All practice questions

A 31-year-old female patient is evaluated in the outpatient setting for secondary amenorrhea. Her last menstrual period was eight months ago. Prior to this, her menses were regular, lasting 5 days and occurring every 29 days. She has no chronic medical conditions and takes no medications. Vital signs include a blood pressure of $112/72 \text{ mmHg}$, a heart rate of $74/\text{min}$, and a respiratory rate of $14/\text{min}$. Physical examination reveals a normal thyroid gland, no galactorrhea, and normal external genitalia with a well-estrogenized vaginal mucosa. Arrange the following diagnostic steps in the correct chronological sequence for evaluating this patient's condition, starting with the most immediate initial test and progressing to tests for anatomical abnormalities.

A 31-year-old female patient presents to the outpatient gynecology office reporting the absence of menstruation for the past 9 months. She experienced menarche at age 12, and her menses were consistently regular until this past year. Her medical history is notable for an incomplete spontaneous abortion 11 months ago, which was managed with a dilation and curettage. She currently denies nipple discharge, headaches, visual field deficits, or vasomotor symptoms. Her blood pressure is 112/72 mm Hg, pulse is 76/min, and body mass index is 22 kg/m^2. Physical examination demonstrates Tanner stage 5 breast development and normal-appearing female external genitalia. Arrange the following diagnostic steps in the classical sequential order to properly evaluate the etiology of this patient's secondary amenorrhea.

A 16-month-old boy is rushed to the pediatric emergency department after sudden-onset choking while eating grapes at home. Upon arrival, the child is cyanotic, diaphoretic, and making high-pitched inspiratory sounds. While the triage nurse is rapidly evaluating the patient, the child abruptly loses consciousness and becomes limp.

Arrange the following next steps in the most appropriate sequence according to pediatric basic life support guidelines for an unresponsive choking child.

A 34-year-old G3P3 woman with a history of poorly controlled asthma and gestational hypertension experiences a massive postpartum hemorrhage immediately following a spontaneous vaginal delivery of a 4200-g neonate. The placenta delivered intact. The uterus is soft, boggy, and palpated 3 cm above the umbilicus. Arrange the following therapeutic interventions in the most appropriate sequential order to manage this patient's hemorrhage, assuming each consecutive measure fails to achieve hemostasis.

A $15$-month-old boy is brought to the emergency department via ambulance after experiencing a generalized tonic-clonic seizure. His parents report that he has had a low-grade fever, vomiting, and poor oral intake for the past $48$ hours. On physical examination, the child is lethargic, hypotonic, and pale. Hepatomegaly is noted on abdominal palpation. Point-of-care testing reveals a blood glucose level of $28$ mg/dL ($1.5$ mmol/L). A urinalysis is notably negative for ketones. A metabolic crisis secondary to a fatty acid oxidation defect (such as medium-chain acyl-CoA dehydrogenase deficiency) is suspected. Arrange the following steps in the most appropriate chronological sequence for the immediate management, diagnostic workup, and long-term care of this patient.

A 30-year-old nulliparous woman presents to the clinic for preconception counseling. She plans to discontinue her oral contraceptives and attempt pregnancy in the coming months. The patient is highly detail-oriented and requests a comprehensive timeline of the routine medical evaluations she should expect once she conceives. The physician explains the standard sequence of prenatal care milestones. Assuming she achieves an uncomplicated, spontaneous singleton pregnancy and establishes care early in the first trimester, arrange the following routine prenatal screening evaluations in the correct chronological order from earliest to latest in gestation.

A 22-year-old woman presents to the outpatient clinic reporting a 5-day history of yellowish vaginal discharge and spotting after intercourse. Her last menstrual period was 6 weeks ago, and she reports inconsistent condom use with a new male partner. Her temperature is 37.2°C (99.0°F), blood pressure is 110/70 mm Hg, and pulse is 82/min. Speculum examination reveals a friable cervix with mucopurulent exudate. Bimanual examination demonstrates mild cervical motion tenderness without uterine or adnexal tenderness. Arrange the following steps in the most appropriate chronological sequence for the clinical and public health management of this patient.

A 2-year-old girl is brought to the emergency department 30 minutes after accidentally ingesting a liquid drain cleaner containing sodium hydroxide. She is crying, drooling continuously, and refusing to swallow. Her temperature is 37.2°C (99.0°F), heart rate is 140/min, respiratory rate is 30/min, and oxygen saturation is 98% on room air. Physical examination reveals mild inspiratory stridor, swollen erythematous lips, and small ulcerations on the buccal mucosa. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 3-week-old female infant is brought to the emergency department by her parents due to poor feeding, extreme fussiness, and rapid breathing for the past 6 hours. Her vital signs are heart rate 265/min, respiratory rate 50/min, blood pressure 78/45 mm Hg, and oxygen saturation 97% on room air. Physical examination reveals a well-perfused infant with brisk capillary refill (less than 2 seconds) and normal peripheral pulses. An electrocardiogram demonstrates a regular, narrow-complex tachycardia with no discernible P waves.

Arrange the following interventions in the most appropriate sequence for managing this patient's condition, from the initial step to subsequent refractory therapies.

A 3-year-old boy is brought to the emergency department by his parents after vomiting a large amount of bright red blood. He has a past medical history of biliary atresia, for which he underwent a Kasai hepatoportoenterostomy during infancy, and subsequent portal hypertension. On presentation, the child appears lethargic and pale. His temperature is 37.1°C (98.8°F), heart rate is 165/min, blood pressure is 70/40 mm Hg, and respiratory rate is 28/min. He has another episode of voluminous hematemesis while in the resuscitation bay. Arrange the following management steps in the most appropriate chronological order for this patient.

A 15-year-old boy, who recently immigrated, presents to the clinic with progressive shortness of breath, generalized cyanosis, and digital clubbing. His parents report that he was diagnosed with a "hole in his heart" as an infant but never received surgical treatment due to limited medical access. Physical examination reveals a loud P2 but no significant murmur. He is diagnosed with Eisenmenger syndrome secondary to a large, unrestrictive ventricular septal defect (VSD). Arrange the following pathophysiological events in the correct chronological sequence that led to this patient's current clinical presentation, starting from the neonatal period.

A 31-year-old G3P3 woman experiences massive postpartum hemorrhage immediately following a spontaneous vaginal delivery of a 4200g neonate. Physical examination reveals a soft, enlarged, and boggy uterus. Initial management with continuous bimanual uterine massage, aggressive intravenous fluid resuscitation, and high-dose intravenous oxytocin has failed to arrest the bleeding. Her past medical history is significant for chronic hypertension and poorly controlled asthma. Arrange the following interventions in the most appropriate stepwise order of escalation for managing this patient's ongoing hemorrhage.

A 26-year-old primigravida presents to the obstetrics clinic for her initial prenatal visit at 8 weeks gestation. She has no significant past medical history and takes a daily prenatal vitamin. Vital signs are normal. A transvaginal ultrasound confirms a viable singleton intrauterine pregnancy. The patient is eager to ensure she receives all standard prenatal care and asks about the schedule of upcoming tests. Assuming a continuous, uncomplicated pregnancy course, arrange the following routine prenatal screening and diagnostic evaluations in the correct chronological order from the earliest to the latest gestational age at which they are optimally performed.

A 66-year-old postmenopausal woman presents to the clinic with a 2-month history of progressive abdominal bloating, early satiety, and vague pelvic pressure. She has no history of abnormal vaginal bleeding. Physical examination reveals a distended abdomen with shifting dullness, and a palpable, firm, irregular right adnexal mass. Arrange the following steps in the most appropriate sequential order for the evaluation and management of this patient, from the initial step to definitive post-surgical treatment.

A 29-year-old woman presents to the clinic reporting the absence of menses for the past eight months, accompanied by a bilateral milky nipple discharge. She previously had regular 28-day menstrual cycles. She takes no medications and reports no headaches, visual disturbances, or cold intolerance. Vital signs and physical examination are within normal limits, aside from expressible galactorrhea. Arrange the following clinical steps in the most appropriate chronological sequence for the evaluation and management of this patient.

A $33$-year-old G2P1 at $40$ weeks and $5$ days gestation is pushing in the second stage of labor. The fetal head delivers but immediately retracts tightly against the maternal perineum. The attending physician applies gentle downward traction, but the anterior shoulder fails to deliver. The estimated fetal weight by third-trimester ultrasound was $4500$ g.

Arrange the following steps for the management of this obstetric emergency in the most appropriate sequential order, from the initial response to the maneuver of last resort.

Following a prolonged second stage of labor, a multiparous patient at 40 weeks gestation delivers a 4,350-g neonate vaginally. Twelve minutes after the intact placenta is delivered, nursing staff observe a sudden, massive surge of continuous vaginal bleeding. Vital signs demonstrate a maternal heart rate of 128/min and a blood pressure of 82/48 mm Hg. Abdominal examination reveals a soft, poorly contracted uterus extending to the level of the umbilicus. After securing two large-bore intravenous lines, administering tranexamic acid, and initiating aggressive fluid resuscitation, the obstetric team begins sequential interventions for refractory uterine atony. Assuming continuous failure to achieve hemostasis at each consecutive stage, arrange the following management steps in the correct, standardized escalating sequence.

An otherwise healthy nulligravid patient in her late twenties is evaluated in the ambulatory clinic for severe vulvar pain that has worsened over the past three days, making it difficult for her to sit or walk. Vital signs are within normal limits. Pelvic examination reveals a 4-cm, exquisitely tender, erythematous, and fluctuant mass located at the left posterior vestibule near the 5 o'clock position. There is no surrounding cellulitis. The physician decides to perform an office-based procedure to definitively treat the condition and minimize the risk of recurrence.

Arrange the following procedural and management steps in the most appropriate sequential order.

A 24-year-old healthy nulligravida presents for preconception counseling. She has a regular 28-day menstrual cycle and no significant past medical history. She and her partner are actively trying to conceive and she is curious about the normal progression of pregnancy. The physician discusses the expected physiological changes and clinical milestones she will experience. Arrange the following normal clinical and physiological milestones in the chronological order in which they typically first occur during an uncomplicated primigravid pregnancy, from earliest in gestation to latest.

A 10-day-old male neonate is brought to the emergency department by his parents due to extreme lethargy, poor feeding, and rapid breathing over the past 12 hours. Physical examination reveals a mottled, pale infant with marked intercostal retractions and grunting. Vital signs are temperature 36.5°C (97.7°F), heart rate 185/min, respiratory rate 75/min, blood pressure 55/35 mm Hg in the right arm, and unobtainable in the lower extremities. Brachial pulses are 2+, but femoral pulses are absent. Capillary refill is 6 seconds. The infant is unresponsive to peripheral venous cannulation. Arrange the following interventions in the most appropriate sequential order for managing this patient's condition.