All practice questions

A 54-year-old man with a history of poorly controlled HIV (most recent CD4 count 112 cells/mm³) is brought to the emergency department by his partner due to fever, severe headache, and confusion over the past 24 hours. His temperature is 39.1°C (102.4°F), blood pressure is 110/70 mm Hg, pulse is 112/min, and respiratory rate is 18/min. Physical examination reveals nuchal rigidity and a new right-sided pronator drift. The physician suspects acute bacterial meningitis. Arrange the following steps in the most appropriate chronological sequence for the management of this patient.

A 38-year-old woman is referred to the endocrinology clinic due to progressive weight gain, facial plethora, and easy bruising over the past eight months. Physical examination reveals prominent supraclavicular fat pads, violaceous abdominal striae, and proximal muscle weakness. Her blood pressure is $155/95$ mm Hg. Suspecting Cushing syndrome, the physician decides to initiate a comprehensive diagnostic evaluation. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological sequence for this patient.

A $42$-year-old man presents with episodic severe headaches, diaphoresis, and palpitations. His blood pressure is $185/110$ mmHg and heart rate is $112$/min during an episode. A $24$-hour urine fractionated metanephrines test is markedly elevated. A non-contrast CT scan of the abdomen reveals a $4.5$-cm right adrenal mass. He is diagnosed with a pheochromocytoma and is scheduled for surgical resection in $3$ weeks. Arrange the following steps in the correct chronological sequence for the optimal preoperative and operative management of this patient.

A 65-year-old man suddenly collapses while walking in the hospital hallway. A physician is the first to arrive and finds the patient unresponsive, with no normal breathing and no palpable carotid pulse. The physician immediately calls for help and requests a resuscitation cart. Arrange the following subsequent steps in the most appropriate chronological sequence for managing this patient's cardiac arrest, assuming the underlying rhythm is ventricular fibrillation.

A 52-year-old man presents to the emergency department with a 48-hour history of severe, colicky abdominal pain accompanied by nausea and multiple episodes of bilious vomiting. He reports no passage of flatus or stool for the past 24 hours. His surgical history is significant for an open appendectomy performed 15 years ago. On initial evaluation, his temperature is 37.1°C (98.8°F), heart rate is 88/min, blood pressure is 130/80 mm Hg, and respiratory rate is 16/min. The abdomen is markedly distended and tympanic, with high-pitched, tinkling bowel sounds and mild diffuse tenderness, but no rebound tenderness or guarding.

Arrange the following interventions in the correct sequential order for the management of this patient, from initial presentation to ultimate definitive care.

A $48$-year-old man presents for a follow-up visit regarding his hypertension. He is currently taking maximum tolerated doses of lisinopril, amlodipine, and hydrochlorothiazide. His blood pressure is $168/102$ mmHg. Laboratory studies reveal a serum sodium of $143$ mEq/L and a serum potassium of $2.8$ mEq/L. The patient is suspected to have a secondary cause of hypertension. Arrange the following diagnostic and management steps in the most appropriate chronological sequence for the evaluation and definitive management of this patient's suspected condition.

A 55-year-old man with a history of intravenous drug use comes to the emergency department reporting severe, unrelenting lower back pain for the past 3 weeks. The pain is worse at night, is not relieved by rest, and is accompanied by subjective fevers. He reports no leg weakness, numbness, or bowel and bladder incontinence. Temperature is 38.2°C (100.8°F), pulse is 92/min, and blood pressure is 128/78 mm Hg. Physical examination shows focal tenderness to percussion over the L4 and L5 spinous processes. Neurologic examination of the lower extremities reveals full strength, normal sensation, and intact reflexes bilaterally. Arrange the following steps in the most appropriate chronological sequence for the diagnostic workup and management of this patient.

A 32-year-old woman comes to the emergency department complaining of sudden-onset palpitations and mild shortness of breath that started 30 minutes ago. She has no significant past medical history. Her temperature is 37.0°C (98.6°F), blood pressure is 118/76 mmHg, pulse is 185/min, and respiratory rate is 18/min. Pulse oximetry is 99% on room air. An electrocardiogram reveals a regular, narrow-complex tachycardia with no discernible P waves. Assuming each subsequent intervention fails to terminate the arrhythmia and the patient remains hemodynamically stable until the final step, arrange the following management options in the correct sequential order from first to last according to standard treatment algorithms.

A 68-year-old man is brought to the emergency department by his daughter due to a 1-day history of fever, severe right upper quadrant abdominal pain, and new-onset confusion. His temperature is 39.4°C (102.9°F), blood pressure is 86/52 mm Hg, and pulse is 122/min. Physical examination reveals scleral icterus and marked right upper quadrant tenderness to palpation with guarding. Laboratory studies show a leukocyte count of 18,500/mm³, an elevated direct bilirubin level, and elevated alkaline phosphatase. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 72-year-old man with a history of advanced prostate cancer presents to the emergency department with severe, progressively worsening mid-back pain over the past two weeks. Over the last 24 hours, he has developed bilateral lower extremity weakness and difficulty voiding urine. Neurological examination reveals 3/5 strength in the bilateral lower extremities, decreased sensation to pinprick below the umbilicus, and hyperreflexia at the knees. A diagnosis of malignant epidural spinal cord compression (MESCC) is highly suspected. Arrange the following management steps in the correct chronological order.

A 74-year-old man is brought to the emergency department after experiencing three episodes of massive, painless hematochezia over the past two hours. His medical history is significant for coronary artery disease, hypertension, and osteoarthritis, for which he takes daily aspirin and naproxen. On arrival, he appears pale and diaphoretic. His temperature is 36.8°C (98.2°F), blood pressure is 84/52 mm Hg, pulse is 122/min, and respirations are 20/min. Abdominal examination is unremarkable with no tenderness or guarding. Rectal examination reveals copious amounts of bright red blood. Arrange the following steps in the most appropriate sequence for the evaluation and management of this patient's acute presentation.

A $62$-year-old man presents to the emergency department with a $3$-day history of worsening left lower quadrant abdominal pain, fever, and anorexia. His temperature is $38.8^\circ\text{C}$ ($101.8^\circ\text{F}$), blood pressure is $122/78\text{ mm Hg}$, and pulse is $102/\text{min}$. Physical examination demonstrates significant focal tenderness and guarding in the left lower quadrant without diffuse peritonitis. Laboratory testing shows a leukocyte count of $17,200/\text{mm}^3$ with a left shift. Empiric broad-spectrum intravenous antibiotics are initiated immediately. Assuming the initial diagnostic imaging confirms acute complicated diverticulitis with a $5\text{ cm}$ pericolic abscess, arrange the following management steps in the most appropriate chronological sequence.

A $28$-year-old male is brought to the trauma bay via helicopter emergency medical services following a severe industrial explosion. On arrival, he is unresponsive. Vital signs are temperature $35.2^{\circ}\text{C}$ ($95.4^{\circ}\text{F}$), blood pressure $70/40\text{ mm Hg}$, heart rate $148/\text{min}$, and respiratory rate $34/\text{min}$. Physical examination reveals sonorous respirations and massive maxillofacial trauma. The trachea is deviated to the left, and breath sounds are absent over the right hemithorax. There is a traumatic amputation of the right mid-thigh with continuous, high-volume pulsatile bleeding. His Glasgow Coma Scale score is $6$. Based on current Advanced Trauma Life Support (ATLS) guidelines, arrange the following initial management steps in the correct chronological sequence.

A 22-year-old woman with a history of type 1 diabetes mellitus is brought to the emergency department due to a 2-day history of worsening nausea, vomiting, and diffuse abdominal pain. She recently had an upper respiratory tract infection and missed several doses of her basal insulin. Her temperature is 37.4°C (99.3°F), blood pressure is 92/60 mm Hg, pulse is 124/min, and respirations are 28/min and deep. Her mucous membranes are dry. Initial laboratory results show:

Arrange the following interventions in the most appropriate chronological sequence for the management of this patient's condition, from initial presentation in the emergency department to the resolution of the acute crisis.

A $67$-year-old man comes to the clinic reporting progressive difficulty swallowing over the past four months. Initially, he noticed food feeling "stuck" in his lower chest when eating solid meals such as meat, but recently he has struggled to swallow liquids as well. He notes an unintentional weight loss of $11$ kg ($24$ lbs) since his symptoms began. His medical history is notable for hypertension, hyperlipidemia, and a $45$-pack-year smoking history. Vital signs are within normal limits. Physical examination reveals temporal wasting but is otherwise unremarkable. Laboratory studies show a hemoglobin of $10.2$ g/dL with a mean corpuscular volume of $76$ fL. Based on current clinical guidelines, arrange the following diagnostic and staging steps in the most appropriate chronological order.

A 58-year-old man is evaluated on postoperative day 5 following an elective left hemicolectomy for colon cancer. Over the past 12 hours, he has developed worsening left lower quadrant abdominal pain, nausea, and chills. His temperature is 39.2°C (102.5°F), heart rate is 115/min, respirations are 20/min, and blood pressure is 112/70 mmHg. Oxygen saturation is 96% on room air. Abdominal examination reveals localized tenderness and voluntary guarding in the left lower quadrant, but no generalized rigidity. Bowel sounds are hypoactive. The surgical incision is clean with no surrounding erythema or discharge.

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

A 62-year-old man presents with severe substernal chest pain. He is diagnosed with an acute ST-segment elevation myocardial infarction (STEMI). In the absence of immediate reperfusion therapy, electrocardiographic (ECG) changes in the affected leads typically evolve in a predictable chronological sequence. Arrange the following classic ECG findings in the chronological order of their appearance, from earliest to latest.

A 35-year-old woman is brought to the emergency department after being rescued from a closed-space house fire. She has deep partial-thickness and full-thickness burns over 40% of her total body surface area. On examination, she has singed facial hair, carbonaceous sputum, and a noticeably hoarse voice. Her blood pressure is 90/60 mm Hg, and her heart rate is 120/min. Arrange the following management steps in the most appropriate chronological sequence for this patient according to standard trauma principles.

A 28-year-old woman presents to the emergency department complaining of a sudden onset of rapid heart palpitations and mild chest fullness that began 30 minutes ago while she was watching television. She denies any chest pain, lightheadedness, or loss of consciousness. Her vital signs are temperature 37.0°C (98.6°F), blood pressure 118/76 mmHg, heart rate 175/min, and respiratory rate 16/min. Physical examination reveals a rapid, regular pulse and clear lungs. A 12-lead electrocardiogram (ECG) demonstrates a regular, narrow-complex tachycardia at a rate of 175/min with no discernible P waves.

Arrange the following therapeutic interventions in the most appropriate chronological sequence for the acute and definitive management of this condition, assuming each preceding step is ineffective.

A 42-year-old man presents to the outpatient clinic reporting episodic severe headaches, profound diaphoresis, and a sensation of a racing heart over the past three months. His blood pressure is 175/105 mm Hg, and his pulse is 110/min. Laboratory evaluation reveals markedly elevated 24-hour urine fractionated metanephrines and catecholamines. An abdominal magnetic resonance imaging (MRI) scan demonstrates a 4.5-cm right adrenal mass. The patient is diagnosed with a pheochromocytoma and is scheduled for definitive surgical resection. Arrange the following preoperative management steps in the correct chronological order to prepare this patient safely for surgery.