All practice questions

A 68-year-old man presents to the emergency department with severe lower abdominal discomfort and an inability to pass urine for the past 14 hours. He reports a two-year history of progressive urinary hesitancy, nighttime awakenings to void, and a weak urinary stream. Vital signs are within normal limits. Physical examination reveals a visibly distended, exquisitely tender suprapubic mass. Arrange the following interventions in the most appropriate sequential order for the standard evaluation and management of this patient's condition, from immediate to definitive.

A 29-year-old woman is brought to the trauma center after being thrown from her motorcycle in a high-speed collision. The primary trauma survey reveals a patent airway, unlabored breathing, and intact circulation. Her vital signs are within normal limits. The secondary survey is notable for a severe right lower extremity injury. There is an obvious deformity of the midshaft tibia with a 14-cm full-thickness laceration. The underlying muscle is severely crushed, and exposed bone is stripped of its periosteum. The dorsalis pedis and posterior tibial pulses are palpable. Arrange the following steps in the most appropriate chronological sequence for the optimal management of this patient's limb injury.

A large tertiary care hospital is preparing to implement a novel barcoded medication administration (BCMA) workflow in its pediatric oncology unit. To proactively mitigate potential risks before the system goes live, the quality improvement committee initiates a Failure Mode and Effects Analysis (FMEA). Arrange the following steps of the FMEA in the correct chronological sequence from first to last.

A 62-year-old man with severe peripheral artery disease is advised to undergo urgent surgical revascularization for a threatened limb. He refuses the procedure, stating he wishes to be discharged immediately. The attending physician must evaluate his decision-making capacity before allowing him to leave against medical advice. Arrange the four standard components of a clinical capacity assessment in their generally accepted order of increasing cognitive complexity, starting with the most basic prerequisite (first) and ending with the most complex functional requirement (last).

A 68-year-old man with a history of severe peripheral arterial disease undergoes an elective endovascular revascularization procedure. During the intervention, a specialized hydrophilic guidewire shears off and a small fragment is retained within the femoral artery, requiring an emergency open arteriotomy for retrieval. The patient recovers without further ischemic complications. The hospital's risk management department is notified and mandates a formal Root Cause Analysis (RCA) to investigate the incident and prevent future occurrences.

Arrange the following steps of the Root Cause Analysis and systemic response in the correct chronological order, from the immediate post-incident action to the final systemic implementation.

A 29-year-old healthy female nurse presents to the occupational health clinic to establish care prior to beginning employment at a large metropolitan hospital. She immigrated to the United States from India at age 12 and received the Bacillus Calmette-Guérin (BCG) vaccine in infancy. She feels well and reports no cough, fever, night sweats, or weight loss. Her past medical history is unremarkable, and her physical examination is normal. Arrange the following clinical steps in the most appropriate sequential order for the preventive screening and management of tuberculosis in this patient.

A 64-year-old man is admitted to the hospital for treatment of a deep vein thrombosis. During his stay, a nurse inadvertently administers a bolus of intravenous heparin at twice the intended dose due to a programming interface error on a newly implemented smart infusion pump. The patient subsequently develops mild epistaxis. His vital signs remain stable, and coagulation studies are immediately obtained to assess the extent of the over-anticoagulation.

Arrange the following steps in the most appropriate chronological sequence for managing and responding to this adverse event, starting with the most immediate action.

A 52-year-old woman presents with a 3-week history of rapid-onset swelling, erythema, and a peau d'orange appearance of her right breast. Examination reveals diffuse induration, warmth, and enlargement of the right breast, along with palpable right axillary lymphadenopathy. Suspecting inflammatory breast cancer, arrange the following steps in the standard diagnostic and therapeutic sequence for this patient, from the initial step to the final step.

A 68-year-old man with a known history of metastatic prostate cancer is brought to the emergency department complaining of severe mid-back pain that has steadily worsened over the past two weeks. Over the last 6 hours, he has developed bilateral leg weakness and urinary incontinence. Vital signs are within normal limits. Neurologic examination reveals 3 out of 5 muscle strength in the lower extremities bilaterally, decreased sensation to pinprick below the umbilicus, and absent patellar and Achilles reflexes. Rectal examination demonstrates severely decreased anal sphincter tone. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological order for managing this patient's condition.

A 62-year-old man presents to the clinic with a 6-month history of cramping pain in his right calf. The pain occurs consistently after walking approximately two blocks and is completely relieved after 5 minutes of rest. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. Vital signs are within normal limits. On physical examination, the right dorsalis pedis and posterior tibial pulses are diminished compared to the left. Bilateral femoral and popliteal pulses are 2+ and symmetric. There is no evidence of dependent rubor, hair loss, resting pain, or non-healing ulcers on the lower extremities.

Arrange the following evaluation and management steps in the most appropriate sequential order for this patient over the course of his disease. Assume that his symptoms persist and become severely lifestyle-limiting despite full compliance with each preceding non-invasive intervention.

A 52-year-old woman is evaluated on postoperative day 10 following an exploratory laparotomy and extensive lysis of adhesions for recurrent small bowel obstruction. Over the past 48 hours, she has developed drainage of feculent fluid through the mid-portion of her healing midline incision. The output is currently measured at 900 mL/day. She is afebrile with a heart rate of 88/min and blood pressure of 110/70 mmHg. Her abdomen is soft and non-tender, but the skin surrounding the drainage site is rapidly becoming severely erythematous and excoriated. Arrange the following management steps in the standard evidence-based chronological sequence for the treatment of a newly diagnosed high-output enterocutaneous fistula, proceeding from the immediate phase to definitive care.

A 74-year-old man develops progressive, massive abdominal distension 4 days after undergoing a coronary artery bypass graft. He reports mild nausea but no significant abdominal pain. His vital signs are within normal limits. Physical examination reveals a markedly distended, tympanitic abdomen with no guarding or rebound tenderness. Laboratory studies show normal potassium and magnesium levels. An abdominal radiograph reveals a diffusely dilated colon with the cecum measuring 11.5 cm in diameter, without evidence of a transition point or pneumoperitoneum. Assuming each subsequent intervention fails to resolve the patient's condition, arrange the following management steps in the correct sequential order.

A 32-year-old healthy woman presents to the clinic for a routine health maintenance examination. She has no significant past medical history. During the visit, she expresses concern about her cancer risk because her mother was diagnosed with bilateral breast cancer at age 46, and her maternal aunt was diagnosed with ovarian cancer at age 52. The patient has not undergone any previous genetic evaluation. According to the United States Preventive Services Task Force (USPSTF) guidelines, arrange the following steps in the correct clinical and chronological sequence for the management of this patient's familial cancer risk, from the immediate next step in the primary care clinic to long-term management.

A 72-year-old woman with a history of persistent atrial fibrillation and nonadherence to her oral anticoagulant therapy presents to the emergency department with sudden, excruciating pain in her right leg that began 3 hours ago. On physical examination, the right lower extremity is pale and cool to the touch. No pulses are palpable distal to the femoral artery. She reports numbness over the dorsum of her right foot and is unable to actively dorsiflex her toes. Arrange the following interventions in the most appropriate chronological sequence for the optimal management of this patient.

A 57-year-old woman is admitted to the hospital for intravenous antibiotic therapy for lower extremity cellulitis. During her stay, a physician writes a handwritten order for '8 U regular insulin' to manage a mild hyperglycemic episode. The covering nurse misreads the 'U' as a zero and inadvertently administers 80 units of regular insulin. Thirty minutes later, the patient becomes profoundly diaphoretic and confused. Point-of-care glucose testing reveals a blood glucose level of 38 mg/dL. The hospital immediately initiates its standardized patient safety and error response protocol.

Arrange the following actions in the most appropriate chronological sequence according to best practices in medical error management and disclosure.

A 5-year-old girl is brought to the emergency department with a 24-hour history of high fever ($39.2^\circ\text{C}$ or $102.6^\circ\text{F}$) and refusal to bear weight on her right leg. On examination, her right hip is exquisitely tender and held rigidly in flexion, abduction, and external rotation. Any attempted passive range of motion elicits severe distress. Assuming all subsequent diagnostic findings support a diagnosis of acute septic arthritis, arrange the following clinical management steps in the most appropriate chronological sequence.

A 28-year-old man is brought to the emergency department after a high-speed motorcycle collision. In the field, his Glasgow Coma Scale (GCS) score was 6, and he was immediately intubated. On arrival, his blood pressure is 170/100 mm Hg, and his heart rate is 50/min. His right pupil is 7 mm and nonreactive to light, while his left pupil is 3 mm and briskly reactive. Extensor posturing is noted on the left side in response to painful stimuli. A stat non-contrast head CT reveals a large right-sided acute subdural hematoma with a 15-mm midline shift. Arrange the following interventions in the most appropriate chronological sequence for managing this patient's condition, from the most immediate initial bedside action to definitive ongoing care.

A 46-year-old man with average risk for colorectal cancer presents for a routine health maintenance examination. He expresses a preference for noninvasive testing options. Assuming abnormal findings at each stage of evaluation, arrange the following clinical steps in the most appropriate chronological order for his screening and subsequent management.

A 45-year-old man undergoes an uncomplicated laparoscopic cholecystectomy. In the post-anesthesia care unit, he is mistakenly administered an intravenous dose of hydromorphone that is 10 times the intended dose due to a pump programming error. He develops profound respiratory depression requiring intubation and transfer to the intensive care unit. He is successfully extubated the next day and recovers without permanent sequelae. The hospital's quality improvement committee initiates a formal root cause analysis (RCA) to investigate this sentinel event.

Arrange the following steps of the root cause analysis process in the correct chronological order.

A 23-year-old male presents to the urgent care clinic with right wrist pain after falling on an outstretched hand while snowboarding. Physical examination reveals focal swelling and significant tenderness to palpation in the anatomic snuffbox. Initial anteroposterior, lateral, and scaphoid-view plain radiographs of the right wrist demonstrate no obvious fracture, dislocation, or joint effusion. Arrange the following management steps in the most appropriate chronological order for this patient.