All practice questions

A 34-year-old man presents to the emergency department with a painful, persistent erection that began 8 hours ago without sexual stimulation. He has a history of sickle cell trait. Physical examination reveals fully rigid, exquisitely tender corpora cavernosa and a flaccid glans penis. Arrange the following diagnostic and therapeutic steps in the optimal chronological sequence for managing this acute urologic emergency, progressing from initial evaluation to definitive refractory management.

A $76$-year-old man presents to the emergency department with the sudden onset of agonizing, diffuse abdominal pain that began $2\text{ hours}$ ago. He has a history of paroxysmal atrial fibrillation and recently stopped taking his apixaban. On physical examination, his temperature is $37.8^\circ\text{C}$ ($100.0^\circ\text{F}$), blood pressure is $145/88\text{ mm Hg}$, pulse is $120/\text{min}$ and irregularly irregular, and respirations are $22/\text{min}$. His abdomen is soft, non-distended, and remarkably exhibits only mild tenderness to deep palpation, without guarding, rebound, or rigidity. Bowel sounds are hypoactive. Laboratory studies show a leukocyte count of $19,000/\text{mm}^3$ and a serum lactate level of $4.2\text{ mmol/L}$. Arrange the following steps in the most appropriate chronological sequence for the optimal diagnosis and management of this patient's condition.

A 28-year-old woman with a history of a ventriculoperitoneal (VP) shunt placed for communicating hydrocephalus presents to the emergency department with a severe headache, nausea, and projectile vomiting. Over the last hour, she has become increasingly lethargic. Her temperature is 37.1°C (98.8°F), heart rate is 52/min, respiratory rate is 10/min, and blood pressure is 165/95 mmHg. Physical examination shows bilateral papilledema and sluggishly reactive pupils. The emergency physician suspects an acute shunt malfunction leading to critically elevated intracranial pressure.

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

A 68-year-old woman is brought to the emergency department due to the sudden onset of severe right leg pain that began 2 hours ago. She has a history of permanent atrial fibrillation and was instructed to stop her apixaban three weeks ago prior to a dental extraction, but she never resumed the medication. On physical examination, the right leg is pale and cool to the touch below the knee. The right femoral pulse is palpable, but the popliteal, dorsalis pedis, and posterior tibial pulses are not palpable. She has intact sensation to light touch in her foot and normal toe movement. Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient.

A hospital's quality improvement committee wants to proactively reduce the risk of wrong-site surgeries in the ambulatory surgical center before any adverse events occur. They decide to conduct a Failure Mode and Effects Analysis (FMEA). Arrange the following steps of the FMEA process in the correct chronological order from first to last.

A local health department receives reports of several individuals developing severe watery diarrhea, abdominal cramps, and vomiting after attending a community picnic. An epidemiologist is immediately tasked with investigating this potential outbreak.

Arrange the following initial steps of the outbreak investigation in the standard chronological sequence recommended by the Centers for Disease Control and Prevention (CDC).

A 60-year-old man presents to the urology clinic to establish care and discuss prostate cancer screening. He is in excellent health with no lower urinary tract symptoms. Arrange the following interventions in the most appropriate chronological order, representing the standard clinical pathway from initial screening to potential definitive surgical management for localized prostate cancer.

A 46-year-old man presents to the primary care clinic for a routine health maintenance evaluation. He has no significant past medical history and no family history of colorectal cancer. He wishes to undergo recommended age-appropriate cancer screening but strongly prefers to avoid invasive procedures unless absolutely necessary. Place the following clinical preventive and diagnostic steps in the correct chronological sequence according to current United States Preventive Services Task Force (USPSTF) guidelines for this patient.

A 55-year-old woman is admitted to the intensive care unit after experiencing severe intraoperative anaphylaxis during an elective laparoscopic cholecystectomy. Review of the electronic health record reveals that she has a documented severe anaphylactic allergy to cephalosporins. However, the surgical team bypassed an automated warning and administered prophylactic cefazolin prior to the incision. The patient required epinephrine, corticosteroids, and prolonged mechanical ventilation but is now physiologically stable. The surgical department chair is coordinating the institutional response to this preventable adverse event.

Arrange the following actions in the most appropriate chronological sequence for managing and investigating this sentinel event according to established patient safety protocols.

A 22-year-old male is brought to the emergency department after a severe collision during a rugby match. On presentation, he is in severe pain. His vital signs are temperature 37.1°C (98.8°F), blood pressure 130/80 mmHg, heart rate 98/min, and respiratory rate 16/min. Physical examination reveals a grossly deformed left knee with a significant posterolateral prominence. The left foot is cool and pale, and both the dorsalis pedis and posterior tibial pulses are not palpable. Capillary refill is delayed. Assume that after initial interventions, the distal pulses return but remain asymmetric compared to the contralateral limb, and subsequent advanced imaging reveals a popliteal artery intimal flap. Arrange the following steps in the correct chronological order for the acute evaluation and management of this patient.

A 42-year-old woman is admitted to an ambulatory surgery center for an elective outpatient procedure. During preoperative preparation, a nurse goes to the automated dispensing cabinet to retrieve intravenous cefazolin for surgical prophylaxis. The nurse almost withdraws a vial of intravenous tranexamic acid instead, as both medications are supplied in similar-looking vials with blue caps and are stored in adjacent bins. The nurse recognizes the near-miss error before administering the medication. The clinic's quality improvement committee decides to initiate a formal investigation to prevent future occurrences. Arrange the following steps of the Root Cause Analysis (RCA) process in the correct chronological order to address this near-miss event.

A 54-year-old man is currently hospitalized in the intensive care unit for severe acute gallstone pancreatitis. On day 21 of his admission, he develops new-onset fevers, a leukocyte count of 22,000/mm³, and worsening hypotension requiring vasopressor support. A contrast-enhanced CT scan of the abdomen reveals extensive walled-off pancreatic necrosis containing multiple pockets of gas. The surgical team is consulted for management. Arrange the following interventions in the correct sequential order according to the modern 'step-up' approach for infected necrotizing pancreatitis.

A 25-year-old male is admitted to the neurosurgical intensive care unit following a severe traumatic brain injury sustained in a motor vehicle collision. He is intubated, mechanically ventilated, and receiving continuous infusions of propofol and fentanyl for sedation and analgesia. An intracranial pressure (ICP) monitor is in place. His ICP acutely rises to 28 mm Hg and remains elevated for 10 minutes despite the current sedation. His vital signs show a blood pressure of 130/80 mm Hg, heart rate of 85/min, and temperature of 37.2°C (99.0°F). Arrange the following interventions in the most appropriate stepwise sequence for managing this patient's elevated intracranial pressure, proceeding from initial, least invasive measures to final salvage therapy.

A 58-year-old man arrives at the emergency department reporting the sudden onset of agonizing, "tearing" chest pain that radiates to his back between his shoulder blades. He appears diaphoretic and in severe distress. Vital signs include a blood pressure of 195/115 mm Hg in the right arm and 145/90 mm Hg in the left arm, and a heart rate of 112/min. A new early diastolic murmur is auscultated at the right sternal border. Electrocardiography demonstrates sinus tachycardia without acute ischemic changes. A portable chest radiograph reveals a widened mediastinum.

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

A 28-year-old primigravida presents for her first prenatal visit at 10 weeks of gestation. She recently immigrated from an area with high endemicity for hepatitis B. Arrange the following clinical preventive, diagnostic, and surveillance steps in the correct chronological order to appropriately screen, evaluate, and manage this patient and her future offspring to minimize vertical transmission.

A 48-year-old woman presents to the clinic with progressive weight gain, facial plethora, and easy bruising over the past year. Examination reveals central adiposity, prominent violaceous abdominal striae, and proximal muscle weakness. Her blood pressure is $155/95$ mmHg. Initial basic metabolic panel reveals mild hypokalemia. Arrange the following diagnostic and management steps in the most appropriate chronological sequence for this patient.

A 42-year-old man visits a new primary care physician for a general health check-up. He reports feeling well and has no chronic medical conditions. His social history is notable for occasional alcohol consumption and a period of injection drug use during his early twenties. Physical examination shows no abnormalities. The physician initiates universal screening for an infectious disease that the patient is at high risk for. Arrange the following clinical steps in the most appropriate chronological order for the screening, diagnosis, and management of Hepatitis C virus (HCV) infection for this patient.

A 65-year-old man is brought to the emergency department unconscious following an ischemic stroke. He requires urgent medical intervention. The patient lacks decision-making capacity and has no written advance directive or formally designated healthcare proxy. Several family members arrive at the hospital and all want to participate in his care decisions. According to standard legal precedence in the United States, arrange the following family members in the correct hierarchy of priority to act as the surrogate decision-maker, from highest priority (first) to lowest priority (last).

A $58$-year-old man is evaluated in the emergency department for a $4$-day history of progressively worsening left lower quadrant abdominal pain, subjective fevers, and chills. His temperature is $38.6^\circ\text{C}$ ($101.5^\circ\text{F}$), pulse is $96/\text{min}$, and blood pressure is $128/80\text{ mm Hg}$. Physical examination reveals marked tenderness in the left lower quadrant with a palpable, tender mass. There is voluntary guarding but no diffuse rigidity or rebound tenderness. Laboratory studies show a leukocyte count of $16,500/\text{mm}^3$. A CT scan of the abdomen and pelvis with intravenous contrast demonstrates severe sigmoid diverticulitis with an adjacent $5.5\text{-cm}$ well-defined, rim-enhancing fluid collection containing gas bubbles.

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

A $24$-year-old man is brought to the emergency department after sustaining a stab wound to the left anterior neck, midway between the cricoid cartilage and the angle of the mandible. He is agitated and has a hoarse voice. His respiratory rate is $28$/min and oxygen saturation is $92\%$ on room air. Blood pressure is $85/50$ mm Hg, and heart rate is $125$/min. Physical examination reveals a large, rapidly expanding hematoma on the left side of the neck with overlying pulsatile bleeding. Arrange the following management steps in the most appropriate chronological sequence for this patient.