All practice questions

A full-term newborn develops visible scleral icterus and facial jaundice at 36 hours of life. Arrange the following steps in the correct chronological order for the standard evaluation and escalating management of neonatal hyperbilirubinemia.

A 38-year-old man with a history of hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations presents with a 10-day history of progressively worsening headache and low-grade fevers. He is hemodynamically stable. He is alert and fully oriented. Neurologic examination reveals a mild right-hand pronator drift but no papilledema or signs of meningeal irritation. An MRI of the brain with contrast reveals a $2.5$-cm ring-enhancing lesion in the left frontal lobe with moderate surrounding vasogenic edema but no midline shift. Arrange the following management steps in the most appropriate chronological order.

A 2-year-old boy is brought to the emergency department by his parents due to a sudden onset of a harsh, barking cough and noisy breathing. On examination, he has inspiratory stridor at rest and moderate suprasternal retractions. He is currently crying and agitated, which appears to be worsening his respiratory distress. His oxygen saturation is 96% on room air. Arrange the following steps in the most appropriate clinical sequence for the acute management of this patient's condition.

A 41-year-old woman is evaluated in the emergency department for a 2-day history of severe epistaxis, easy bruising, and profound fatigue. Laboratory studies reveal a hemoglobin of $7.8 \text{ g/dL}$, a leukocyte count of $1,200/\mu\text{L}$, and a platelet count of $18,000/\mu\text{L}$. Coagulation studies show a prolonged prothrombin time, a prolonged activated partial thromboplastin time, a significantly elevated D-dimer, and a fibrinogen level of $85 \text{ mg/dL}$ (normal: $150-400 \text{ mg/dL}$). The patient is suspected to have acute promyelocytic leukemia (APL). Arrange the following diagnostic and therapeutic steps in the most appropriate chronological sequence for managing this patient.

A $65$-year-old man is brought to the emergency department by his daughter due to a $24$-hour history of severe headache, fever, and progressive confusion. His temperature is $39.2^{\circ}\text{C}$ ($102.6^{\circ}\text{F}$), blood pressure is $118/76 \text{ mmHg}$, pulse is $112/\text{min}$, and respiratory rate is $18/\text{min}$. On physical examination, the patient is lethargic and oriented only to his name. He resists passive neck flexion. Pupils are equal and reactive to light, and there are no focal motor deficits. A purpuric rash is not present. Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for this patient's management.

A 48-hour-old full-term male newborn develops bright green vomiting in the nursery. He was born via an uncomplicated vaginal delivery and passed meconium at 18 hours of life. His vital signs are temperature $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), heart rate 145/min, respiratory rate 42/min, and blood pressure 65/40 mm Hg. Physical examination shows a mildly distended but soft abdomen without erythema. The patient is hemodynamically stable. Arrange the following diagnostic and therapeutic steps in the correct chronological sequence to evaluate and definitively manage the most critical time-sensitive etiology of this presentation.

A 65-year-old man is brought to the emergency department by his wife due to fever, severe headache, and progressive confusion for the past 12 hours. His temperature is 39.2°C (102.6°F), blood pressure is 110/70 mmHg, and pulse is 115/min. Physical examination reveals nuchal rigidity, lethargy, and a new-onset left-sided pronator drift. Suspecting acute bacterial meningitis, arrange the following management steps in the most appropriate chronological order.

An unimmunized 4-year-old male child arrives at the pediatric triage with sudden-onset high fever, a muffled voice, and severe drooling. He is sitting upright, leaning forward with his neck extended, and exhibits notable inspiratory stridor. The clinical presentation is highly suspicious for acute epiglottitis. Arrange the following management steps in the most appropriate sequential order, from first to last.

A newborn is delivered at $38$ weeks gestation and immediately exhibits severe respiratory distress and cyanosis. Physical examination reveals a scaphoid abdomen and absent breath sounds over the left hemithorax. The neonate's heart rate is $110/\text{min}$, and oxygen saturation is $78\%$ on room air. Based on the suspected diagnosis, arrange the following management steps in the most appropriate chronological sequence.

A 68-year-old man is brought to the emergency department by his daughter due to a 24-hour history of fever, severe headache, and worsening confusion. He has a medical history of type 2 diabetes mellitus and hypertension. His temperature is 39.4°C (102.9°F), blood pressure is 105/65 mm Hg, pulse is 118/min, and respirations are 22/min. On physical examination, the patient is lethargic and oriented only to person. He has marked nuchal rigidity. Neurologic examination reveals a newly developed left-sided facial droop and left arm weakness. Funduscopic examination is limited due to poor patient cooperation.

Arrange the following steps in the most appropriate chronological sequence for the optimal management of this patient.

A primary care network is developing an automated electronic medical record system to alert pediatricians about critical immunization milestones. Arrange the following immunization-related events in chronological order from the earliest age to the oldest age at which they are typically recommended to occur for a healthy pediatric patient following the standard CDC schedule.

A 24-year-old man presents to the clinic for a routine wellness examination and sexual health screening. He reports having multiple male sexual partners and inconsistent condom use. He currently feels well and has no acute symptoms. The physician decides to screen him for human immunodeficiency virus (HIV). Assuming the patient has an acute HIV-1 infection, arrange the following laboratory evaluation steps in the correct chronological sequence according to the standard diagnostic algorithm.

A $12$-day-old female neonate is brought to the emergency department due to a $1$-day history of fever, lethargy, and poor feeding. Physical examination reveals a cluster of intact and ruptured erythematous vesicles on the scalp at the site of a prior fetal scalp monitor. The neonate has a temperature of $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), a heart rate of $190/\text{min}$, a respiratory rate of $65/\text{min}$, and a blood pressure of $50/30\text{ mm Hg}$. The extremities are cool and mottled, with a capillary refill time of $5$ seconds. Based on the clinical presentation, arrange the following management steps in the most appropriate chronological sequence.

A $5$-year-old boy is brought to the emergency department due to a $24$-hour history of high fever and refusal to walk. His temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), heart rate is $118/\text{min}$, respiratory rate is $22/\text{min}$, and blood pressure is $105/65\text{ mm Hg}$. Physical examination reveals that the right hip is held in flexion, abduction, and external rotation. Any passive movement of the right hip elicits severe pain and crying. The patient is hemodynamically stable and appears well-perfused. Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient's condition.

A $48$-year-old man presents to the oncology unit with a temperature of $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$) and rigors. He is currently on day $10$ of induction chemotherapy for acute myeloid leukemia (AML). Vital signs are pulse $118\text{ /min}$, blood pressure $95/60\text{ mmHg}$, and respirations $22\text{ /min}$. He has an indwelling central venous catheter with no surrounding erythema or purulence. Laboratory studies demonstrate a hemoglobin of $8.5\text{ g/dL}$, platelets of $45,000/\mu\text{L}$, and an absolute neutrophil count (ANC) of $100/\mu\text{L}$.

Arrange the following management steps in the optimal chronological sequence for this patient according to standard oncologic guidelines.

A $5$-year-old girl is brought to the emergency department due to a $12$-hour history of high fever, severe frontal headache, and repeated vomiting. Over the past $2$ hours, she has become increasingly somnolent and difficult to rouse. Her temperature is $39.5^\circ\text{C}$ ($103.1^\circ\text{F}$), blood pressure is $112/68\text{ mm Hg}$, pulse is $135/\text{min}$, and respirations are $26/\text{min}$. Physical examination reveals marked nuchal rigidity and a positive Brudzinski sign. Neurologic examination demonstrates a Glasgow Coma Scale score of $10$, sluggishly reactive pupils, and new-onset right-sided hemiparesis.

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

During routine pediatric well-child visits, physicians must provide evidence-based anticipatory guidance regarding infant nutrition. Proper timing of dietary transitions is critical to support growth and prevent nutrient deficiencies or developmental issues. Arrange the following nutritional interventions in the correct chronological order of their typical implementation for a healthy term infant, from the earliest age to the latest age.

A $41$-week-gestation male neonate is delivered via emergent cesarean section due to fetal bradycardia. The amniotic fluid is thick with meconium. In the delivery room, the infant is limp, cyanotic, and apneic. After initial stabilization with positive pressure ventilation, he begins spontaneous respirations but exhibits severe retractions and grunting. He is admitted to the neonatal intensive care unit. Despite receiving non-invasive continuous positive airway pressure with a fraction of inspired oxygen ($FiO_2$) of $1.0$, his pre-ductal oxygen saturation is $94\%$ and post-ductal oxygen saturation is $76\%$. A chest radiograph demonstrates bilateral coarse infiltrates with areas of lung hyperinflation. Arrange the following management and diagnostic interventions in the most appropriate escalating chronological sequence for this patient, from initial step to final salvage therapy.

A 5-year-old unimmunized boy is brought to the emergency department by his parents due to sudden onset of high fever, difficulty swallowing, and drooling. He is sitting upright, leaning forward with his neck extended, and appears toxic. He has marked inspiratory stridor and severe suprasternal retractions. Arrange the following steps in the most appropriate sequential order for the acute management of this patient.

A 4-year-old boy presents to the emergency department with acute-onset limping and an inability to bear weight on his right lower extremity. His parents report that he developed a high fever earlier today. He was previously healthy and has no recent history of trauma. Temperature is 39.1°C (102.4°F), blood pressure is 100/65 mm Hg, and pulse is 125/min. On examination, the patient is distressed. The right hip is held in a position of flexion, abduction, and external rotation. Passive range of motion of the right hip elicits severe pain. There is no overlying erythema or swelling. Arrange the following steps in the most appropriate chronological order for the evaluation and management of this patient's condition.