All practice questions

A 70-year-old woman is currently hospitalized on the general medical ward for a deep vein thrombosis of the left lower extremity, which is being treated with a direct oral anticoagulant. On hospital day 3, she reports a sudden increase in shortness of breath, a "tight" chest, and a productive cough with greenish sputum that started yesterday. Her past medical history includes severe emphysema and hypertension. She appears anxious and is utilizing her scalene muscles for respiration. Her temperature is $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$), pulse is $108/\text{min}$, respirations are $26/\text{min}$, and blood pressure is $142/88 \text{ mm Hg}$. Oxygen saturation is $86\%$ on room air. Physical examination is notable for a prolonged expiratory phase and prominent diffuse polyphonic rhonchi. Jugular veins are not distended. A bedside echocardiogram shows a normal left ventricular ejection fraction and normal right ventricular size. An arterial blood gas analysis reveals a pH of $7.27$, $PaCO_2$ of $65 \text{ mm Hg}$, $PaO_2$ of $52 \text{ mm Hg}$, and $HCO_3^-$ of $29 \text{ mEq/L}$.

Which of the following are the most appropriate immediate steps in the management of this patient's respiratory status? (Select all that apply)

A respiratory therapy consult is requested for a 64-year-old woman who has developed mild shortness of breath on her second day of recovery following an open ventral hernia repair. She has a known history of chronic obstructive pulmonary disease and diet-controlled type 2 diabetes mellitus. Current vital signs reveal a temperature of 37.8°C (100°F), a heart rate of 102/min, a respiratory rate of 22/min, and blood pressure of 138/85 mmHg. Oxygen saturation is 92% on ambient air. When questioned, the patient states that taking large breaths causes significant discomfort at the incision site. Physical examination demonstrates shallow respirations with noticeably diminished breath sounds at both pulmonary bases. The lungs are otherwise clear, without wheezes, rhonchi, or crackles. The jugular veins are flat, and cardiac auscultation shows a regular rhythm with no gallops or murmurs. The surgical wound appears clean, dry, and intact. Which of the following is the most appropriate initial intervention to manage this patient's current respiratory presentation?

Match each clinical scenario to the most appropriate mandatory public health reporting timeline and initial disease control measure.

Review the following patient profiles. Match each patient with the most appropriate United States Preventive Services Task Force (USPSTF) Grade A or Grade B recommendation for screening or preventive care.

Clinical researchers must critically evaluate study designs to identify methodological flaws. Read the following study descriptions and pair each one with the corresponding type of bias or confounding.

During a comprehensive family planning clinic session, four patients present for contraceptive counseling. Based on the United States Medical Eligibility Criteria (US MEC) for Contraceptive Use, match each patient's clinical profile with the most appropriate contraceptive method.

Correlate the following pediatric clinical vignettes with their most likely underlying embryologic or pathophysiologic etiology.

Evaluate the following four adult patients who have presented to the emergency department with acute cardiopulmonary distress. Match each patient's clinical presentation to the single most appropriate initial pharmacological or procedural treatment strategy.

Several patients present to a women's health clinic requesting initiation of a highly effective, reversible contraceptive method. Review their clinical histories and match each patient with the single most appropriate contraceptive option based on the Medical Eligibility Criteria and the patient's specific requests.

Antimicrobial stewardship emphasizes selecting the appropriate agent, dose, and duration while minimizing unnecessary broad-spectrum coverage to prevent resistance. Match each of the following common infectious disease presentations with the most appropriate guideline-concordant initial management strategy.

During an evidence-based medicine seminar, medical students are evaluating various study designs and interpreting their statistical outcomes. Match each specific clinical question raised by the students to the most appropriate epidemiological measure of disease frequency or association that provides the answer.

A 6-year-old girl is evaluated in the emergency department after falling from a trampoline onto her outstretched left arm. She is in significant distress and refuses to move her upper extremity. Vital signs are stable. Physical examination reveals a gross S-shaped deformity and severe swelling of the left elbow. The skin over the antecubital fossa is intact without puckering. Capillary refill in the left fingers is 1.5 seconds, and the hand is warm and pink. However, the left radial pulse is completely absent to palpation and cannot be detected with a hand-held Doppler device. Neurologic examination reveals an inability to actively flex the interphalangeal joint of the left thumb, but she is able to extend her wrist and fingers against resistance. Radiographs demonstrate a completely displaced, extension-type supracondylar fracture of the distal humerus. The patient is emergently taken to the operating room, where an anatomic closed reduction and percutaneous pinning are performed. Intraoperative fluoroscopy confirms perfect alignment and stable fixation. Immediate post-procedural evaluation reveals that the left hand remains warm and pink with a capillary refill of 1.5 seconds. However, the radial pulse remains undetectable by Doppler. Which of the following is the most appropriate next step in the management of this patient?

A $62$-year-old woman is brought to the emergency department by her husband due to progressive confusion, profound weakness, and mild shortness of breath over the past $3$ days. She has a history of estrogen receptor-positive breast cancer treated with lumpectomy and radiation $4$ years ago. Two months ago, she developed severe back pain and was diagnosed with widespread osteolytic metastases. For the past week, she has been extremely thirsty, urinating frequently, and has not had a bowel movement in $4$ days. Her husband reports she has become increasingly lethargic today.

Vital signs are: temperature $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), pulse $112$/min, blood pressure $88/55$ mm Hg, and respirations $18$/min.

Physical examination reveals dry mucous membranes and decreased skin turgor. The lungs are clear to auscultation. Heart sounds are rapid but regular. The abdomen is mildly distended with decreased bowel sounds. Neurologic examination shows a lethargic patient who is oriented to name only.

Which of the following is the most appropriate initial step in the management of this patient's current condition?

A 52-year-old woman is admitted to the hospital with a 2-day history of progressively worsening crampy abdominal pain, abdominal distension, and bilious vomiting. She has not passed flatus or stool for the past 24 hours. Her surgical history is significant for a total abdominal hysterectomy performed 5 years ago for uterine fibroids. Vital signs show a temperature of 37.1°C (98.8°F), pulse of 86/min, and blood pressure of 126/82 mm Hg. Physical examination reveals a distended and tympanic abdomen. There is diffuse mild tenderness to palpation, but no rebound tenderness, guarding, or rigidity. Laboratory studies show a normal leukocyte count and a serum potassium of 3.8 mEq/L. Computed tomography (CT) of the abdomen reveals multiple dilated loops of small bowel with air-fluid levels and a discrete transition point in the mid-ileum. There is no evidence of bowel wall thickening, pneumatosis intestinalis, or free intraperitoneal air. What is the most appropriate next step in the management of this patient?

A 58-year-old man is examined in the hospital one week after undergoing a laparoscopic-assisted right hemicolectomy for a ruptured appendix with a localized abscess. He was initially recovering well but has developed worsening right shoulder pain and a mild, persistent cough over the last two days. His temperature is 39.0°C (102.2°F), blood pressure is 128/82 mmHg, pulse is 112/min, and respirations are 20/min. Pulse oximetry is 96% on room air. Cardiopulmonary examination reveals diminished breath sounds over the right posterior lung base. The abdomen is soft, with moderate focal tenderness in the right upper quadrant. The surgical incisions are healing well without erythema, fluctuance, or discharge. His leukocyte count is 18,500/mm^3. A portable chest radiograph demonstrates a small right-sided pleural effusion with an elevated right hemidiaphragm.

Which of the following is the most appropriate next step in management?

A 27-year-old male is transported to the trauma bay after sustaining a knife wound to his right thigh during an altercation. On initial assessment, the patient is diaphoretic and confused. Vital signs show a heart rate of 134/min and a blood pressure of 80/42 mmHg. Examination of the right lower extremity reveals a 4-cm laceration over the anteromedial thigh with a rapidly expanding, pulsatile swelling beneath the skin. The right foot is markedly pale compared to the left, and no pulses are audible on Doppler ultrasound over the right dorsalis pedis or posterior tibial arteries. Intravenous access is established and rapid crystalloid infusion is started. Which of the following is the most appropriate next step in management?

Match each clinical presentation in a patient with a history of Roux-en-Y gastric bypass to the most likely postoperative complication.

While recovering on the surgical unit, a 68-year-old male is evaluated for new-onset respiratory distress and increased sputum production. The patient is currently on postoperative day 2 following an open partial colectomy for adenocarcinoma. His past medical history includes severe chronic obstructive pulmonary disease (COPD), osteoarthritis, and hypertension. He continues to smoke one pack of cigarettes daily.

Vital signs show a temperature of 38.7°C (101.6°F), pulse of 112/min, blood pressure of 138/82 mm Hg, and respirations of 26/min. Pulse oximetry reading is 88% on ambient air. Physical examination reveals a barrel-shaped chest with diffuse, bilateral expiratory wheezing and a prolonged expiratory phase. Jugular venous pressure is normal, and heart sounds are regular without any S3 gallop. The abdominal incision is clean, dry, and intact with no surrounding erythema. Both calves are soft, compressible, and nontender. A portable chest radiograph displays hyperinflated lung fields along with a newly developed dense consolidation in the left lower lobe.

Which of the following are the most appropriate next steps in the management of this patient? (Select 3)

A 54-year-old woman is brought to the emergency department by her daughter due to progressive confusion, unsteadiness, and shaking. The patient has a history of bipolar I disorder that has been well controlled on a stable dose of lithium for the past 8 years. Two weeks ago, she visited a primary care clinic for routine evaluation and was started on a new daily medication. Today, her temperature is 37.1°C (98.8°F), blood pressure is 128/78 mm Hg, and heart rate is 82/min. Physical examination reveals an unsteady, broad-based gait and a coarse tremor in both hands. Deep tendon reflexes are 3+ bilaterally. She also reports several days of nausea, vomiting, and diarrhea. Which of the following medications was most likely added to her regimen two weeks ago?

Match each acute trauma clinical presentation with the most appropriate next step in management.