Tüm alıştırma soruları

A 39-week gestation male neonate is born via spontaneous vaginal delivery to a 28-year-old primigravida. The pregnancy was uncomplicated. At birth, the neonate is limp, apneic, and cyanotic. Place the following steps of neonatal resuscitation in the correct chronological order of execution according to standard neonatal resuscitation guidelines, assuming the neonate's clinical status does not improve and the heart rate remains consistently below 60/min despite each successive intervention.

A 35-year-old woman is evaluated in the clinic for progressively worsening pain and color changes in her fingers. She has a known history of diffuse cutaneous systemic sclerosis. She describes her fingers turning white, then blue, and finally red upon exposure to cold. These episodes are now occurring even in mildly cool environments and are severely impacting her daily activities. Physical examination reveals thickened skin over her hands and forearms, as well as tiny, pitted scars on the distal fingertips. She asks about the therapeutic options available for her condition as it progresses.

Arrange the following interventions in the standard stepwise order of therapeutic escalation for the management of Raynaud phenomenon, from the initial approach to the final option for medically refractory, critical ischemia.

A 54-year-old woman is evaluated on the general medical ward for new-onset chills and a temperature of 38.8°C (101.8°F). She recently completed her second cycle of systemic chemotherapy for invasive ductal carcinoma. Laboratory studies demonstrate a white blood cell count of 900/mm³ and an absolute neutrophil count of 250/mm³. Her blood pressure is 110/70 mm Hg, pulse is 105/min, and respiratory rate is 18/min. Physical examination reveals an indwelling central venous port in the right upper chest with no overlying erythema, fluctuance, or tenderness. The remainder of the examination is unremarkable.

Arrange the following steps in the most appropriate chronological order for the acute diagnostic and therapeutic management of this patient.

A 26-year-old woman presents to the clinic for sexually transmitted infection screening. She reports having condomless sexual intercourse with a new male partner three weeks ago. She recently learned that this partner is living with HIV and is not taking any medications. She currently feels well and has no symptoms of acute illness. Vital signs and physical examination are unremarkable. The physician decides to evaluate her for HIV. Assuming her initial screening test is reactive, but her subsequent confirmatory antibody test is indeterminate, arrange the following diagnostic and management steps in the correct chronological sequence according to the standard Centers for Disease Control and Prevention (CDC) HIV algorithm.

A 38-week gestation male neonate is born via spontaneous vaginal delivery. Immediately after birth, he develops severe respiratory distress, cyanosis, and grunting. Physical examination reveals a scaphoid abdomen, absent breath sounds over the left hemithorax, and heart sounds displaced to the right. The medical team highly suspects a congenital diaphragmatic hernia. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 28-year-old woman, gravida 2 para 1, presents to the labor and delivery unit in active labor. Her prenatal laboratory screening is positive for Hepatitis B surface antigen (HBsAg). She delivers a healthy, full-term male newborn. The pediatric team formulates a comprehensive management pathway to prevent vertical Hepatitis B transmission, confirm the infant's immunity, and manage potential vaccine non-response. Arrange the following steps in the standard protocol for this infant in the correct chronological order, representing the sequence of interventions from birth through the management of an inadequate initial immune response (anti-HBs < 10 mIU/mL).

A 28-year-old male graduate student presents to the university health center reporting a 3-day history of profound fatigue, a severe sore throat, and a widespread rash. He notes that 14 days ago, he engaged in unprotected receptive anal intercourse with a new male partner whose infectious status is unknown. His temperature is $38.4^\circ\text{C}$ ($101.1^\circ\text{F}$). Physical examination reveals tender cervical and axillary lymphadenopathy, pharyngeal erythema without exudate, and a diffuse maculopapular rash on the trunk and extremities. The physician suspects an acute viral illness and initiates the standard diagnostic algorithm for the most likely pathogen.

Arrange the following steps in the most appropriate chronological sequence for the diagnosis and initial management of this patient.

A 68-year-old woman is admitted to the hospital with profound fatigue, exertional dyspnea, and tingling in her toes. Laboratory studies reveal a hemoglobin of $5.8\text{ g/dL}$, a mean corpuscular volume (MCV) of $122\text{ fL}$, and a platelet count of $105,000/\mu\text{L}$. A peripheral blood smear demonstrates macro-ovalocytes and neutrophils with six to seven nuclear lobes. The patient is diagnosed with severe cobalamin (vitamin $B_{12}$) deficiency secondary to pernicious anemia, and daily intramuscular cyanocobalamin therapy is initiated.

Arrange the following anticipated clinical and hematologic responses in the correct chronological order of their occurrence, from earliest to latest.

A $24$-year-old man presents to the clinic with a $2$-month history of painless swelling in the right side of his neck. He also reports drenching night sweats and an unintentional $5$-kg ($11$-lb) weight loss over this period. Physical examination reveals a non-tender, firm, mobile $3$-cm cervical lymph node. Arrange the following steps in the correct sequential order for the definitive diagnosis, staging, and management of this patient's most likely condition.

A 48-year-old woman is brought to the emergency department by her husband due to a 24-hour history of severe generalized headache, high fever, and progressive confusion. She has a history of a deceased-donor renal transplant 3 years ago and takes tacrolimus, mycophenolate mofetil, and prednisone. Her temperature is 39.2°C (102.6°F), blood pressure is 112/68 mmHg, pulse is 115/min, and respirations are 18/min. On examination, the patient is lethargic but arousable to verbal stimuli. Marked nuchal rigidity is present. Neurologic examination reveals a new-onset right-sided pronator drift and a mild right lower facial droop. Arrange the following next steps in management in the most appropriate chronological order.

A pediatric clinic is auditing its health maintenance protocols to ensure alignment with current American Academy of Pediatrics (AAP) guidelines. As part of the protocol review, the clinical director maps out the timeline for required universal screenings for patients with no specific medical or family risk factors. Arrange the following universal pediatric screening interventions in the expected chronological order that they are first recommended for a typically developing, average-risk child, from earliest to latest age.

A 45-year-old woman presents to the clinic with a 3-month history of bilateral wrist and metacarpophalangeal joint pain, accompanied by 2 hours of morning stiffness. Physical examination reveals symmetric synovitis of the hands and wrists. Arrange the following clinical steps in the most appropriate chronological order for the diagnosis and longitudinal pharmacologic management of this patient, assuming she experiences inadequate treatment responses at each subsequent stage.

A 68-year-old woman is brought to the emergency department by her family due to a severe headache, fever, and confusion that started earlier today. On examination, her temperature is 39.2°C (102.6°F), blood pressure is 110/70 mm Hg, and heart rate is 115/min. She exhibits nuchal rigidity and a new-onset right-sided facial droop with right arm weakness. Arrange the following steps in the most appropriate chronological sequence for the immediate management of this patient.

Arrange the following developmental milestone groupings in the chronological order they would typically be expected to first appear in a neurotypically developing child, from earliest age to latest age.

A term neonate born to a mother with blood type O, Rh-negative develops visible scleral and cutaneous icterus at 24 hours of life. Assuming the infant has confirmed ABO incompatibility and the clinical condition progressively worsens despite each preceding intervention, arrange the following diagnostic and therapeutic steps in the correct escalating chronological sequence.

A $38$-year-old woman is brought to the emergency department due to a $4$-day history of worsening fatigue, spontaneous bruising, and continuous oozing of blood from her gums. Her temperature is $37.9^\circ\text{C}$ ($100.2^\circ\text{F}$), blood pressure is $110/65 \text{ mm Hg}$, and pulse is $112/\text{min}$. Physical examination shows scattered petechiae and large ecchymoses over her extremities.

Laboratory studies reveal the following:

A peripheral blood smear demonstrates pancytopenia and atypical promyelocytes with abundant primary granules and multiple rod-like intracytoplasmic inclusions bundled together.

Arrange the following steps in the most appropriate chronological order for the diagnosis and management of this patient's condition:

A term newborn is delivered via emergency cesarean section due to fetal bradycardia. At birth, the infant is apneic, limp, and cyanotic. Assume the infant's condition continues to deteriorate and fails to respond to each successive intervention. Arrange the following neonatal resuscitation steps in the correct chronological order according to standard guidelines.

A 42-year-old man presents to the emergency department with a 4-week history of a persistent productive cough, subjective low-grade fevers, drenching night sweats, and an unintentional 5-kg (11-lb) weight loss. He immigrated to the United States from Southeast Asia five years ago. His vital signs are temperature 38.1°C (100.6°F), blood pressure 118/76 mmHg, heart rate 92/min, and respiratory rate 18/min. A portable chest radiograph performed in the emergency department demonstrates a 3-cm cavitary lesion in the apical segment of the right upper lobe. The patient is currently resting in a standard emergency department examination room with the door closed.

Arrange the following interventions in the most appropriate chronological sequence for the comprehensive management of this patient.

A 38-week-gestation male neonate is born to a 28-year-old G2P1 mother with blood type O, Rh-negative. The mother did not receive prenatal care or anti-D immune globulin during her pregnancy. At 8 hours of life, the infant becomes progressively lethargic and is noted to have significant scleral icterus and jaundice extending to the lower abdomen. A transcutaneous bilirubin measurement is markedly elevated above the 95th percentile for his age in hours. Arrange the following diagnostic and therapeutic steps in the most appropriate escalating chronological sequence for the management of this patient's condition.

A 68-year-old man with a history of prostate cancer presents to the emergency department with progressively worsening lower back pain for the past two weeks. Today, he developed profound weakness in both legs and has been unable to urinate for the past 12 hours. Physical examination reveals motor strength of $3/5$ in the bilateral lower extremities, decreased pinprick sensation below the umbilicus, and hyperreflexia at the knees and ankles. The bladder is palpable above the pubic symphysis. Arrange the following management steps in the most appropriate chronological order for this patient.