Tüm alıştırma soruları

Match each clinical presentation of a suspected blood transfusion complication with its most likely diagnosis.

A 58-year-old man with a history of end-stage renal disease presents to the emergency department with profound muscle weakness. He missed his last two scheduled hemodialysis appointments due to transportation issues. His blood pressure is 110/70 mmHg, and his pulse is 52/min. An electrocardiogram (ECG) reveals peaked T waves, a prolonged PR interval, and widened QRS complexes. Laboratory testing shows a serum potassium level of 7.6 mEq/L. Arrange the following therapeutic interventions in the most appropriate chronological order for this patient's acute management.

A 12-month-old girl is brought to the clinic for a routine well-child visit. She was diagnosed with perinatal human immunodeficiency virus (HIV) infection. Over the past 6 months, she has been treated for an episode of *Pneumocystis jirovecii* pneumonia and recurrent oral candidiasis. Her current medications include a combination antiretroviral therapy regimen and trimethoprim-sulfamethoxazole. Her mother expresses concern because the infant is pulling to a stand and cruising along furniture but is not yet walking independently without support. The infant babbles and consistently says "mama" and "dada." Vital signs are within normal limits for age. Physical examination is unremarkable. Laboratory studies obtained 3 days ago show a CD4 T-lymphocyte percentage of 12%. The patient has received all previously scheduled age-appropriate immunizations. Which of the following is the most appropriate next step in management regarding this patient's preventive care today?

Match each clinical vignette describing a systemic or opportunistic infection with the most appropriate primary therapeutic management.

A 13-month-old boy is evaluated in the pediatric clinic for a routine well-child visit. His parents express significant anxiety regarding his motor progression. They note that their older daughter took her first independent steps at 10 months of age, but their son only pulls to a stand and cruises along the living room furniture. He has just started standing without support for a few seconds. Furthermore, the father reports that the boy's toes spread outward when the soles of his feet are tickled during bath time. The parents read online that this foot reflex indicates brain damage. The patient was born at term following an uncomplicated pregnancy. He easily picks up small pieces of cereal using the tips of his thumb and index finger. His vocabulary includes "mama", "dada", "ball", and "no", which he uses appropriately. He enjoys playing interactive games like peek-a-boo. Neurologic examination demonstrates symmetric muscle tone. Plantar stimulation yields bilateral dorsiflexion of the great toe and fanning of the lesser toes. Which of the following is the most appropriate next step in the care of this patient?

Match each clinical presentation with the most appropriate first-line targeted antimicrobial therapy.

Match each clinical presentation of a hypertensive emergency to the most appropriate initial targeted pharmacologic intervention. Assume all patients require immediate medical management.

A 14-year-old adolescent female is brought to the office by her mother because she has not yet had her first menstrual period. The mother experienced menarche at age 12 and is highly anxious that her daughter may have an underlying reproductive or genetic disorder. The patient feels well, performs excellently in high school, and participates in recreational swimming two days a week. She reports a noticeable growth spurt over the past 18 months. Her medical history is unremarkable, and she takes no medications. On physical examination, her height is at the 65th percentile and weight is at the 55th percentile. Breast examination reveals projection of the areola and papilla to form a secondary mound above the level of the breast. Coarse, curly pubic hair covers the mons pubis but does not extend to the medial thighs. External genitalia appear normal with a patent vaginal opening. Which of the following is the most appropriate next step in management?

A 68-year-old man with a history of advanced prostate cancer presents to the emergency department with a 3-day history of progressively worsening mid-back pain and new-onset bilateral leg weakness. Earlier today, he developed urinary incontinence. Neurologic examination reveals 3/5 motor strength in both lower extremities, hyperreflexia at the knees and ankles, and decreased sensation to pinprick below the T10 dermatome level. Suspecting an oncologic emergency, arrange the following clinical interventions in the most appropriate chronological sequence for managing this patient.

A 72-year-old man is brought to the emergency department by emergency medical services due to severe, progressively worsening shortness of breath that began abruptly $4\text{ hours}$ ago. Over the past week, he has noticed increased swelling in his lower legs and difficulty sleeping flat. He has a history of essential hypertension, type 2 diabetes mellitus, and a 50-pack-year smoking history. Current medications include metformin, sitagliptin, and amlodipine. On arrival, he is visibly distressed, diaphoretic, and using accessory muscles of respiration. Temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), pulse is $118/\text{min}$, blood pressure is $178/102\text{ mm Hg}$, and respirations are $28/\text{min}$. Pulse oximetry shows an oxygen saturation of $88\%$ on room air. Physical examination reveals jugular venous distention to the angle of the mandible while the patient is sitting upright. Lung auscultation reveals prolonged expiration, diffuse expiratory wheezes, and fine crackles at both lung bases. Cardiac auscultation reveals a regular tachycardia and an S3 gallop. Bilateral 2+ pitting edema is present up to the mid-calves.

Laboratory studies show:
Leukocyte count: $8,400/\text{mm}^3$
Serum sodium: $136\text{ mEq/L}$
Serum potassium: $4.1\text{ mEq/L}$
Serum bicarbonate: $16\text{ mEq/L}$
Blood urea nitrogen: $32\text{ mg/dL}$
Serum creatinine: $1.4\text{ mg/dL}$
Serum lactate: $4.0\text{ mmol/L}$
Thyroid-stimulating hormone (TSH): $1.8\ \mu\text{U/mL}$ (Normal: $0.4 - 4.0\ \mu\text{U/mL}$)
Free thyroxine (T4): $0.6\text{ ng/dL}$ (Normal: $0.9 - 1.7\text{ ng/dL}$)

Arterial blood gas on room air:
pH: $7.34$
pCO2: $30\text{ mm Hg}$
pO2: $58\text{ mm Hg}$

A chest radiograph shows cardiomegaly, bilateral perihilar opacities, and fluid in the horizontal fissure. Gram stain of the frothy sputum shows rare polymorphonuclear leukocytes and abundant normal respiratory flora without predominant organisms.

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

A medical student is preparing for the pediatrics shelf examination by reviewing normal developmental milestones. Precise knowledge of the chronological emergence of fine motor skills is essential for recognizing developmental delays during routine well-child visits. Arrange the following fine motor milestones in the chronological order in which they are typically achieved by a normally developing child, from earliest to latest.

A 24-year-old man is admitted to the hospital with newly diagnosed Burkitt lymphoma. He has a massive abdominal mass and significant cervical lymphadenopathy. Temperature is 37.2°C (99.0°F), blood pressure is 120/78 mmHg, heart rate is 88/min, and respiratory rate is 16/min. Initial laboratory studies show:

The patient is scheduled to receive intensive, multi-agent cytotoxic induction chemotherapy. Arrange the following interventions in the most appropriate chronological sequence for the prophylaxis and subsequent step-wise management of tumor lysis syndrome in this patient.

A 64-year-old woman with a 10-year history of severe, erosive rheumatoid arthritis comes to the emergency department due to a 2-week history of worsening shortness of breath, orthopnea, and a persistent dry cough. Four months ago, her rheumatologist added a new biologic disease-modifying antirheumatic drug (DMARD) to her regimen of methotrexate and folic acid due to inadequate joint symptom control. She also has a history of mild asthma and diet-controlled type 2 diabetes mellitus.

Vital signs are temperature 37.1°C (98.8°F), blood pressure 110/70 mm Hg, pulse 108/min, and respirations 22/min. Oxygen saturation is 92% on room air.

Physical examination reveals jugular venous distention to 10 cm H2O. Pulmonary auscultation reveals bibasilar crackles without wheezing. Cardiac examination shows a regular tachycardia with a prominent S3 gallop. There is 2+ pitting edema in the bilateral lower extremities.

Chest radiograph reveals bilateral interstitial markings, prominent pulmonary vasculature, and cardiomegaly.

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

Match each clinical scenario describing a high-risk infectious exposure with the most appropriate post-exposure prophylaxis (PEP) or management strategy.

A 68-year-old man is brought to the emergency department by his daughter due to a 1-week history of progressively worsening lethargy, confusion, and severe mid-back pain. He has a past medical history of chronic obstructive pulmonary disease (COPD) and hypertension. For the past few days, he has also experienced severe constipation and increased urinary frequency. His temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $105/65\text{ mmHg}$, heart rate is $108/\text{min}$, and respiratory rate is $16/\text{min}$. Physical examination reveals dry mucous membranes and diminished skin turgor. His lungs are clear to auscultation bilaterally. Neurologic examination shows a lethargic patient who is oriented only to person. There are no focal motor or sensory deficits. Initial laboratory studies show:

Which of the following is the most appropriate initial step in the management of this patient?

A $54$-year-old man is evaluated in the emergency department for a fever and chills that started $6$ hours ago. He has a history of diffuse large B-cell lymphoma and received his most recent cycle of chemotherapy $10$ days ago. His temperature is $39.1^\circ$ C ($102.4^\circ$ F), blood pressure is $110/70$ mm Hg, pulse is $115$/min, and respirations are $24$/min. Physical examination is unremarkable, with no focal source of infection identified. His central venous port site appears clean without erythema or induration.

Laboratory results are as follows:

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

Emergency medical services bring a 59-year-old woman to the emergency department after her daughter found her unarousable at home. The daughter reports that the patient has had a productive cough, subjective fevers, and generalized weakness for the past three days. Medical history is significant for severe chronic obstructive pulmonary disease and type 2 diabetes mellitus. Her current temperature is 38.6°C (101.5°F), blood pressure is 88/54 mm Hg, pulse is 118/min, and respirations are 24/min and shallow. Pulse oximetry shows 84% on room air. On physical examination, the patient is obtunded and only withdraws to painful stimuli. Lung auscultation reveals diffuse coarse rhonchi bilaterally.

A peripheral intravenous line is established, and a bolus of isotonic crystalloid is initiated along with empiric ceftriaxone and azithromycin. Which of the following is the most appropriate next step in the management of this patient?

During a shift in the emergency department, you evaluate a febrile patient who reports recent intravenous drug use. Physical examination reveals splinter hemorrhages, Janeway lesions, and a prominent holosystolic murmur at the apex radiating to the axilla. Suspecting acute infective endocarditis, the medical team prepares to initiate care. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological order.

A 68-year-old man presents to the clinic with progressive dyspnea and a nonproductive cough over the past week. He reports waking up several times at night feeling starved for air and has recently started using three pillows to sleep comfortably. His medical history includes hypertension, hyperlipidemia, and a 30-pack-year smoking history, though he quit 10 years ago. Current medications include amlodipine and atorvastatin. Blood pressure is 155/92 mm Hg, pulse is 96/min, and respirations are 22/min. Oxygen saturation is 92% on room air. Physical examination shows elevated jugular venous pressure. Lung auscultation reveals bibasilar crackles and mild expiratory wheezing. There is 2+ pitting edema in the bilateral lower extremities. Which of the following is the most appropriate next step in pharmacological management?

Select the newly indicated universal screening test that corresponds to each pediatric patient attending their scheduled health maintenance visit according to current guidelines.