All practice questions

A 54-year-old man with a history of alcohol-associated cirrhosis presents to the clinic for management of new-onset abdominal distension. Ultrasound confirms the presence of uncomplicated ascites. Arrange the following interventions in the standard chronological step-wise sequence for the management of cirrhotic ascites, proceeding from first-line initial therapy to definitive interventions for refractory disease.

A $32$-year-old woman with no significant past medical history presents with a $6$-month history of progressive exertional dyspnea, atypical chest pain, and near-syncope during exercise. Vital signs are within normal limits. Physical examination reveals a prominent 'a' wave in the jugular venous pulse, a loud pulmonic component of the second heart sound ($P_2$), and a right ventricular heave. Lungs are clear to auscultation. An electrocardiogram demonstrates right axis deviation and right ventricular hypertrophy.

Arrange the following diagnostic steps in the most appropriate chronological order according to current guidelines for the evaluation of this patient's suspected condition.

A $42$-year-old man is evaluated in the gastroenterology clinic for a $6$-month history of chronic, watery diarrhea and recurrent epigastric pain. His symptoms have persisted despite taking high-dose omeprazole twice daily. Esophagogastroduodenoscopy reveals thickened gastric folds and multiple $1$- to $2$-cm ulcers in the stomach, duodenal bulb, and descending duodenum. Rapid urease test for Helicobacter pylori is negative. The physician suspects a neuroendocrine tumor. Arrange the following diagnostic and management steps in the most appropriate chronological sequence for this patient's suspected condition.

A 58-year-old man is evaluated in the emergency department for sudden-onset, severe "tearing" chest pain that radiates to his interscapular region. He is markedly anxious and diaphoretic. His blood pressure is $218/115\text{ mmHg}$ in the right arm and $182/95\text{ mmHg}$ in the left arm. His heart rate is $114\text{/min}$. Physical examination reveals a new prominent early diastolic decrescendo murmur at the right upper sternal border. An electrocardiogram reveals sinus tachycardia and voltage criteria for left ventricular hypertrophy. Bedside chest radiography demonstrates a widened mediastinum. Arrange the following interventions in the most appropriate sequential order for the acute management of this patient.

A $22$-year-old tall, thin man is brought to the emergency department by emergency medical services with sudden-onset severe right-sided chest pain and profound shortness of breath. He is in severe respiratory distress. His blood pressure is $78/48$ mmHg, heart rate is $135$ /min, and oxygen saturation is $85\%$ on high-flow oxygen. Physical examination reveals absent breath sounds over the right hemithorax, hyperresonance to percussion on the right, and the trachea is visibly deviated to the left. The patient has markedly distended neck veins. Arrange the following management steps in the most appropriate chronological order.

A $48$-year-old man is brought to the emergency department after expectorating approximately $600\text{ mL}$ of bright red blood over the past two hours. He has a history of cavitary pulmonary tuberculosis that was fully treated $10$ years ago. On arrival, he is in moderate respiratory distress and continues to cough up large volumes of blood. Vital signs are temperature $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure $105/65\text{ mmHg}$, pulse $118/\text{min}$, and respirations $28/\text{min}$. Pulse oximetry shows an oxygen saturation of $88\%$ on room air. Pulmonary auscultation reveals coarse crackles and gurgling sounds over the right mid-to-upper lung fields, while breath sounds on the left are completely clear. Arrange the following management steps in the most appropriate sequential order for this patient.

A 64-year-old man presents to the outpatient clinic reporting a 2-month history of retrosternal chest tightness. The discomfort occurs predictably after walking two blocks and resolves completely with 5 minutes of rest. He has a history of type 2 diabetes mellitus, hyperlipidemia, and hypertension. Current medications include lisinopril and metformin. Vital signs are within normal limits. Physical examination is unremarkable. A resting 12-lead electrocardiogram shows normal sinus rhythm without ST-segment or T-wave abnormalities.

Arrange the following steps in the most appropriate sequential order for the optimal long-term evaluation and management of this patient's condition, assuming each successive step reveals findings that appropriately warrant further escalation of care.

An otherwise healthy $28$-year-old female patient presents to the urgent care clinic complaining of a sudden onset of sharp, right-sided chest pain that worsens with deep inspiration. She returned from a long-haul international flight two days ago. Her vital signs are stable, including a heart rate of $82$/min and oxygen saturation of $99\%$ on room air. The physical examination, including lung auscultation and lower extremity inspection, shows no abnormalities. The physician suspects a pulmonary embolism. Arrange the following clinical actions in the most appropriate chronological order to accurately evaluate and manage this patient.

A $68$-year-old man with a history of prior myocardial infarction and ischemic cardiomyopathy is brought to the emergency department after a witnessed episode of near-syncope at home. Upon arrival, he appears pale and lethargic but withdraws to painful stimuli. His vital signs show a temperature of $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), a heart rate of $188\text{ /min}$, a blood pressure of $78/50\text{ mmHg}$, and a respiratory rate of $22\text{ /min}$. Continuous cardiac monitoring reveals a regular, wide-complex tachycardia. His oxygen saturation is $94\%$ on room air.

Based on the Advanced Cardiovascular Life Support (ACLS) guidelines, arrange the following acute management steps in the correct sequential order for this patient.

A 38-year-old man presents to the clinic with a 3-month history of persistent epigastric pain and dyspepsia. He has no alarm symptoms such as unintended weight loss, gastrointestinal bleeding, early satiety, or dysphagia. You decide to employ a 'test-and-treat' strategy for suspected Helicobacter pylori infection. Arrange the following steps in the most appropriate chronological order for the diagnosis, treatment, and follow-up of this patient.

An ICU team is managing a $53$-year-old male patient who remains profoundly hypoxemic $24$ hours after being intubated for viral pneumonia-induced acute respiratory distress syndrome (ARDS). Arrange the following management strategies in the standard sequential order of escalation for progressive, refractory hypoxemia, from foundational standard of care to the final salvage therapy.

A 64-year-old man is brought to the emergency department due to sudden-onset, excruciating chest pain that radiates to his back. His blood pressure is 210/120 mm Hg in the right arm and 185/105 mm Hg in the left arm. Heart rate is 118/min. Physical examination reveals a bounding pulse and a new early diastolic decrescendo murmur at the right upper sternal border. Electrocardiogram shows sinus tachycardia and left ventricular hypertrophy. The physician strongly suspects an acute aortic dissection and prepares to manage the patient. Arrange the following diagnostic and therapeutic interventions in the most appropriate sequential order for this patient.

A 24-year-old man is brought to the emergency department after a severe motor vehicle collision. He is in profound respiratory distress. Vital signs show a heart rate of 135/min, blood pressure of 75/40 mm Hg, and oxygen saturation of 82% on room air. Physical examination reveals distended neck veins, marked tracheal deviation to the left, and completely absent breath sounds over the right hemithorax. The clinical diagnosis of a right-sided tension pneumothorax is made. Arrange the following management steps in the correct chronological sequence for this patient.

A 38-year-old woman presents to the emergency department with a 1-week history of worsening fatigue, spontaneous gum bleeding, and easy bruising. Her temperature is 37.8°C (100°F), blood pressure is 110/70 mm Hg, and pulse is 105/min. Physical examination is notable for diffuse petechiae across her chest and extremities, as well as oozing from her intravenous catheter site.

Laboratory studies show:

A peripheral blood smear demonstrates numerous atypical promyelocytes with multiple needle-like cytoplasmic inclusions.

Arrange the following steps in the most appropriate chronological sequence for the management of this patient's condition.

A 32-year-old man presents to the emergency department with a 4-week history of productive cough, occasional hemoptysis, low-grade fevers, and night sweats. He has experienced a 5-kg (11-lb) unintentional weight loss during this time. The patient immigrated to the United States from a region highly endemic for tuberculosis two months ago. His temperature is 37.8°C (100.0°F), blood pressure is 120/78 mm Hg, pulse is 88/min, and respiratory rate is 16/min. Physical examination reveals bronchial breath sounds and crackles in the right upper lung field. The clinical presentation is highly suspicious for active pulmonary tuberculosis. Arrange the following management steps in the most appropriate chronological order.

A 22-year-old man with a history of type 1 diabetes mellitus is brought to the emergency department due to progressive lethargy, nausea, vomiting, and diffuse abdominal pain over the past 24 hours. He reports having a severe sore throat and fever for the last three days. His temperature is 37.5°C (99.5°F), blood pressure is 92/58 mm Hg, pulse is 128/min, and respirations are 28/min and deep. Physical examination reveals dry mucous membranes, delayed capillary refill, and a fruity breath odor. Laboratory evaluation reveals:

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

A 52-year-old man is admitted to the intensive care unit with acute severe gallstone pancreatitis. Over the course of a prolonged 6-week hospitalization, his condition requires dynamic management of evolving complications. According to current evidence-based guidelines, arrange the following clinical management steps in the correct chronological order from the initial presentation to the definitive management of late complications.

A 42-year-old woman is evaluated in the post-anesthesia care unit 90 minutes after undergoing an uncomplicated total thyroidectomy for a large multinodular goiter. The nurse urgently requests an evaluation because the patient has developed acute-onset stridor, agitation, and severe shortness of breath. On physical examination, her blood pressure is 145/85 mm Hg, pulse is 112/min, and oxygen saturation is 86% on room air. There is a tense, rapidly expanding, firm swelling directly beneath the cervical incision. Arrange the following management steps for this patient in the most appropriate chronological order.

A patient in his mid-forties is evaluated in the gastroenterology outpatient clinic due to chronic, high-volume watery diarrhea and persistent burning epigastric pain. His symptoms have been refractory to high-dose omeprazole therapy over the past six months. An upper gastrointestinal endoscopy performed recently revealed thickened gastric folds, multiple ulcerations in the descending duodenum, and an additional solitary ulcer in the proximal jejunum. Rapid urease testing and histology for Helicobacter pylori were negative. The physician strongly suspects a neuroendocrine etiology. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological order for evaluating and managing this patient's suspected condition.

A 62-year-old woman presents to the emergency department with a 4-day history of progressively worsening left lower quadrant abdominal pain, fever, and chills. Her temperature is 38.9°C (102.0°F), blood pressure is 105/65 mm Hg, and pulse is 112/min. Physical examination reveals focal tenderness, erythema, and localized guarding in the left lower quadrant, but no diffuse abdominal rigidity. Bowel sounds are hypoactive. Laboratory studies show a leukocyte count of 17,500/mm³. Arrange the following management steps in the most appropriate chronological order for this patient.