All practice questions

A 28-year-old man is brought to the emergency department after sustaining a stab wound to the right lower chest during an altercation. On arrival, his blood pressure is 115/75 mmHg, heart rate is 105/min, and respiratory rate is 22/min. Oxygen saturation is 94% on room air. Primary survey reveals a 2-cm laceration in the right fifth intercostal space at the midaxillary line. The trachea is midline. Breath sounds are decreased over the right hemithorax, and dullness to percussion is noted at the right lung base. An extended bedside focused assessment with sonography for trauma (eFAST) confirms a moderate right-sided hemothorax. Two large-bore intravenous lines are established, and fluid resuscitation is initiated.

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

Following a near-miss incident involving an improperly loaded decentralized automated medication dispensing system on an inpatient ward, a hospital's patient safety committee decides to proactively evaluate the entire medication dispensing workflow. The goal is to systematically identify and mitigate system vulnerabilities before a harmful medication error occurs by conducting a Failure Mode and Effects Analysis (FMEA). Arrange the procedural steps of the FMEA process in the correct chronological sequence from start to finish.

A 72-year-old woman is brought to the emergency department after a syncopal episode. She is currently conscious but complains of severe dizziness and chest pressure. Her blood pressure is 80/50 mm Hg, and her heart rate is 35/min. Arrange the following management steps in the most appropriate chronological sequence according to standard Advanced Cardiovascular Life Support (ACLS) guidelines for symptomatic bradycardia.

A large tertiary care center is preparing to integrate a novel, automated continuous insulin infusion algorithm into the electronic health record (EHR) for the medical intensive care unit. Because intravenous insulin administration is highly prone to errors, the patient safety committee decides to proactively evaluate this system prior to its deployment. They initiate a Failure Mode and Effects Analysis (FMEA). Arrange the following procedural steps of the FMEA in the correct chronological sequence.

A $52$-year-old man with a history of recurrent pulmonary infections and bronchiectasis is brought to the emergency department after coughing up approximately $700$ mL of bright red blood over the past two hours. On arrival, he is in severe respiratory distress, lethargic, and coughing continuously. Vital signs show a temperature of $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure of $88/54\text{ mm Hg}$, pulse of $128\text{/min}$, and respiratory rate of $28\text{/min}$. Oxygen saturation is $85\%$ on high-flow oxygen. Auscultation reveals coarse crackles and diminished breath sounds over the right hemithorax. Large-bore intravenous access is established. Arrange the following interventions in the most appropriate sequential order for the acute management of this patient's condition.

A 72-year-old female presents to the gynecology clinic reporting a six-month history of severe vulvar pruritus and a painful, non-healing sore. Her past medical history is significant for hypertension and lichen sclerosus. Physical examination reveals a 3.5-cm ulcerated, indurated plaque located on the right labium majus. Palpation of the right inguinal region identifies a firm, mobile, 1.5-cm lymph node. The left groin is unremarkable. Arrange the following steps in the most appropriate chronological sequence for the diagnosis and management of this patient's condition.

A 32-year-old woman presents to the clinic with a 6-month history of progressive exertional dyspnea, fatigue, and occasional exertional syncope. Physical examination reveals a right ventricular heave, a loud pulmonic component of the second heart sound (P2), and clear lung fields. A transthoracic echocardiogram demonstrates right atrial and ventricular enlargement with an estimated right ventricular systolic pressure of $65 \text{ mm Hg}$. Left ventricular size and function are normal, with no left-sided valvular abnormalities. Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for the standard evaluation and definitive management of this patient's condition.

A 54-year-old man with a known history of alcohol-associated cirrhosis presents to the emergency department after vomiting a large amount of bright red blood. On presentation, his blood pressure is 85/55 mm Hg, and his pulse is 120/min. He is lethargic but is maintaining his airway and oxygenating well on room air. Arrange the following management steps in the most appropriate chronological sequence.

A 28-year-old man with a history of intravenous drug use presents to the emergency department with a 2-day history of high fever, chills, and severe fatigue. Temperature is 39.4°C (102.9°F), blood pressure is 105/65 mm Hg, and pulse is 118/min. Physical examination reveals a new holosystolic murmur at the left lower sternal border and pinpoint petechiae on the conjunctivae. Arrange the following management steps in the most appropriate sequential order for this patient.

A pediatric clinic is establishing a new electronic medical record protocol that automatically prompts physicians to order specific universal screening tests during well-child visits. The clinic director wants to ensure the prompts appear at the correct milestone visits for healthy, asymptomatic children with no known risk factors. Arrange the following universal screening interventions in chronological order according to the earliest age at which the system should first prompt the physician to perform them.

A 62-year-old woman with a body mass index of 34 kg/m² presents to the clinic with chronic, progressive bilateral knee pain. She notes the pain worsens with weight-bearing activities, such as walking up stairs, and is relieved by rest. She experiences morning stiffness in her knees lasting approximately 15 minutes. Physical examination reveals bony enlargement, crepitus, and a limited range of motion in both knees, without significant warmth or large effusions. Radiographs demonstrate asymmetric joint space narrowing, subchondral sclerosis, and prominent osteophyte formation. Arrange the following management steps for this patient's condition in the most appropriate sequential order, progressing from initial conservative measures to definitive advanced interventions.

A 21-year-old woman with type 1 diabetes mellitus is brought to the emergency department due to lethargy, abdominal pain, and vomiting. She stopped taking her insulin two days ago because she was unable to eat. Her blood pressure is $88/55 \text{ mm Hg}$, heart rate is $132\text{/min}$, and respiratory rate is $26\text{/min}$ with deep, sighing breaths. Mucous membranes are markedly dry. Laboratory studies reveal:

Arrange the following targeted management steps in the most appropriate chronological sequence according to standard diabetic ketoacidosis (DKA) protocols.

A 5-year-old boy is brought to the clinic by his parents for a routine health maintenance visit prior to starting kindergarten. He was born at 39 weeks gestation via uncomplicated spontaneous vaginal delivery. Vital signs include temperature 37.1°C (98.8°F), heart rate 95/min, and blood pressure 92/58 mm Hg. Physical examination reveals a cooperative, healthy-appearing child. His parents report that they recently immigrated, and his last well-child visit was at age 4 months. He is significantly behind on his immunizations, and a catch-up schedule is initiated today. The physician also reviews the boy's developmental history, and the parents recall his past progress clearly. Arrange the following developmental milestones in the expected chronological order of their acquisition in a normally developing child, from earliest to latest.

A 45-year-old man presents to the clinic with complaints of progressive enlargement of his hands and feet over the past two years, requiring him to buy larger shoes and a new wedding ring. He also reports excessive sweating and recently began snoring loudly at night. On physical examination, he has a prominent jaw, an enlarged nose, and macroglossia. You suspect a growth hormone-secreting pituitary adenoma. Arrange the following steps in the most appropriate chronological sequence for the diagnosis and initial management of this patient's condition.

A $35$-year-old man who recently emigrated from a country with high tuberculosis endemicity presents to the emergency department. He reports a $6$-week history of a persistent, blood-tinged cough, subjective fevers, drenching night sweats, and a $6$-kg ($13$-lb) weight loss. While in the crowded triage area, he is actively coughing. His vital signs show a temperature of $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$). Arrange the following steps in the most appropriate chronological order for the optimal management of this patient.

A 45-year-old man with a history of intravenous drug use presents to the emergency department with a 1-week history of high fevers, chills, and profound fatigue. His temperature is 39.2°C (102.6°F), blood pressure is 110/70 mm Hg, and heart rate is 115/min. Physical examination is notable for a new early diastolic murmur heard best at the left lower sternal border, and painless erythematous macules on the palms of his hands. Laboratory results show a leukocyte count of 18,000/mm³ with a left shift. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological order for managing this patient's acute presentation.

A 42-year-old woman is diagnosed with severe, seropositive rheumatoid arthritis characterized by symmetric polyarthritis involving the metacarpophalangeal joints, morning stiffness lasting 2 hours, and bone erosions on radiography. She is preparing to begin long-term pharmacotherapy. Arrange the following clinical steps in the correct chronological sequence according to current consensus guidelines for the escalating management of rheumatoid arthritis.

A $34$-year-old woman is evaluated in the emergency department for a $2$-day history of heavy gingival bleeding, recurrent epistaxis, and a large bruise on her thigh after minor trauma. Her temperature is $37.9^\circ\text{C}$ ($100.2^\circ\text{F}$), pulse is $112/\text{min}$, and blood pressure is $105/65 \text{ mm Hg}$. Physical examination reveals pallor, diffuse petechiae over the chest and extremities, and continuous oozing of blood from the intravenous line insertion site. Laboratory studies show:

A peripheral blood smear demonstrates numerous atypical mononuclear cells with folded nuclei, heavily granulated cytoplasm, and bundles of rod-shaped cytoplasmic inclusions.

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

An 18-year-old male with homozygous sickle cell disease is brought to the emergency department due to a two-day history of progressively worsening chest pain, productive cough, and subjective fevers. Initial vital signs show a temperature of 38.8°C (101.8°F), blood pressure of 118/76 mm Hg, heart rate of 112/min, and respiratory rate of 26/min. Pulse oximetry reveals an oxygen saturation of 87% on room air. Physical examination is notable for scleral icterus and decreased breath sounds with crackles over the right lower lung fields. Laboratory evaluation demonstrates a hemoglobin of 7.2 g/dL, leukocyte count of 16,500/mm³, and reticulocyte count of 12%. A chest radiograph reveals a new consolidation in the right lower lobe.

What is the most appropriate chronological sequence for the management of this patient's condition?

A 19-year-old man with type 1 diabetes mellitus is brought to the emergency department due to lethargy, deep and rapid breathing, and a fruity breath odor. Laboratory results show a blood glucose of $580 \text{ mg/dL}$, arterial pH of $7.12$, serum bicarbonate of $10 \text{ mEq/L}$, and a serum potassium of $5.6 \text{ mEq/L}$. He is diagnosed with severe diabetic ketoacidosis (DKA).

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