Tüm alıştırma soruları

A 14-day-old male neonate is brought to the pediatric clinic by his parents due to a facial rash that appeared 2 days ago. The infant was born at 39 weeks gestation via uncomplicated vaginal delivery to a 25-year-old primigravida. His birth weight was 3.4 kg (7 lb 8 oz), and Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The parents report that the infant is breastfeeding vigorously every 2 to 3 hours and produces 6 to 8 wet diapers daily. Maternal history is significant for recurrent genital herpes; she was treated with daily acyclovir starting at 36 weeks gestation and had no active lesions at the time of delivery. Maternal group B Streptococcus screening was negative.

The infant appears comfortable and well-hydrated. Current vital signs are as follows:

Physical examination reveals multiple $1$- to $2\text{-mm}$ erythematous papules and pustules predominantly distributed across the cheeks, chin, and forehead. There are no vesicles, comedones, or areas of honey-colored crusting. The lesions lack a broad surrounding area of erythema. The remainder of the physical examination, including a detailed neurologic assessment, is normal.

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

During a health maintenance visit, a 54-year-old man reports a four-month history of worsening sluggishness, generalized muscle aches, and dry skin. He mentions needing to wear a sweater even when indoors. His temperature is $36.0^\circ\text{C}$ ($96.8^\circ\text{F}$), blood pressure is $112/74\text{ mmHg}$, and pulse is $54/\text{min}$. Physical examination reveals a puffy face, nonpitting edema of the lower extremities, and a notably delayed relaxation phase of the deep tendon reflexes. The thyroid gland is not palpable.

Laboratory evaluation shows the following:

Which of the following mechanisms best explains this patient's clinical presentation and laboratory findings?

A 56-year-old man presents to the clinic with a 6-month history of worsening fatigue, generalized weakness, and decreased libido. He also reports new-onset discomfort in his hands, specifically involving the second and third metacarpophalangeal joints. On physical examination, there is hepatomegaly and a grayish-bronze discoloration of his skin. Laboratory studies show a fasting blood glucose level of 142 mg/dL. Thyroid function testing reveals a free thyroxine (T4) level of 0.6 ng/dL (normal: 0.9-1.7 ng/dL) and a thyroid-stimulating hormone (TSH) level of 1.4 mU/L (normal: 0.4-4.2 mU/L). Which of the following is the most likely underlying mechanism for this patient's thyroid laboratory findings?

A term male neonate is born at 39 weeks gestation to a 28-year-old mother who received no prenatal care. Her blood type is subsequently found to be O-negative. The infant develops visible scleral and cutaneous jaundice within the first 12 hours of life. Arrange the following diagnostic and therapeutic interventions in the correct escalating sequence for managing suspected severe isoimmune hemolytic disease of the newborn, from the initial evaluation to the most advanced intervention for severe, refractory cases.

During a routine prenatal evaluation at 34 weeks gestation, a primigravid patient with a well-documented history of systemic lupus erythematosus reports new-onset swelling in her hands and face over the past week. Her blood pressure today is 152/96 mmHg, which is elevated from a baseline of 110/70 mmHg. Laboratory evaluation reveals a serum creatinine of 1.1 mg/dL (baseline 0.6 mg/dL) and a urine dipstick showing 3+ protein. The physician is attempting to determine whether these findings represent severe preeclampsia or an acute lupus nephritis flare. Which of the following laboratory findings would most specifically support a diagnosis of an active lupus flare in this patient?

Match each specific clinical presentation and isolated pathogen of infective endocarditis with its most appropriate targeted antimicrobial regimen according to current clinical guidelines.

A 24-year-old woman presents to the clinic with a 2-month history of a photosensitive facial rash, profound fatigue, and symmetric inflammatory polyarthralgia. Over the next several months, her disease progresses and she develops significant peripheral edema and frothy urine. Arrange the following diagnostic and therapeutic steps in the optimal chronological sequence for managing this patient's evolving condition, from initial presentation to the long-term management of her organ-threatening disease.

Match each complex clinical scenario and corresponding arterial blood gas/basic metabolic panel profile with the most accurate interpretation of the patient's mixed acid-base disorder. Evaluate the anion gap, delta gap (delta-delta), and appropriate respiratory compensation to determine the correct physiological state.

Match the following neonatal clinical presentations and investigative findings to their most likely underlying diagnosis.

Shortly after an uncomplicated, scheduled cesarean delivery at 38 weeks of gestation for breech presentation, an infant develops rapid, shallow breathing. The mother received standard prenatal care and had intact membranes until the time of the operation. At 2 hours of life, the neonate's respiratory rate is 74/min, and oxygen saturation is 96% on room air. Physical examination reveals mild nasal flaring, subcostal retractions, and clear breath sounds bilaterally. Cardiac auscultation demonstrates a regular rate and rhythm without murmurs. Additionally, the physician notes several scattered blanching erythematous macules containing central yellow-white papules on the infant's chest and abdomen. A chest radiograph demonstrates hyperinflation, prominent perihilar vascular markings, and a small amount of fluid in the right minor fissure. Which of the following is the most appropriate management for this patient?

A $56$-year-old man is brought to the emergency department after vomiting a large amount of bright red blood. He has a history of alcohol use disorder and was diagnosed with cirrhosis two years ago. On arrival, he is lethargic but easily arousable. His temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $88/54\text{ mm Hg}$, pulse is $118/\text{min}$, and respiratory rate is $20/\text{min}$. Physical examination reveals scleral icterus, spider angiomas on the chest, and a distended abdomen with shifting dullness. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 45-year-old woman presents to the clinic with episodic palpitations, severe headaches, and unprovoked sweating. Her blood pressure during these episodes reaches 190/110 mmHg. The physician suspects a pheochromocytoma. Arrange the following steps in the correct chronological sequence for the standard workup and management of this condition.

A 48-year-old man is hospitalized for the initiation of induction chemotherapy for recently diagnosed Burkitt lymphoma. Twenty-four hours after starting the multi-agent regimen, he develops diffuse muscle cramps, generalized weakness, and nausea. His temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $115/75\text{ mmHg}$, pulse is $112/\text{min}$, and respirations are $18/\text{min}$. Physical examination reveals hyperactive deep tendon reflexes and occasional muscle twitching. Laboratory results are as follows:

* Sodium: $138\text{ mEq/L}$
* Potassium: $7.1\text{ mEq/L}$
* Bicarbonate: $18\text{ mEq/L}$
* Blood urea nitrogen (BUN): $48\text{ mg/dL}$
* Creatinine: $3.2\text{ mg/dL}$ (Baseline: $0.9\text{ mg/dL}$)
* Calcium: $6.2\text{ mg/dL}$
* Phosphorus: $9.0\text{ mg/dL}$
* Uric acid: $15.5\text{ mg/dL}$

An electrocardiogram reveals peaked T waves and a shortened QT interval. Which of the following is the most appropriate immediate next step in management?

A $6$-day-old male neonate is evaluated in the emergency department due to poor feeding, lethargy, and increased work of breathing over the past $12$ hours. He was born at $39$ weeks gestation via an uncomplicated vaginal delivery and was discharged home at $48$ hours of life. Temperature is $36.4^\circ\text{C}$ ($97.5^\circ\text{F}$), heart rate is $185$/min, and respiratory rate is $68$/min. Oxygen saturation is $94\%$ on room air in the right hand; a reliable plethysmographic waveform cannot be obtained in either foot. Physical examination reveals an ashen, mottled appearance with a prolonged capillary refill time of $5$ seconds. Marked subcostal retractions and grunting are present. The right brachial pulse is full and bounding, while bilateral femoral pulses are barely palpable. Blood pressure measured in the right arm is $84/45$ mmHg, and in the left leg is $46/24$ mmHg. Arterial blood gas analysis reveals a pH of $7.12$, pCO $_2$ of $32$ mmHg, and pO $_2$ of $75$ mmHg, with a calculated bicarbonate of $10$ mEq/L. Which of the following is the most appropriate initial step in management?

A 6-year-old girl is brought to the pediatric oncology clinic by her father. The patient has acute lymphoblastic leukemia and is currently in the maintenance phase of chemotherapy, which includes daily oral mercaptopurine and weekly oral methotrexate. The father is concerned because the patient's 8-year-old brother was diagnosed with chickenpox yesterday after developing a widespread, pruritic, vesicular rash. The brother's symptoms began 48 hours ago. The patient has no history of clinical chickenpox. Review of her medical record indicates she received her first dose of the varicella vaccine at 12 months of age but missed the second dose. She is currently afebrile and asymptomatic, with an unremarkable physical examination. Which of the following is the most appropriate next step in management?

An evaluation is requested for a $48$-year-old male who reports a pervasive sense of exhaustion, a $12\text{-kg}$ ($26.5\text{-lb}$) weight gain, and significantly reduced libido over the past eight months. He has no significant past medical history and takes no medications.

Vital signs show a blood pressure of $96/60\text{ mmHg}$ and a heart rate of $54/\text{min}$. Neurologic examination reveals bilateral temporal visual field deficits. Deep tendon reflexes exhibit delayed relaxation.

Laboratory studies yield the following results:

The physician determines that thyroid hormone replacement is indicated. Which of the following is the most critical step to perform prior to initiating this specific therapy?

An obstetric patient comes to the clinic for her 16-week follow-up appointment. The 25-year-old primigravida reports mild dizziness upon standing but denies syncope, visual changes, or vaginal bleeding. Her baseline blood pressure prior to conception was 118/76 mm Hg. Today, her vitals include a heart rate of 88/min and a blood pressure of 100/58 mm Hg. Physical examination reveals a grade 1/6 systolic ejection murmur and clear lungs. What is the underlying physiological mechanism responsible for the alteration in her hemodynamics?

A 72-year-old man is brought to the emergency department from a nursing home due to altered mental status, fever, and rapid breathing for the past day. He has a history of benign prostatic hyperplasia and type 2 diabetes mellitus. His temperature is $39.1^\circ\text{C}$ ($102.4^\circ\text{F}$), blood pressure is $85/50\text{ mm Hg}$, pulse is $122/\text{min}$, and respiratory rate is $32/\text{min}$. Physical examination reveals a lethargic man with dry mucous membranes and right costovertebral angle tenderness.

Laboratory results are as follows:

Which of the following best describes this patient's primary and concurrent acid-base disturbances?

Match the following classic urinalysis sediment findings with their most likely associated renal pathology.

A 25-year-old female with a history of type 1 diabetes mellitus is brought to the emergency department by her roommate due to severe lethargy and abdominal pain. Over the preceding 48 hours, she has experienced intractable nonbilious emesis and has consequently withheld her scheduled insulin doses. On physical examination, she appears confused and has markedly dry mucous membranes with decreased skin turgor.

Laboratory results:
- Serum $Na^+$: $140 \text{ mEq/L}$
- Serum $K^+$: $3.4 \text{ mEq/L}$
- Serum $Cl^-$: $86 \text{ mEq/L}$
- Serum $HCO_3^-$: $14 \text{ mEq/L}$
- Serum glucose: $545 \text{ mg/dL}$
- Blood urea nitrogen: $38 \text{ mg/dL}$
- Serum creatinine: $1.6 \text{ mg/dL}$

Assuming a normal anion gap of $12 \text{ mEq/L}$ and a normal serum bicarbonate of $24 \text{ mEq/L}$, what is this patient's calculated delta-delta ratio?