All practice questions

Match each type 2 diabetes mellitus medication to its most characteristic adverse effect or clinical contraindication.

An unvaccinated 6-month-old infant is evaluated for a prolonged, severe cough. The pediatrician suspects an infection with Bordetella pertussis. This illness typically progresses through a very predictable sequence of distinct clinical phases. Arrange the following classic stages of a pertussis infection in the correct chronological order, from earliest (first) to latest (last).

A 40-week gestation female infant is delivered vaginally to a 29-year-old gravida 2, para 1 mother following an uncomplicated pregnancy and labor. At the time of birth, the infant is breathing spontaneously, crying vigorously, and exhibits active flexion of all extremities. Arrange the following standard neonatal care interventions in the correct chronological sequence in which they should be executed for this healthy newborn, from earliest (immediately after birth) to latest (prior to hospital discharge).

A 12-year-old girl is brought to the emergency department with a 1-day history of high fever, severe headache, and recurrent vomiting. On examination, her temperature is $39.5^\circ\text{C}$ ($103.1^\circ\text{F}$), blood pressure is $110/70$ mm Hg, pulse is $115$/min, and respiratory rate is $20$/min. She is lethargic and oriented only to person. Neck flexion produces involuntary flexion of the hips and knees. Fundoscopic examination reveals bilateral blurring of the optic disc margins. Arrange the following steps in the most appropriate chronological sequence for the initial management of this patient.

A series of neonates evaluated in the intensive care unit present with severe hypoxemia. To isolate the etiology, the clinical team performs hyperoxia testing (measuring $PaO_2$ before and after administration of $100\%$ $FiO_2$) and dual pulse oximetry (measuring $SpO_2$ simultaneously in the right hand and right foot). Match each neonatal clinical and oximetry profile with its corresponding primary underlying hemodynamic or pathophysiological mechanism.

A 5-year-old boy is brought to the clinic by his father due to a runny nose and cough that began four days ago. The boy initially had a subjective fever on the first day of illness, but he has been afebrile since. The cough is non-productive and occurs intermittently throughout the day. He is eating and drinking normally and remains active at home. His temperature is 37.1°C (98.8°F), blood pressure is 94/60 mm Hg, pulse is 98/min, and respirations are 20/min. Physical examination reveals clear rhinorrhea and slightly boggy nasal turbinates. The tympanic membranes are translucent and mobile bilaterally. The oropharynx is clear without erythema or exudates. Auscultation of the lungs reveals clear breath sounds bilaterally without wheezes, crackles, or rhonchi. Which of the following is the most appropriate next step in management?

Evaluate the following pediatric patients presenting with localized or generalized lymphadenopathy. Match each clinical vignette with the most appropriate specific management or pharmacotherapy.

A 3-day-old (72 hours of life) male neonate is brought to the pediatric clinic by his parents for worsening skin yellowing and a new rash. He was born at 39 weeks gestation via uncomplicated vaginal delivery to a 26-year-old primigravid woman. His birth weight was 3,300 g. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The infant is exclusively breastfed for 10 minutes on a single breast every 4 to 5 hours. The parents report a decrease in wet diapers and noted "brick-red dust" in his diaper this morning. His current weight is 2,930 g, representing an 11.2% decrease from birth weight. Vital signs are normal. Physical examination reveals scleral icterus and jaundice extending to the lower abdomen. Scattered erythematous macules with central yellow pustules are noted on the chest and back, sparing the palms and soles. The neonate is alert, vigorously cries during the examination, and has a normal Moro reflex.

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

Match each clinical scenario involving a potential infectious exposure with the most appropriate post-exposure prophylaxis (PEP) or management strategy.

A $42$-year-old woman is evaluated in the clinic due to progressive fatigue, constant chilling, and a $6$-kg ($13.2$-lb) weight gain over the past $6$ months. She also reports worsening shortness of breath when climbing stairs, frequent morning headaches, and a tendency to bump into objects on her sides. She has not had a menstrual period in $8$ months. Her medical history is unremarkable, and she takes no medications. Vital signs show a temperature of $36.1^\circ$ C ($97.0^\circ$ F), blood pressure of $88/58$ mmHg, pulse of $54$/min, and respiratory rate of $14$/min. Physical examination reveals a lethargic, pale woman with a delayed relaxation phase of the deep tendon reflexes. Visual field testing reveals bitemporal hemianopsia. She has non-pitting edema of the bilateral lower extremities. The lungs are clear to auscultation.

Laboratory studies reveal:
Sodium: $131$ mEq/L
Potassium: $4.1$ mEq/L
Creatinine: $0.8$ mg/dL
Thyroid-stimulating hormone (TSH): $1.1$ $\mu$ U/mL (Normal: $0.4$–$4.0$ $\mu$ U/mL)
Free thyroxine (T4): $0.4$ ng/dL (Normal: $0.9$–$2.4$ ng/dL)

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

A 2-month-old boy is brought to the clinic for a routine well-child visit. He was born at 39 weeks gestation via an uncomplicated vaginal delivery. His mother has a history of severe Crohn's disease that was well controlled during pregnancy with intravenous infliximab. She received her last infusion of infliximab at 35 weeks gestation. The infant is exclusively breastfed and is gaining weight appropriately. His vital signs and physical examination are unremarkable. The mother asks about the infant's scheduled 2-month immunizations, which typically include the diphtheria, tetanus, and acellular pertussis (DTaP); Haemophilus influenzae type b (Hib); inactivated poliovirus (IPV); pneumococcal conjugate (PCV); and rotavirus vaccines. Which of the following is the most appropriate immunization plan for this patient today?

Match each classic infectious disease clinical presentation with its most appropriate first-line antimicrobial therapy.

A group of pediatric patients presents to the outpatient clinic during the spring with various rash illnesses. Based on the distinctive clinical features described below, match each patient's presentation with the most likely diagnosis.

Match each clinical presentation with the most likely rheumatologic diagnosis.

During a routine follow-up for chronic hepatitis B infection, a 45-year-old male construction worker reports a 6-week history of intermittent fevers, severe muscle aches, and an unintentional $6$ kg ($13$ lb) weight loss. He also describes a new, crampy abdominal pain that predictably begins 30 to 45 minutes after every meal. Yesterday, he stumbled while walking and noticed difficulty lifting his right foot. His hepatitis B is currently untreated.

Vital signs show a temperature of $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), blood pressure of $168/102$ mmHg, and heart rate of $98$/min. Neurologic examination reveals 2/5 strength in right ankle dorsiflexion and decreased pinprick sensation over the dorsum of the right foot. Skin examination demonstrates a violaceous, net-like pattern over both lower extremities.

Which of the following is the most appropriate next step in the diagnosis of this patient's condition?

Match each high-risk pediatric patient presentation with the most appropriate specific preventive care or immunization intervention.

Emergency medical services transport a toxic-appearing $3$-year-old male to the trauma bay due to rapidly progressive respiratory distress over the past $6$ hours. The patient has not received any childhood immunizations. He is sitting on his mother's lap, leaning forward with his neck hyperextended, drooling profusely, and exhibiting marked inspiratory stridor. His temperature is $39.6^\circ\text{C}$ ($103.3^\circ\text{F}$), heart rate is $165/\text{min}$, respiratory rate is $48/\text{min}$, and oxygen saturation is $91\%$ on room air. He is highly anxious but responsive. Auscultation reveals transmitted upper airway sounds with no wheezing or crackles in the lower lung fields.

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

A 7-year-old boy is brought to the emergency department by his parents due to a high fever, severe headache, and recurrent vomiting for the past 24 hours. Over the last 2 hours, the parents noticed that he has become increasingly drowsy and is not moving his right arm normally. His temperature is 39.4°C (102.9°F), blood pressure is 110/70 mmHg, heart rate is 115/min, and respiratory rate is 22/min. Physical examination reveals marked nuchal rigidity and right-sided hemiparesis. Fundoscopic examination shows blurring of the optic disc margins bilaterally.

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

Immediately following an unmonitored spontaneous vaginal delivery at $38$ weeks gestation, a newborn boy exhibits profound respiratory distress. Initial assessment in the delivery room reveals severe retractions, cyanosis, and an oxygen saturation of $74\%$ on room air. His abdomen appears remarkably sunken (scaphoid). Thoracic auscultation demonstrates an absence of breath sounds over the entire left hemithorax, and the cardiac point of maximal impulse is shifted to the right. Arrange the following interventions in the most appropriate chronological order for the management of this patient.

A 70-year-old male with long-standing diabetic nephropathy arrives at the emergency department reporting profound generalized weakness and progressive palpitations that started earlier today. He missed his last two nephrology appointments and recently began taking an angiotensin-receptor blocker for uncontrolled hypertension. His heart rate is 55/min and blood pressure is 110/60 mmHg. An electrocardiogram is immediately obtained and demonstrates absent P waves, widening of the QRS complexes, and tall, symmetric, peaked T waves. Laboratory testing shows a serum potassium level of $7.4$ mEq/L.

Arrange the following therapeutic interventions in the most appropriate chronological sequence for the acute stabilization and management of this patient.