All practice questions

A 24-year-old man is brought to the emergency department following a high-speed motorcycle collision. He complains of severe pelvic pain and an inability to void. Vital signs are within normal limits, and he is hemodynamically stable. Physical examination reveals blood at the urethral meatus, a scrotal hematoma, and a 'high-riding' prostate on digital rectal examination. Pelvic radiography confirms a straddle fracture of the pelvis. Arrange the following steps in the most appropriate chronological sequence for the urologic management of this patient.

A healthy 48-year-old male visits his primary care physician to establish care. His medical record indicates no prior preventive screenings for gastrointestinal malignancies, and he has no family history of cancer. When counseled on available screening modalities, he explicitly requests a noninvasive stool-based test. Arrange the subsequent clinical interventions and findings in the correct chronological order, from the initial screening to the appropriate long-term surveillance interval.

A 28-year-old woman is hired as a healthcare worker and presents to the occupational health clinic for baseline tuberculosis screening. She is entirely asymptomatic but received the Bacille Calmette-Guérin (BCG) vaccine as an infant in her home country. Assume her initial screening test is positive and her subsequent imaging reveals no abnormalities. Place the following clinical steps in the correct chronological sequence for her screening, diagnosis, and management.

A previously healthy 52-year-old male is evaluated in the trauma bay after complaining of a sudden, ripping sensation in his anterior chest that rapidly progressed to his interscapular region. Vital signs show a pulse of 118/min and blood pressures of 185/105 mm Hg in the right upper extremity and 145/88 mm Hg in the left upper extremity. Physical examination demonstrates a new high-pitched early diastolic murmur along the right sternal border. An electrocardiogram demonstrates sinus tachycardia and left ventricular hypertrophy. Arrange the following steps in the most appropriate chronological order for the management of this patient.

A $71$-year-old man presents to the emergency department with a $4$-day history of progressive abdominal distension, crampy lower abdominal pain, and an inability to pass stool or flatus. He has had two episodes of bilious vomiting today. He has not seen a physician in over ten years and has never undergone colorectal cancer screening. Vital signs show a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure of $138/86\text{ mmHg}$, pulse of $88\text{/min}$, and respirations of $16\text{/min}$. Examination reveals marked abdominal distension with hyperactive, high-pitched bowel sounds. The abdomen is tympanic to percussion but soft, with no rebound tenderness, rigidity, or palpable masses. Digital rectal examination reveals an empty rectal vault and no gross blood. Assume advanced institutional capabilities (including interventional endoscopy) are available. Arrange the following steps in the most appropriate chronological sequence for the comprehensive evaluation and management of this patient's condition.

A 50-year-old woman presents to the clinic after a 2.5-cm palpable nodule was found in the right lobe of her thyroid during a routine physical examination. She reports no palpitations, weight changes, dysphagia, or hoarseness. Arrange the following diagnostic and management steps in the most appropriate chronological sequence for this patient. Assume that her initial laboratory testing reveals a subnormal serum TSH level and that subsequent cytological testing indicates malignancy.

A $52$-year-old man with a history of poorly controlled diabetes mellitus presents to the emergency department with a $24$-hour history of severe right knee pain, swelling, and subjective fevers. His temperature is $39.0^\circ\text{C}$ ($102.2^\circ\text{F}$), blood pressure is $130/80\text{ mm Hg}$, and pulse is $110/\text{min}$. Physical examination reveals a markedly erythematous, warm, and swollen right knee held in slight flexion. Any passive range of motion of the knee elicits excruciating pain. A large joint effusion is palpable.

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

An evaluation is requested in the emergency department for a 54-year-old woman reporting two days of severe, colicky abdominal pain accompanied by progressive swelling of her abdomen. She notes an inability to pass stool or flatus over the past 24 hours and has experienced three episodes of bilious emesis today. Her past surgical history is notable for an open total abdominal hysterectomy performed five years ago. On presentation, her temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), pulse is $98/\text{min}$, and blood pressure is $110/70\text{ mmHg}$. Abdominal examination demonstrates marked distension and tympany with hyperactive, high-pitched bowel sounds. Palpation reveals diffuse mild tenderness, but there is no guarding, rigidity, or rebound tenderness. Initial laboratory evaluations show:

Leukocyte count: $11,200/\text{mm}^3$
Serum sodium: $136\text{ mEq/L}$
Serum potassium: $3.2\text{ mEq/L}$
Serum chloride: $96\text{ mEq/L}$
Serum bicarbonate: $28\text{ mEq/L}$
Serum lactate: $1.1\text{ mmol/L}$ (normal: $0.5$-$2.2\text{ mmol/L}$)

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

A 72-year-old man presents to the urology clinic with a one-week history of painless gross hematuria. He has a 40-pack-year smoking history. Vital signs are within normal limits, and physical examination is unremarkable. Office flexible cystoscopy reveals a completely normal bladder mucosa and urethra. Urine cytology returns positive for high-grade malignant cells. Arrange the following interventions in the correct chronological order for the definitive evaluation and management of this patient's condition.

A $24$-year-old man is brought to the emergency department after falling off his skateboard and striking the right side of his head. Witnesses report he had a brief loss of consciousness lasting approximately $1$ minute, followed by a period where he was awake and conversing. En route to the hospital, he became progressively lethargic and unresponsive. On arrival, his blood pressure is $170/95$ mmHg, heart rate is $52$/min, and respirations are $10$/min and irregular. His Glasgow Coma Scale score is $6$ (Eye: $1$, Verbal: $2$, Motor: $3$ with abnormal flexion). Physical examination reveals a right pupil that is $7$ mm and nonreactive to light, as well as left-sided hemiparesis. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 65-year-old man is evaluated in the clinic after a routine chest radiograph, obtained prior to an elective inguinal hernia repair, incidentally revealed a widened mediastinum and an enlarged aortic contour. He has a history of essential hypertension and a 40-pack-year smoking history but currently feels well, reporting no chest, abdominal, or back pain. His blood pressure is 148/92 mm Hg, and his heart rate is 78/min. Arrange the following steps in the most appropriate chronological order for the definitive evaluation and long-term management of this patient's suspected condition.

A hospital safety committee is reviewing a recent sentinel event in which a patient received an incorrect dose of a high-risk medication due to a misprogrammed infusion pump. The hospital administration initiates a formal root cause analysis (RCA) to investigate the incident and prevent future occurrences. Arrange the following fundamental steps of a root cause analysis in the correct chronological order of execution.

A 55-year-old man with average risk for colorectal cancer opts for noninvasive screening at his annual wellness visit. Arrange the following clinical steps in the correct chronological order for his preventive care and subsequent management, assuming his initial screening test is positive and reveals advanced adenomas.

A 28-year-old man presents to the clinic for routine health maintenance and sexually transmitted infection screening. He reports having unprotected receptive anal intercourse with a new male partner 4 weeks ago. He is completely asymptomatic and has no history of opportunistic infections. His vital signs and physical examination are unremarkable. The physician decides to initiate the standard Centers for Disease Control and Prevention (CDC) recommended HIV testing algorithm.

Assuming the patient was recently infected and is currently in the acute phase of HIV, arrange the following diagnostic and management steps in the correct chronological sequence from first to last.

A 45-year-old asymptomatic man with no significant past medical history presents for a routine wellness examination. He has not seen a physician in over a decade. He takes no medications and has no known risk factors for viral hepatitis. The physician decides to implement age-appropriate clinical preventive services.

Arrange the following steps in the correct chronological sequence for this patient's Hepatitis C screening and subsequent management, assuming positive or abnormal findings at each diagnostic step.

An emergency medical team brings a 6-year-old female to the trauma bay after she sustained a fall from a playground structure onto an outstretched left arm. She is crying and refusing to move her left upper extremity. Physical examination reveals a significant "S-shaped" deformity and severe swelling around the left elbow. The left hand is pale and cool to the touch. Capillary refill is 4 seconds. Radial and ulnar pulses are absent on palpation and cannot be detected with a handheld Doppler. She is unable to flex the interphalangeal joint of her thumb. Radiographs confirm a completely displaced, extension-type supracondylar humerus fracture. Arrange the following management steps in the most appropriate chronological order for this patient.

A 35-year-old man comes to the clinic to establish care. He has no significant past medical history and takes no medications. The patient reports a history of intravenous drug use in his early twenties but has been in recovery for the past 10 years. Physical examination is unremarkable. He is interested in undergoing appropriate health screenings. Arrange the following clinical steps in the correct chronological order for the screening, diagnosis, and management of the infectious disease most strongly associated with his risk factors.

Emergency medical services arrive at the trauma bay with a 78-year-old man who developed sudden, excruciating, and diffuse abdominal pain two hours ago. He has a known history of severe coronary artery disease and noncompliant medication management for atrial fibrillation. Upon arrival, he appears ashen, profoundly lethargic, and diaphoretic. Vital signs include a temperature of 37.8°C, an irregularly irregular pulse of 132/min, a blood pressure of 82/50 mm Hg, and respirations of 24/min. Abdominal examination demonstrates striking rigidity with widespread guarding and rebound tenderness in all four quadrants. Initial point-of-care testing reveals a serum lactate of 9.4 mmol/L and a marked leukocytosis of 22,000/mm³. An electrocardiogram shows atrial fibrillation with rapid ventricular response. Arrange the following interventions in the most appropriate chronological sequence for the definitive management of this patient.

A $62$-year-old postmenopausal woman is evaluated in the clinic for hypercalcemia found on routine laboratory screening. She is entirely asymptomatic and has no history of nephrolithiasis, fragility fractures, or abdominal pain. Her serum calcium is $10.9$ mg/dL (normal range: $8.4-10.2$ mg/dL), albumin is $4.0$ g/dL, and intact parathyroid hormone (PTH) is $115$ pg/mL (normal range: $10-65$ pg/mL). Renal function is normal. Arrange the following steps in the most appropriate chronological sequence for the diagnostic workup and surgical management of this patient.

A triage nurse immediately calls a surgical code for a patient who just collapsed in the hospital waiting room. The patient, a 72-year-old male with a history of hypertension and tobacco use, was initially presenting for evaluation of sudden, tearing flank pain. Vital signs on the monitor show a heart rate of 128/min and a blood pressure of 72/38 mm Hg. The patient is confused and visibly diaphoretic. Physical examination reveals a large, expansile periumbilical mass. Arrange the following steps in the most appropriate chronological sequence for the optimal management of this hemodynamically unstable patient's condition.