All practice questions

A 62-year-old man is hospitalized for right lower lobe pneumococcal pneumonia. After 72 hours of targeted intravenous antibiotic therapy, he has persistent fevers, tachypnea, and pleuritic chest pain. A chest radiograph reveals a new, moderate-to-large, free-flowing right-sided pleural effusion.

Assuming each subsequent intervention indicates the need for further escalation due to inadequate clinical resolution or complex fluid characteristics, arrange the following management steps in the most appropriate chronological sequence.

A 14-month-old boy is brought to the pediatrician for a well-child visit. His parents report that he has been developing normally and has met all his developmental milestones on time. Arrange the following gross motor milestones in the chronological order in which this patient most likely achieved them, from earliest to latest.

A 60-year-old man suddenly collapses while walking in the hospital lobby. He is found to be unresponsive, pulseless, and apneic. Bystanders immediately begin high-quality chest compressions. An automated external defibrillator (AED) is attached, and the rhythm monitor displays ventricular fibrillation. Arrange the following subsequent interventions in the correct chronological order according to standard Advanced Cardiovascular Life Support (ACLS) guidelines.

A 66-year-old man presents to the emergency department with the sudden onset of severe, tearing chest pain that radiates to his back. He appears diaphoretic and in severe distress. Blood pressure is 188/112 mm Hg in the right arm and 156/94 mm Hg in the left arm. Pulse is 112/min and bounding. Cardiac auscultation reveals a new decrescendo diastolic murmur at the right upper sternal border. An electrocardiogram shows sinus tachycardia with no ST-segment or T-wave changes. Suspecting an acute aortic syndrome, the physician prepares to manage the patient.

Arrange the following next steps in the most appropriate chronological order for the initial stabilization and management of this patient.

A 55-year-old male with long-standing hepatic cirrhosis presents to the emergency department via ambulance due to a large episode of hematemesis. On arrival, his blood pressure is 88/50 mm Hg and pulse is 120/min. The physical examination reveals a distended abdomen with shifting dullness and prominent cutaneous telangiectasias. Arrange the following interventions in the correct chronological sequence for the management of this patient.

A medical student is reviewing the typical progression of motor development in early childhood. Arrange the following gross motor milestones in the chronological order in which they typically emerge in a healthy, full-term infant.

A 42-year-old parous female presents to the emergency department complaining of steady, severe pain in her right upper abdomen that radiates to her right scapula. The pain began 6 hours ago after she consumed a large, fatty meal. She reports nausea and two episodes of vomiting. Her temperature is 38.2°C (100.8°F), blood pressure is 130/80 mm Hg, and pulse is 98/min. Physical examination reveals focal tenderness with inspiratory arrest upon deep palpation of the right upper quadrant. Laboratory studies show a leukocyte count of 14,000/mm³ with a left shift, but normal liver chemistries and pancreatic enzymes.

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

A 28-year-old woman with a history of extensive ulcerative colitis is hospitalized due to a severe disease flare characterized by 12 bloody bowel movements daily, severe lower abdominal cramping, and a temperature of $38.6^\circ\text{C}$ ($101.5^\circ\text{F}$). Her heart rate is $118/\text{min}$ and blood pressure is $110/70 \text{ mm Hg}$. Arrange the following management steps in the correct chronological sequence of escalation, assuming she remains refractory to each successive medical intervention.

A clinician is designing a standardized developmental screening tool for a pediatric outpatient clinic. The module focusing on visual-motor and adaptive skill progression needs to be organized developmentally. Arrange the following pediatric fine motor milestones in chronological order, from the earliest typical age of expected acquisition to the latest.

A $64$-year-old man with a history of hypertension, hyperlipidemia, and a $45$-pack-year smoking history presents to the primary care clinic with a $3$-month history of a cramping ache in his left calf. The pain reliably occurs after walking approximately two city blocks and resolves completely with $5$ minutes of rest. He has no leg pain at rest and no history of foot ulcers. His blood pressure is $142/86$ mmHg, and his pulse is $76$/min. Physical examination reveals thinning of the skin and loss of hair on the distal lower extremities bilaterally. The dorsalis pedis and posterior tibial pulses are faintly palpable bilaterally.

Arrange the following management steps in the most appropriate chronological sequence for this patient, from the initial diagnostic step to the last-resort intervention.

A 48-year-old woman with a history of severe rheumatoid arthritis presents to the clinic with large, unexplained ecchymoses on her thighs and arms over the past two weeks. She has no prior personal or family history of bleeding disorders. Initial laboratory testing reveals an isolated, significantly prolonged activated partial thromboplastin time (aPTT) with a normal prothrombin time (PT) and normal platelet count. Arrange the following steps in the standard diagnostic algorithm used to definitively diagnose an acquired coagulation factor inhibitor in this patient in the correct chronological sequence.

A 64-year-old man with a history of metastatic prostate cancer presents to the emergency department with severe, progressively worsening mid-back pain for the past 2 weeks. Today, he developed bilateral leg weakness and urinary incontinence. Temperature is 37.1°C (98.8°F), blood pressure is 145/90 mmHg, pulse is 92/min, and respiratory rate is 16/min. Physical examination reveals 3/5 motor strength in both lower extremities, decreased pinprick sensation below the T10 dermatome, and hyperreflexia at the knees. Anal sphincter tone is decreased. Laboratory results show a hemoglobin of 11.2 g/dL, leukocyte count of 7,500/μL, platelet count of 210,000/μL, serum creatinine of 1.1 mg/dL, and serum calcium of 9.8 mg/dL. Suspecting a neurologic emergency, arrange the following management steps in the most appropriate chronological order from first to last to optimize his neurologic outcome.

A 74-year-old woman is brought to the emergency department reporting a new, severe right-sided headache, scalp tenderness, and a sudden visual field defect in her right eye. She also notes pain in her jaw when chewing food. Arrange the following medical steps in the most appropriate chronological sequence for the standard management of this patient's condition.

A 68-year-old man with a history of metastatic prostate cancer is brought to the emergency department due to progressively worsening lower back pain and new-onset weakness in both legs over the past 24 hours. He also reports urinary retention since this morning. Neurological examination reveals bilateral lower extremity weakness, hyperreflexia, and decreased sensation below the T10 dermatome. Arrange the following management steps in the most appropriate chronological sequence for this patient.

An established clinic patient, a 42-year-old female with known limited cutaneous systemic sclerosis, presents to discuss worsening symptoms in her hands. She describes increasingly frequent and painful episodes where her fingers turn white, then blue, upon exposure to mild temperature drops. The episodes are now significantly limiting her daily activities. Arrange the following management steps in the correct chronological order of therapeutic escalation, starting from initial baseline management and progressing to interventions for critical, medically refractory ischemia.

A 28-year-old woman with a known history of systemic lupus erythematosus (SLE) presents to the clinic with bilateral lower extremity edema and new-onset hypertension (blood pressure 152/94 mmHg). A preliminary urine dipstick in the clinic shows 3+ protein. She is suspected of having lupus nephritis. Arrange the following steps in the appropriate clinical sequence for the diagnostic evaluation and long-term pharmacological management of this patient's renal condition, from first to last.

A 24-year-old man presents to the clinic with a 2-month history of profound fatigue, intermittent fevers, and drenching night sweats. Physical examination reveals a 4-cm, painless, rubbery right supraclavicular lymph node. A preliminary CT scan of the neck and chest confirms the presence of an isolated 4.2-cm right supraclavicular lymph node without significant mediastinal or axillary lymphadenopathy. Laboratory studies show a normal complete blood count, but the erythrocyte sedimentation rate is elevated at 65 mm/hr.

Arrange the following steps in the most appropriate sequential order for the definitive diagnosis, staging, and management of this patient's most likely condition.

A 22-year-old man with type 1 diabetes mellitus is brought to the emergency department with abdominal pain, nausea, and confusion. He recently had a respiratory infection. His blood pressure is 90/60 mm Hg, and heart rate is 122/min. Point-of-care capillary blood glucose is 550 mg/dL. An arterial blood gas reveals a pH of 7.15 and a bicarbonate of 10 mEq/L. The remainder of his laboratory results, including a basic metabolic panel, are pending. Arrange the following management steps in the most appropriate chronological order for this patient.

A 62-year-old female presents to the emergency room accompanied by her daughter, who reports that her mother has been increasingly confused and feverish over the preceding 24 hours. Her past medical history is notable for a deceased-donor renal transplant performed three years ago, maintained on a regimen of tacrolimus and mycophenolate mofetil. Vital signs show a temperature of 39.4°C (102.9°F), blood pressure of 110/65 mm Hg, pulse of 112/min, and respirations of 20/min. Physical examination reveals marked nuchal rigidity and a positive Kernig sign. The patient is somnolent but arousable to verbal stimuli. There are no focal motor deficits, but fundoscopic examination is deferred due to poor patient cooperation. The clinical team suspects acute bacterial meningitis and prepares to initiate the management protocol. Arrange the following critical next steps in the most appropriate chronological sequence.

A 28-year-old man presents to a primary care clinic requesting an HIV test. He reports having unprotected receptive anal intercourse with a new male partner two months ago. He currently has no symptoms, and his physical examination is unremarkable. Arrange the following steps in the most appropriate chronological sequence for the diagnosis and initial management of this patient, assuming all subsequent tests confirm the presence of HIV.