All practice questions

A 40-week gestation female neonate is delivered via emergency cesarean section due to a severe placental abruption. At delivery, the infant is completely flaccid, has no spontaneous respiratory effort, and has an initial heart rate of 80/min. Arrange the following neonatal resuscitation interventions in the correct chronological sequence, assuming the infant's clinical status continuously deteriorates to a heart rate below 60/min despite the optimal execution of each preceding step.

A 55-year-old man presents to the emergency department with acute-onset, severe pain, swelling, and erythema of his right knee, accompanied by a fever of 39.2°C (102.6°F). He has a history of poorly controlled diabetes mellitus. On physical examination, the right knee is warm, exquisitely tender, and has a significantly restricted range of motion. What is the most appropriate chronological order of diagnostic and therapeutic management steps for this patient?

A primigravida at 41 weeks of gestation is in the second stage of labor. Following the delivery of the fetal head, it immediately retracts tightly against the maternal perineum. The attending physician attempts gentle downward traction, but the anterior shoulder fails to pass beneath the pubic symphysis. Arrange the following interventions in the correct chronological sequence of escalation for managing this obstetric emergency.

A 4-year-old boy, who recently immigrated from a country with a high tuberculosis prevalence, is brought to the pediatric clinic due to a 4-week history of low-grade fevers, night sweats, poor appetite, and a persistent, non-productive cough. He appears fatigued and malnourished. His vital signs show a temperature of 38.1°C (100.6°F), heart rate of 115/min, and respiratory rate of 26/min. The clinical facility is equipped with specialized infection control rooms. Arrange the following steps in the most appropriate sequential order for the evaluation and management of this patient.

Emergency medical services arrive at the trauma center with a 32-year-old male victim of a high-speed motorcycle crash. He was found unresponsive at the scene after a prolonged extrication time. Upon presentation, the patient exhibits loud, gurgling respirations and central cyanosis. Hemodynamic monitoring reveals a blood pressure of 65/40 mmHg and a heart rate of 145/min. The physical examination is notable for active, pulsatile arterial bleeding from a severely mangled left lower extremity. Arrange the following acute management steps in the correct chronological sequence according to the Advanced Trauma Life Support (ATLS) protocol.

A 26-year-old man comes to the clinic requesting sexually transmitted infection screening. He reports a condomless sexual encounter with a partner of unknown serostatus approximately 3 weeks ago. He currently feels well and reports no fever, rash, sore throat, or lymphadenopathy. The physician decides to screen for HIV. Assuming the patient has indeed contracted HIV from this recent encounter, arrange the following steps in the correct chronological order according to the standard diagnostic algorithm for acute HIV infection.

A 58-year-old man with a known history of advanced squamous cell carcinoma of the lung is brought to the emergency department by his family due to progressive confusion, severe lethargy, and frequent urination over the past three days. His blood pressure is 85/55 mmHg, heart rate is 118/min, and respiratory rate is 18/min. Physical examination demonstrates dry mucous membranes and markedly decreased skin turgor. Laboratory studies show a serum calcium level of 15.2 mg/dL and a serum albumin level of 3.5 g/dL. An electrocardiogram reveals a shortened QT interval.

Arrange the following management steps in the optimal sequential order, from the most immediate initial intervention to the long-term definitive therapy.

A 24-year-old man presents to the clinic requesting sexually transmitted infection screening after a high-risk sexual encounter two weeks ago. He reports a mild sore throat, low-grade fever, and fatigue over the past few days. The physician suspects acute HIV infection. Arrange the following steps in the correct chronological sequence for the diagnosis and initial management of this patient, assuming he is ultimately confirmed to have acute HIV-1 infection.

A $45$-year-old man is hospitalized for community-acquired pneumonia. Ten minutes after starting his first dose of intravenous ceftriaxone, he develops sudden-onset diffuse urticaria, shortness of breath, and throat tightness. His temperature is $37.2^{\circ}\text{C}$ ($99.0^{\circ}\text{F}$), blood pressure is $82/50\text{ mm Hg}$, pulse is $124/\text{min}$, and respiratory rate is $26/\text{min}$. Oxygen saturation is $90\%$ on room air. Examination reveals diffuse expiratory wheezing and facial angioedema. Arrange the following steps in the most appropriate chronological order for the acute management of this patient's condition.

A $44$-year-old woman is evaluated for a $6$-month history of progressive weight gain, new-onset facial hair growth, and easy bruising. Her blood pressure is $160/100$ mmHg. Physical examination reveals a rounded face, dorsocervical fat pad, prominent proximal muscle weakness, and wide, violaceous abdominal striae.

Arrange the following diagnostic steps in the most appropriate sequential order to establish the diagnosis and definitively localize the source of this patient's condition, assuming each successive biochemical test points toward a pituitary origin but initial anatomic imaging remains equivocal.

A $42$-year-old man presents to the clinic for follow-up of hypertension. His blood pressure remains poorly controlled at $165/100$ mmHg despite adherence to maximum doses of amlodipine, lisinopril, and chlorthalidone. Laboratory results reveal a serum potassium level of $3.1$ mEq/L. The physician suspects secondary hypertension due to primary hyperaldosteronism.

Arrange the following diagnostic steps in the correct sequential order to evaluate and localize this patient's suspected condition.

A $59$-year-old woman with a history of squamous cell carcinoma of the lung is admitted to the hospital with worsening lethargy, abdominal pain, and confusion over the past $3$ days. Her vital signs show a blood pressure of $102/64$ mmHg and a heart rate of $110$/min. Physical examination reveals dry mucous membranes and delayed capillary refill. Laboratory testing reveals a severely elevated serum calcium level of $15.2$ mg/dL. The decision is made to initiate acute medical management for severe hypercalcemia.

Arrange the following interventions in the correct chronological order of their required administration and physiological onset of action, starting with the most immediate first-line resuscitative step and ending with the therapy that provides delayed but sustained long-term control.

A 28-year-old G3P3 woman experiences sudden cardiovascular collapse and a large gush of vaginal bleeding immediately following the vaginal delivery of a healthy infant at 39 weeks of gestation. Physical examination reveals a beefy red, smooth mass protruding from the introitus. The uterine fundus cannot be palpated on abdominal examination. Her blood pressure is 75/40 mm Hg and pulse is 130/min. Intravenous fluids and blood products are rapidly initiated. Arrange the following steps in the correct escalation sequence for the definitive management of this patient's condition.

A 71-year-old woman is assessed by the on-call physician in the surgical ward on postoperative day 6 following a subtotal colectomy with end ileostomy for severe ischemic colitis. Her medical history is notable for severe chronic obstructive pulmonary disease and poorly controlled type 2 diabetes mellitus. While attempting to transition from her bed to a chair, she experiences a forceful, prolonged coughing spasm. She immediately reports a sudden "tearing" sensation in her lower abdomen. Shortly thereafter, the primary nurse observes a copious amount of salmon-colored fluid soaking the patient's abdominal binder. Removal of the binder and superficial dressings reveals viable, intact loops of small intestine protruding through a complete dehiscence of the midline fascial closure. Arrange the following management steps in the most appropriate chronological order for this patient.

A 34-year-old woman presents to an outpatient rheumatology clinic with a four-month history of symmetric pain, swelling, and pronounced morning stiffness in her wrists and metacarpophalangeal joints. Serologic testing demonstrates high titers of anti-cyclic citrullinated peptide (anti-CCP) antibodies, and imaging confirms early periarticular osteopenia. She is diagnosed with active, moderate-to-severe rheumatoid arthritis. Assuming this patient experiences an inadequate clinical response or refractory disease progression at each stage of standard management over the next decade, arrange the following therapeutic interventions in the most appropriate chronological order of step-up therapy.

A 25-year-old man is brought to the trauma bay via ambulance after being ejected from a vehicle during a high-speed collision. On arrival, he is comatose with gurgling respirations. Vital signs are temperature 36.1°C (97.0°F), blood pressure 65/35 mm Hg, pulse 145/min, and respirations 8/min. Physical examination reveals a trachea deviated to the left, absent breath sounds on the right hemithorax, and dramatically distended neck veins. Anteroposterior compression of the pelvis reveals mechanical instability. Arrange the following critical interventions in the exact sequential order they should be performed according to Advanced Trauma Life Support (ATLS) priority protocols.

A $61$-year-old woman with a known history of advanced HIV (recent CD4 count $85/\text{mm}^3$) arrives at the emergency department accompanied by her daughter. She has a $2$-day history of progressively severe generalized headache, subjective fevers, and profound lethargy. Upon arrival, her temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), blood pressure is $110/65\text{ mmHg}$, pulse is $112/\text{min}$, and respirations are $18/\text{min}$. On physical examination, she is difficult to arouse and oriented only to person. Neck flexion produces involuntary hip and knee flexion. Neurologic evaluation reveals that the right pupil is $4\text{ mm}$ and sluggishly reactive, while the left is $2\text{ mm}$ and briskly reactive. Arrange the following diagnostic and therapeutic steps in the optimal chronological sequence for this patient's initial management.

A 62-year-old man with a history of metastatic prostate cancer is brought to the emergency department due to three days of progressively worsening mid-back pain. Over the last 12 hours, he has developed bilateral lower extremity weakness and urinary retention. Vital signs are within normal limits. Neurologic examination reveals 3/5 motor strength in the lower extremities bilaterally, 3+ patellar reflexes, and decreased sensation to pinprick below the level of the umbilicus. Post-void residual volume is 600 mL.

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

During a routine employment health screening, a $28$-year-old man is found to have an incidental serum calcium level of $11.2$ mg/dL. The patient is entirely asymptomatic, reporting no fatigue, nephrolithiasis, bone pain, or abdominal discomfort. His family history is notable for mild, asymptomatic hypercalcemia in both his father and paternal aunt, neither of whom has undergone neck surgery. His renal function is normal. Arrange the following diagnostic and management steps in the correct chronological sequence to properly evaluate and manage this patient's condition.

A 24-year-old male with no significant past medical history is undergoing an elective open reduction and internal fixation of a right clavicle fracture. Induction of general anesthesia is achieved with propofol and succinylcholine, and anesthesia is maintained with sevoflurane. Thirty minutes into the procedure, the anesthesiologist notes a sudden and abrupt rise in the end-tidal carbon dioxide ($ETCO_2$) to $78\text{ mmHg}$. The patient develops generalized muscle rigidity, most notably in the masseter muscles. His core body temperature begins to rise rapidly and is currently $39.5^\circ\text{C}$ ($103.1^\circ\text{F}$). His heart rate is $152\text{/min}$, and blood pressure is $155/95\text{ mmHg}$.

Arrange the following management steps in the most appropriate chronological priority order for this patient's acute perioperative complication.