All practice questions

A 65-year-old man with a 40-pack-year smoking history visits the clinic for a routine evaluation. A screening chest radiograph reveals a new 15-mm noncalcified solitary pulmonary nodule in the right upper lobe. No previous chest radiographs are available for comparison. Arrange the following diagnostic modalities in the most appropriate standard chronological sequence for the evaluation of this patient's pulmonary nodule.

A 64-year-old man with a history of poorly controlled hypertension is brought to the emergency department after suddenly collapsing. Initial non-contrast computed tomography (CT) of the head demonstrates a massive right basal ganglia intraparenchymal hemorrhage. He is admitted to the neurointensive care unit. Over the next several weeks, he undergoes serial magnetic resonance imaging (MRI) of the brain to monitor the hematoma's evolution. Arrange the following MRI signal characteristics in the exact chronological sequence they would be expected to appear as the hematoma undergoes physiologic degradation, starting from the earliest (hyperacute) stage to the latest (chronic) stage.

A 67-year-old man is evaluated in the intensive care unit on postoperative day 4 following an elective open repair of an infrarenal abdominal aortic aneurysm. Over the last 12 hours, he has developed worsening diffuse abdominal pain, two episodes of bloody diarrhea, and a low-grade fever (37.8°C). His medical history includes hypertension, hyperlipidemia, and peripheral artery disease. Vitals show a blood pressure of 90/60 mm Hg, heart rate of 115/min, and respiratory rate of 22/min. Physical examination reveals a distended abdomen that is diffusely tender but without rebound or guarding; bowel sounds are absent. Laboratory studies show a leukocyte count of 16,000/mm³ (85% neutrophils, 10% bands) and a serum lactate of 4.5 mmol/L (normal: 0.5-1.0 mmol/L).

Arrange the following differential diagnoses in order of their pre-test probability for this patient's acute deterioration, from HIGHEST probability (1) to LOWEST probability (4).

A 32-year-old female computer programmer presents to an urgent care clinic reporting a severe headache that started 4 hours ago. She describes the pain as a throbbing sensation on the right side of her head. Prior to the onset of the pain, she noticed flashing zigzag lines in her peripheral vision that lasted for about 30 minutes before resolving. She currently feels nauseated and requests that the lights in the examination room be turned off. Her vital signs are within normal limits. A comprehensive neurological examination reveals no focal deficits, no papilledema, and no nuchal rigidity.

Arrange the following differential diagnoses in order from the most likely (highest pre-test probability) to the least likely based on this patient's clinical presentation.

A 22-year-old college student is brought to the emergency department by his roommates because he is unarousable. He had complained of a severe headache and fever for the past 24 hours. Vital signs show temperature $39.5^\circ\text{C}$ ($103.1^\circ\text{F}$), blood pressure 80/40 mm Hg, pulse 135/min, and respirations 28/min. Oxygen saturation is 88% on room air. Physical examination reveals a petechial rash on the lower extremities and nuchal rigidity. The patient only withdraws to pain and does not open his eyes or make any sounds (Glasgow Coma Scale score of 6).

Arrange the following management steps in the most appropriate sequential order for this patient's initial stabilization and diagnostic workup.

A 56-year-old man is evaluated in the clinic for persistent hypertension. He has a 4-year history of elevated blood pressure that remains poorly controlled despite adherence to maximum tolerated doses of amlodipine, lisinopril, and hydrochlorothiazide. His blood pressure today is 162/98 mm Hg. Laboratory studies show a serum potassium level of 3.2 mEq/L and a serum sodium level of 145 mEq/L. The physician suspects primary aldosteronism.

Arrange the following diagnostic interventions in the most appropriate chronological order to establish the diagnosis, localize the pathology, and guide surgical management, assuming each successive test yields abnormal findings that necessitate further workup.

A 64-year-old man with a 45-pack-year smoking history presents to his primary care physician complaining of a persistent cough, worsening exertional dyspnea, and an unintentional 5-kg (11-lb) weight loss over the past two months. Physical examination reveals decreased breath sounds and dullness to percussion in the right upper lung field. The physician initiates a diagnostic workup for suspected bronchogenic carcinoma.

Arrange the following imaging studies in the most appropriate evidence-based chronological sequence for the initial detection, regional characterization, and distant metastatic staging of this patient's suspected condition.

A 32-year-old man with a known history of epilepsy is brought to the emergency department by ambulance. His roommate reports that the patient has been experiencing continuous generalized tonic-clonic movements for the past 20 minutes without regaining consciousness. Upon arrival, the patient is actively seizing. The airway is secured, and peripheral intravenous access is immediately established. Arrange the following pharmacologic interventions in the correct sequential order of escalation for the management of status epilepticus, from first-line therapy to refractory management.

Emergency medical services arrive at the trauma bay with a 35-year-old construction worker who fell approximately 20 feet from scaffolding. On presentation, the patient is obtunded with gurgling respirations and profound maxillofacial bleeding. The cardiac monitor displays a sinus tachycardia of 138/min. Noninvasive blood pressure is 75/40 mm Hg, and respiratory rate is 28/min.

According to standard trauma resuscitation protocols, arrange the following initial stabilization steps in the most appropriate chronological sequence.

A 48-year-old female is evaluated in the emergency department for a sudden, severe headache that reached maximum intensity within seconds, accompanied by photophobia and nausea. She has a history of autosomal dominant polycystic kidney disease (ADPKD). Her blood pressure is 172/98 mmHg. Neurological examination shows no focal deficits, but nuchal rigidity is present. She is admitted for comprehensive management of a suspected ruptured intracranial aneurysm.

Arrange the following imaging modalities in the correct chronological sequence reflecting standard guidelines for the initial diagnosis, vascular mapping, definitive periprocedural evaluation, and subsequent neurocritical care monitoring of this patient.

A 45-year-old man presents to the clinic complaining of increasing ring and shoe size over the past three years. He also reports excessive sweating, worsening snoring, and joint pain. Physical examination reveals coarse facial features, a prominent jaw, and enlarged, doughy hands. The physician strongly suspects a condition caused by a hyperfunctioning anterior pituitary adenoma. What is the correct sequence of the following diagnostic steps to evaluate this patient's condition? Arrange the items from the initial screening test to the final localization study.

Paramedics transport a 19-year-old man to the trauma bay following a headfirst diving accident in a shallow lake. On arrival, he is apneic and completely unresponsive to noxious stimuli. Emergency medical personnel are actively providing assisted ventilation via a bag-valve-mask device. His temperature is $35.2^\circ\text{C}$ ($95.4^\circ\text{F}$), blood pressure is $72/40\text{ mmHg}$, heart rate is $44\text{/min}$, and oxygen saturation is $94\%$ on $100\%$ oxygen. Physical examination reveals flaccid paralysis and absent deep tendon reflexes in all four extremities. A $6\text{-cm}$ scalp laceration over the vertex is actively oozing blood.

Arrange the following initial management steps in the most appropriate chronological order.

A 72-year-old man comes to the primary care clinic for evaluation of a 3-week history of painless yellowing of his eyes and skin, dark urine, pale stools, and an unintentional 6.8-kg (15-lb) weight loss. Vital signs are stable. Physical examination reveals marked scleral icterus and a palpable, non-tender mass in the right upper abdominal quadrant. Laboratory testing shows a total bilirubin of 14.2 mg/dL, direct bilirubin of 11.5 mg/dL, and a significantly elevated alkaline phosphatase level. Arrange the following diagnostic imaging and interventional modalities in the most appropriate chronological sequence for the evaluation and staging of this patient's suspected condition.

Emergency Medical Services arrives at the trauma bay with a 28-year-old construction worker who fell approximately 30 feet from scaffolding. Upon transfer to the resuscitation stretcher, the patient demonstrates decerebrate posturing, absent vocalizations, and no eye opening to sternal rub.

Initial assessment reveals the following vital parameters:
- Temperature: 36.2°C (97.2°F)
- Heart rate: 138/min
- Blood pressure: 78/42 mm Hg
- Respiratory rate: 8/min (shallow and irregular)
- Oxygen saturation: 88% on ambient air

A rapid physical survey identifies a large, actively bleeding avulsion of the right parietal scalp. Neurologic evaluation shows anisocoria, with the right pupil fixed and dilated at 7 mm while the left is 3 mm and reactive. The left thigh exhibits massive swelling and a noticeable angular deformity.

Arrange the following management steps in the most appropriate chronological sequence of execution to stabilize this critically ill patient.

A 65-year-old woman with a history of prior abdominal surgeries is admitted for suspected mechanical small bowel obstruction. If the condition remains unresolved and progresses to bowel ischemia and eventual perforation, arrange the following imaging findings in their typical chronological order of appearance on abdominal imaging.

A 36-year-old woman presents to the clinic with progressive weight gain, fatigue, and easy bruising over the past 8 months. She also reports irregular menstrual periods and new-onset facial hair growth. Blood pressure is 158/98 mmHg, pulse is 82/min, and BMI is 34 kg/m². Physical examination reveals facial plethora, prominent dorsocervical and supraclavicular fat pads, wide purple abdominal striae, and significant weakness when rising from a seated position. A baseline metabolic panel demonstrates a fasting blood glucose of 145 mg/dL and a serum potassium of 3.3 mEq/L. The physician suspects a specific endocrine disorder. Assuming positive or equivocal findings at each step that require further investigation, arrange the following diagnostic tests in the most appropriate chronological order to establish the diagnosis and definitive etiology, from initial screening to final preoperative localization.

A 22-year-old tall, thin man presents to the emergency department with a sudden onset of right-sided chest pain and shortness of breath. The symptoms started abruptly while he was sitting and studying. He has no significant past medical history, takes no medications, and does not smoke. His temperature is 37.0°C (98.6°F), blood pressure is 120/80 mmHg, heart rate is 112/min, respiratory rate is 22/min, and oxygen saturation is 96% on room air. Physical examination reveals decreased breath sounds and hyperresonance to percussion over the right hemithorax. Arrange the following differential diagnoses in order from highest to lowest pre-test probability based on this patient's clinical presentation.

Emergency medical personnel transport a 55-year-old man to the acute care bay following an episode of voluminous hematemesis at his home. The patient's wife notes he has a long-standing history of alcohol-associated cirrhosis. Upon transfer to the stretcher, the patient is obtunded, pale, and has audible gurgling during inspiration. Vital signs include a temperature of 36.5 C (97.7 F), a blood pressure of 72/42 mm Hg, a heart rate of 144/min, and a respiratory rate of 28/min. Oxygen saturation cannot be reliably obtained due to poor peripheral perfusion.

Arrange the following management steps in the most appropriate chronological sequence for this patient's initial stabilization and triage.

A 28-year-old woman, G1P0 at 24 weeks gestation, presents to the emergency department with sudden-onset shortness of breath and right-sided pleuritic chest pain. Vital signs are temperature 37.1°C (98.8°F), heart rate 115/min, blood pressure 110/70 mm Hg, respiratory rate 22/min, and oxygen saturation 94% on room air. Physical examination reveals clear breath sounds bilaterally and normal heart sounds. The lower extremities show no asymmetric swelling or erythema. Electrocardiogram demonstrates sinus tachycardia. The physician suspects a pulmonary embolism. Arrange the following diagnostic imaging studies in the most appropriate sequential order for evaluating this patient, assuming each preceding test is nondiagnostic.

A 72-year-old man is brought to the emergency department by his family at 08:00 after they found him in bed with dense right-sided hemiplegia and severe global aphasia. He was last known to be neurologically at baseline when he went to sleep at 22:00 the previous night. Initial vital signs reveal a blood pressure of 165/90 mm Hg and a heart rate of 88/min. The acute stroke team is activated to evaluate the patient for potential endovascular reperfusion therapy.

Arrange the following neuroimaging modalities and their corresponding primary interpretive objectives in the correct chronological sequence required to definitively qualify this patient for extended-window mechanical thrombectomy.