropriate sequential order of escalation for this patient's condition, starting from the most conservative initial step to the most definitive treatment.

A pediatric oncology clinic is evaluating a 5-year-old girl who is currently on a maintenance chemotherapy regimen for acute lymphoblastic leukemia. Her parents arranged this urgent visit after learning that a child in her kindergarten class was diagnosed with chickenpox (varicella) two days ago. The two children sit next to each other in class. The patient has no history of clinical varicella infection and has never received the varicella vaccine. She currently feels well, is playing comfortably in the examination room, and is completely asymptomatic. Vital signs show a temperature of $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), heart rate of $105/\text{min}$, and respiratory rate of $24/\text{min}$. Physical examination reveals a clear oropharynx, clear lungs, and normal skin without any rashes or lesions. Based on this exposure, which of the following is the most appropriate next step in management?

Match each clinical presentation of an immunocompromised patient with the most appropriate primary pharmacotherapy for their underlying condition.

A 54-year-old woman is brought to the emergency department by her partner due to progressive confusion, a severe generalized headache, and fever for the past 14 hours. Her past medical history is significant for severe rheumatoid arthritis, for which she currently takes methotrexate and infliximab. Her temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $105/65\text{ mmHg}$, pulse is $118/\text{min}$, and respiratory rate is $22/\text{min}$. On physical examination, she is lethargic but localizes to painful stimuli. She has marked nuchal rigidity and positive Kernig and Brudzinski signs. Fundoscopic examination reveals blurring of the bilateral optic disc margins.

Arrange the following management steps in the most appropriate chronological order for this patient.

Match each hematologic disorder with its most characteristic peripheral blood smear finding and associated laboratory profile.

A $42$-year-old woman is evaluated in the hospital on postoperative day $2$ following a total thyroidectomy for a large toxic multinodular goiter. Her current medications include levothyroxine. She reports new-onset tingling around her mouth and in the fingertips of both hands. She also mentions mild nausea and states she has not had a bowel movement since before the surgery. She has no difficulty breathing or voice changes. Vital signs are temperature $38.0^{\circ}\text{C}$ ($100.4^{\circ}\text{F}$), blood pressure $122/78\text{ mmHg}$, heart rate $84/\text{min}$, and respiratory rate $14/\text{min}$. Physical examination reveals twitching of the ipsilateral facial muscles when the area just anterior to the earlobe is tapped. The surgical incision is clean, dry, and intact without erythema or fluctuance. The lungs are clear to auscultation. The abdomen is soft and non-distended with hypoactive bowel sounds.

Laboratory results are as follows:

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

A 48-hour-old term male neonate is evaluated in the newborn nursery for a newly developed skin rash. He was born via uncomplicated vaginal delivery to a 26-year-old primigravida. The mother has a history of recurrent genital herpes simplex virus (HSV) infections but had no active lesions or prodromal symptoms at the time of delivery. She took suppressive oral acyclovir from 36 weeks of gestation. The infant's temperature is 37.1°C (98.8°F), heart rate is 145/min, and respiratory rate is 40/min. He is feeding well and has normal tone. Physical examination reveals widespread 2- to 3-mm firm, pale yellow pustules surrounded by a prominent erythematous macular base (a "flea-bitten" appearance), distributed over his trunk, face, and proximal extremities. The palms and soles are spared. The remainder of the examination is unremarkable. Which of the following is the most appropriate next step in the management of this patient?

During morning rounds on the hematology-oncology ward, a 45-year-old female patient is noted to have a temperature of $38.8^\circ C$ ($101.8^\circ F$). She was admitted two weeks ago for induction chemotherapy to treat acute myeloid leukemia. The patient reports moderate fatigue but denies any localizing symptoms such as cough, dysuria, abdominal pain, or skin changes. Vital signs show a blood pressure of $115/75$ mm Hg, a heart rate of $105$/min, and a respiratory rate of $16$/min. Physical examination demonstrates an indwelling central venous catheter with clean, non-erythematous margins and no tenderness to palpation. Her lungs are clear to auscultation, and her abdomen is soft and non-tender. Laboratory analysis reveals a leukocyte count of $400/\mu L$ with an absolute neutrophil count of $50/\mu L$. After drawing blood cultures from the catheter and a peripheral vein, which of the following is the most appropriate initial pharmacologic management?

A 34-year-old man presents to the emergency department with a 4-day history of progressively worsening right upper quadrant abdominal pain and abdominal swelling. Over the past several months, he has experienced profound fatigue and noticed that his first morning urine is often dark, gradually clearing up as the day progresses. He takes no medications and has no significant past medical history. Temperature is 37.2°C (99.0°F), blood pressure is 118/76 mm Hg, and pulse is 98/min. Physical examination shows scleral icterus and a distended abdomen with shifting dullness. The liver edge is markedly tender and palpable 4 cm below the right costal margin.

Doppler ultrasonography of the abdomen reveals the absence of blood flow in the hepatic veins. Which of the following is the most appropriate next step in diagnosing the underlying cause of this patient's condition?

During a visit to the student health clinic, a 20-year-old male describes a sudden onset of severe throat pain and subjective fever over the past 24 hours. He reports no cough or rhinorrhea. Vital signs reveal a temperature of 38.3°C (101.0°F). Physical examination demonstrates bilateral tonsillar erythema with purulent exudates and tender anterior cervical lymph nodes. A rapid antigen detection test for Group A Streptococcus is positive. Which of the following is the most appropriate antimicrobial regimen for this patient?

An elderly man is evaluated on the surgical ward on postoperative day 3 following an elective sigmoid resection for diverticular disease. His medical history is significant for ischemic cardiomyopathy and stage 3a chronic kidney disease. Overnight, he developed acute, intense pain and marked swelling in his right knee. His temperature is 38.3°C (101.0°F), blood pressure is 132/82 mmHg, and pulse is 98/min. Physical examination of the right knee reveals significant erythema, warmth, and a large effusion. Passive range of motion is severely restricted by pain. Mild bilateral pitting edema is present at the ankles, which the patient states is his baseline. Arthrocentesis is performed, yielding synovial fluid with a leukocyte count of 35,000/μL (85% neutrophils). Microscopic analysis under polarized light reveals rhomboid-shaped crystals exhibiting weak positive birefringence. Gram stain of the fluid shows no organisms. Which of the following is the most appropriate next step in management?