Tüm alıştırma soruları

Match the following postpartum complications to their classic clinical presentations and defining characteristics.

A 26-year-old woman, gravida 1, para 0, presents to the clinic at 6 weeks gestation for her initial prenatal visit. She has a completely uncomplicated medical history. Her blood type is O negative, and her partner is known to be A positive. The patient is a systems engineer and requests a highly detailed, chronological roadmap of her anticipated maternal physiological changes, physical examination milestones, and routine prenatal care interventions. Based on current obstetric guidelines for an uncomplicated normal pregnancy, arrange the following events in the correct chronological order from earliest in gestation to latest.

Match each classic pediatric clinical presentation with the most likely underlying gastrointestinal diagnosis.

A gravida $1$, para $0$ patient at $38$ weeks of gestation presents to the obstetric triage unit with a chief complaint of a sudden gush of clear vaginal fluid that occurred $20$ hours ago. She is currently experiencing painful uterine contractions every $3$ to $4$ minutes. Her temperature is $39.1^\circ\text{C}$ ($102.4^\circ\text{F}$), blood pressure is $112/74\text{ mm Hg}$, pulse is $115/\text{min}$, and respiratory rate is $18/\text{min}$. Physical examination reveals a tender uterine fundus. The cervix is visually assessed at $5\text{ cm}$ dilation and $90\%$ effacement. The fetal heart rate monitor displays a baseline of $168/\text{min}$ with moderate variability and no decelerations. Which of the following is the most appropriate next step in the management of this patient?

Match each pediatric patient's clinical and laboratory presentation to the most likely underlying endocrine disorder.

A 28-year-old male warehouse worker is brought to the emergency department after being crushed laterally against a wall by a moving forklift. Upon arrival, he is confused and diaphoretic. Vital signs are temperature 36.2°C, heart rate 132/min, blood pressure 78/50 mmHg, and respiratory rate 22/min. Oxygen saturation is 96% on room air. Primary survey reveals a patent airway and equal breath sounds bilaterally. The abdomen is soft and non-distended with no peritoneal signs. Palpation of the pelvis reveals gross mechanical instability. Genitourinary examination shows marked scrotal ecchymosis, and digital rectal examination reveals a high-riding prostate. An anteroposterior pelvic radiograph confirms a severely displaced open-book pelvic ring fracture. A pelvic binder is immediately applied, and the patient is resuscitated with 2 units of uncrossmatched packed red blood cells. Following this intervention, his blood pressure remains 80/52 mmHg. A focused assessment with sonography for trauma (FAST) scan is performed and shows no free intraperitoneal or pericardial fluid. Which of the following is the most appropriate next step in management?

Following a spontaneous vaginal delivery, the obstetrician examines the perineum to assess the extent of tissue injury and determine the appropriate surgical repair. Match the following degrees of obstetric perineal lacerations with the correct anatomical structures involved.

Match the following pediatric hematologic malignancies with their characteristic molecular, cytogenetic, or immunophenotypic findings.

A patient at 37 weeks gestation is hospitalized on the antepartum unit for management of preeclampsia with severe features. Her admission laboratory evaluation revealed a platelet count of 70,000/mm³, an aspartate aminotransferase level of 380 U/L, and an alanine aminotransferase level of 410 U/L. She is currently receiving an intravenous magnesium sulfate infusion. Three hours after admission, she suddenly reports acute, excruciating right upper quadrant pain that radiates to her right scapula. Her vital signs now show a blood pressure of 85/45 mm Hg and a heart rate of 132/min. Electronic fetal monitoring demonstrates a baseline heart rate of 155/min with absent variability and recurrent late decelerations. Which of the following is the most appropriate next step in management?

A healthy $28$-year-old woman presents to the outpatient clinic at $9$ weeks gestation for initial obstetric care. Her obstetric history includes an uncomplicated spontaneous vaginal delivery three years ago. She currently complains of mild fatigue and morning nausea but denies palpitations, heat intolerance, or weight loss. Vital signs are normal. The thyroid gland is not enlarged on palpation. Screening laboratory tests return the following results:

Which of the following pairs of maternal adaptations best explains this patient's thyroid panel?

A 31-year-old woman, gravida 2, para 1, is evaluated in the labor ward at 40 weeks gestation. She is currently in the active phase of the first stage of labor. Uterine contractions are occurring every 3 minutes. The continuous electronic fetal heart rate tracing demonstrates a baseline of 135/min with moderate variability. Following each of the last four contractions, the fetal heart rate gradually decreases to a nadir of 115/min and then returns to the baseline roughly 20 seconds after the contraction has finished. Which of the following is the most appropriate initial step in the management of this patient?

A $29$-year-old multiparous woman at $40$ weeks gestation is currently on the labor ward receiving an oxytocin infusion to augment active labor. Her pregnancy history includes $1$ prior uncomplicated vaginal delivery. Vital signs are within normal limits. The continuous electronic fetal monitor displays a baseline heart rate of $145$/min with minimal variability. Upon review of the tracing, the physician notes recurrent, smooth, gradual decreases in the fetal heart rate. The lowest point of each deceleration consistently occurs after the peak of the corresponding uterine contraction, and the heart rate returns to baseline after the contraction has finished. Cervical examination reveals $6$ cm dilation and $80\%$ effacement with the fetal vertex at $0$ station. Which of the following is the most appropriate next step in management?

Match each clinical presentation of a pregnant patient in the third trimester with the pathophysiologic description of the most likely underlying obstetric complication.

A male newborn is evaluated in the neonatal intensive care unit $2$ hours after birth for rapid breathing. The infant was delivered at $38$ weeks gestation via elective cesarean delivery to a $28$-year-old primigravid woman. The mother's pregnancy was uncomplicated, and she did not experience labor prior to the procedure. Her group B Streptococcus screen was negative at $36$ weeks. The infant's Apgar scores were $8$ and $9$ at $1$ and $5$ minutes, respectively. Currently, the infant's temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), heart rate is $150$/min, and respiratory rate is $74$/min. Pulse oximetry is $91\%$ on room air. Physical examination reveals nasal flaring and mild intercostal retractions. Lung auscultation demonstrates clear breath sounds bilaterally without murmurs. A chest radiograph reveals hyperinflation, prominent perihilar vascular markings, and fluid in the interlobar fissures. Which of the following is the most appropriate next step in the management of this patient?

A 4-year-old boy of East Asian descent is admitted to the pediatric ward with a 6-day history of persistent fever measuring up to $39.8^\circ\text{C}$ ($103.6^\circ\text{F}$). His parents report that he has been highly irritable and refuses to eat. On physical examination, the child is tachycardic but normotensive. He has bilateral nonexudative conjunctival injection, cracked and fissured lips, a prominent 'strawberry tongue,' and tender cervical lymphadenopathy. Erythema and edema of the dorsal hands and feet are noted, along with a polymorphous maculopapular rash over the trunk. A baseline transthoracic echocardiogram obtained upon admission shows structurally normal coronary arteries. He is diagnosed with classic Kawasaki disease.

Arrange the following management and follow-up steps in the correct chronological sequence for this patient, starting with immediate inpatient treatment and concluding with long-term outpatient preventive care.

A 4-year-old girl is brought to the pediatric emergency department with a 2-day history of high fever, severe headache, and vomiting. Over the last 6 hours, she has become increasingly lethargic. Her temperature is 39.5°C (103.1°F), heart rate is 145/min, blood pressure is 112/68 mmHg, and respiratory rate is 26/min. On physical examination, she is difficult to arouse. She exhibits marked nuchal rigidity and a newly appreciated right-sided abducens nerve (cranial nerve VI) palsy. The remainder of the neurologic examination is limited by her somnolence but shows symmetric withdrawal to pain.

Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for managing this patient.

Parents bring their 24-month-old son to the outpatient clinic after noticing a large amount of maroon-colored stool in his diaper earlier today. The child has no history of fever, abdominal pain, diarrhea, or vomiting. He is currently playing comfortably in the examination room. Vital signs show a heart rate of 105/min, respiratory rate of 24/min, and blood pressure of 90/55 mm Hg. Physical examination reveals a soft, non-tender abdomen with normal active bowel sounds and no palpable masses. Inspection of the perianal area shows no fissures, but residual maroon-colored stool is present on the examining glove. Which of the following is the most appropriate next diagnostic step to establish the underlying cause of this patient's bleeding?

Paramedics bring a 14-day-old infant to the emergency department due to severe lethargy, poor feeding, and mottled skin. On physical examination, the infant has a depressed level of consciousness and is in marked respiratory distress with grunting and severe subcostal retractions. Capillary refill time is 6 seconds. Vital signs show a heart rate of 195/min, respiratory rate of 75/min, and oxygen saturation of 89% on room air. Palpation of the extremities reveals bounding brachial pulses and imperceptible femoral pulses. Arterial blood gas analysis demonstrates severe uncompensated metabolic acidosis. Arrange the following clinical interventions and diagnostic steps in the most appropriate chronological sequence for managing this patient.

A 29-year-old primigravida at 41 weeks gestation is admitted to the labor and delivery unit for induction of labor due to postterm pregnancy. She is currently receiving a continuous intravenous oxytocin infusion. Her vital signs are temperature 37.0°C (98.6°F), blood pressure 122/78 mmHg, and heart rate 88/min. Cervical examination reveals 7 cm dilation, 100% effacement, and the fetal vertex is at 0 station. Uterine contractions are occurring every 3 minutes and palpate firm. The continuous fetal heart rate monitor shows a baseline of 140/min with minimal variability. There are gradual, symmetric decreases in the fetal heart rate that reach their nadir after the peak of the uterine contractions and return to baseline after the contractions end. These decelerations occur with more than 50% of the contractions. Which of the following is the most appropriate next step in management?

Match each clinical and sonographic presentation of third-trimester complications with the most appropriate obstetric etiology.