Tüm alıştırma soruları

A female infant born at 26 weeks gestation is evaluated in the neonatal intensive care unit on day 16 of life. The nursing staff notes that she has become increasingly lethargic over the last 6 hours and has had multiple episodes of apnea and bradycardia. She has been tolerating small volumes of expressed breast milk via an orogastric tube. Vital signs show a temperature of 35.1°C (95.2°F), heart rate of 178/min, and blood pressure of 42/22 mm Hg. Physical examination reveals a tense, shiny, and grossly distended abdomen with absent bowel sounds. Capillary refill time is 4 seconds. Laboratory studies demonstrate a leukocyte count of 3,200/mm³ and a serum bicarbonate of 11 mEq/L. A supine anteroposterior abdominal radiograph displays air in the bowel wall and a distinct area of radiolucency outlining the falciform ligament. Which of the following is the most appropriate next step in management?

During a busy winter shift in the pediatric emergency department, a physician evaluates an infant born at term who is now 7 months of age. The child's parents report a three-day prodrome of rhinorrhea and low-grade pyrexia, which has recently progressed to marked work of breathing and a refusal to breastfeed. Vital signs demonstrate a temperature of 37.9°C (100.2°F), respiratory rate of 74/min, heart rate of 172/min, and a pulse oximetry reading of 87% on ambient air. Physical examination reveals an irritable infant with significant nasal flaring, prominent suprasternal retractions, and diffuse bilateral polyphonic wheezes and fine crackles. The child has no history of atopy, eczema, or previous wheezing episodes. Which of the following interventions represent appropriate management for this patient? (Select exactly 2 options)

An $8$-year-old boy with a known history of severe hemophilia A is brought to the emergency department by his parents after falling from a tree and striking his head. The parents report a brief loss of consciousness. He is now awake but complains of a severe headache and has vomited twice. His vital signs are temperature $37.1^\circ\text{C}$, heart rate $110\text{ /min}$, blood pressure $115/75\text{ mmHg}$, and respiratory rate $20\text{ /min}$. Physical examination reveals a large boggy hematoma over the right parietal region. Neurologic examination shows a Glasgow Coma Scale score of $14$ (confused conversation). Arrange the following management steps in the most appropriate chronological order for this patient.

A 29-year-old man is evaluated in the clinic for a 4-week history of chronic cough, night sweats, and weight loss. Sputum acid-fast bacilli smear and culture confirm a diagnosis of active pulmonary tuberculosis. The patient is employed as a public transit bus driver. He has not signed any documents authorizing the release of his protected health information. Based on medical ethics and federal privacy regulations, which of the following disclosures regarding this patient's medical information are permissible WITHOUT his explicit consent? (Select all that apply)

A $26$-year-old woman, gravida $2$, para $1$, at $39$ weeks gestation undergoes an uncomplicated vaginal delivery of a $3800$ g neonate. During the third stage of labor, excessive umbilical cord traction is applied before complete placental separation. Shortly after, a firm, purple, globular mass is noted protruding from the introitus, and the uterine fundus is no longer palpable in the abdomen. The patient experiences sudden, severe vaginal bleeding and her blood pressure drops to $85/50$ mmHg. Arrange the following steps in the optimal chronological order for the acute management of this obstetric emergency.

A $33$-year-old woman comes to the clinic reporting the absence of menses for the past $9$ months. Her menarche occurred at age $12$, and her menstrual cycles were regular every $28$ days until $9$ months ago. She also reports progressive fatigue, feeling cold constantly, and a $6\text{-kg}$ ($13\text{-lb}$) weight gain over the past year despite no changes in her diet or exercise routine. She occasionally notices a milky white discharge from her breasts. The patient has no headaches, visual field deficits, or abnormal facial hair growth. She takes no medications and uses condoms for contraception. Vital signs show a blood pressure of $110/70\text{ mm Hg}$, pulse of $58/\text{min}$, and temperature of $36.5^\circ\text{C}$ ($97.7^\circ\text{F}$). Her body mass index is $26\text{ kg/m}^2$. The thyroid gland is not palpable. Breast examination reveals bilateral, non-bloody, milky discharge that is easily expressible on palpation. Neurologic examination shows a delayed relaxation phase of the patellar reflexes. Visual fields are full to confrontation. A urine pregnancy test is negative.

Laboratory studies show the following:
Prolactin: $68\text{ ng/mL}$ (Normal: $4$ - $23\text{ ng/mL}$)
Thyroid-stimulating hormone (TSH): $0.2\text{ } \mu\text{U/mL}$ (Normal: $0.5$ - $5.0\text{ } \mu\text{U/mL}$)
Free thyroxine (T4): $0.4\text{ ng/dL}$ (Normal: $0.9$ - $2.4\text{ ng/dL}$)

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

An asymptomatic 26-year-old pregnant woman, gravida 2, para 1, is evaluated at the clinic during her 10th week of gestation for a routine prenatal visit. Her medical history is unremarkable, and her prior pregnancy ended in an uncomplicated full-term vaginal delivery. The patient reports no pelvic pain, dysuria, vaginal itching, or abnormal discharge. Vital signs are within normal limits. During a speculum examination performed for routine cervical cancer screening, a scant amount of thin, homogeneous, grayish fluid is noted in the vaginal vault. Point-of-care testing of the fluid reveals a pH of 5.0. Microscopic evaluation of a wet mount preparation demonstrates rare leukocytes and multiple squamous epithelial cells studded with coccobacilli that obscure the cell borders. An amine odor is appreciated upon the addition of 10% potassium hydroxide to the sample. Which of the following is the most appropriate next step in the management of this patient?

Match each clinical presentation during routine prenatal care with its most appropriate next step in management based on standard obstetric protocols.

Match each of the following definitive histopathologic or mucosal biopsy findings to the corresponding pediatric gastrointestinal disorder it most accurately diagnoses.

Match the characteristic histopathologic finding with the most likely associated gynecologic neoplasm.

A 14-month-old infant is brought to the emergency department with a 3-day history of severe watery diarrhea and non-bilious vomiting. On examination, the infant is lethargic, has sunken eyes, dry mucous membranes, and a delayed capillary refill of 4 seconds. Vital signs show a heart rate of 170/min, respiratory rate of 40/min, and blood pressure of 70/40 mmHg. Arrange the following management steps in the correct sequential order from immediate priority to subsequent care.

A 34-year-old multiparous woman delivers a 4200-g (9 lb 4 oz) neonate vaginally following a prolonged second stage of labor. Routine prophylactic intravenous oxytocin is administered immediately after delivery. Ten minutes later, the placenta delivers spontaneously and intact. Shortly after, the patient develops profuse vaginal bleeding. Her blood pressure is 90/50 mm Hg, and her pulse is 118/min. On abdominal examination, the uterine fundus is soft, boggy, and palpable just above the umbilicus. Speculum examination reveals no vaginal or cervical lacerations. Arrange the following management steps for this patient's hemorrhage in the correct sequential order, from the initial immediate intervention to the most invasive definitive treatment.

A 64-year-old postmenopausal woman presents to her physician complaining of progressively worsening abdominal bloating, early satiety, and vague pelvic pressure over the past three months. She has no significant past medical history and takes no medications. Her physical examination reveals a positive fluid wave indicating ascites and a firm, immobile, irregular mass palpable in the right adnexa. Arrange the following steps in the standard diagnostic and initial therapeutic management pathway for this patient in the correct chronological sequence.

Match each clinical presentation of an obstetric complication to its most likely etiology.

A 4-year-old unimmunized boy is brought to the emergency department by his parents due to the sudden onset of a high fever and difficulty breathing. His parents state that he was well yesterday but woke up this morning complaining of a severe sore throat and pain with swallowing. In the exam room, the child appears toxic, anxious, and is leaning forward with his neck extended and mouth open. He is actively drooling. His temperature is $39.5^\circ\text{C}$ ($103.1^\circ\text{F}$), heart rate is $145/\text{min}$, respiratory rate is $32/\text{min}$, and oxygen saturation is $94\%$ on room air. Inspiratory stridor is audible without a stethoscope.

Arrange the following steps in the most appropriate chronological order for the management of this patient.

Match each patient's clinical profile with the most appropriate contraceptive method based on the World Health Organization Medical Eligibility Criteria (WHO MEC) and non-contraceptive benefits.

A 22-year-old nulliparous woman presents to the emergency department reporting severe lower abdominal pain, nausea, and multiple episodes of vomiting over the past 24 hours. Her temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), blood pressure is 105/65 mm Hg, and pulse is 112/min. Physical examination reveals significant lower abdominal tenderness with involuntary guarding. You suspect severe, complicated pelvic inflammatory disease. Arrange the following diagnostic and management steps in the most appropriate chronological sequence for this patient.

Match each gestational age milestone during an uncomplicated pregnancy with the most appropriate routine prenatal screening or intervention recommended by standard obstetric guidelines.

A $28$-year-old primigravida at $40$ weeks gestation is admitted to the labor and delivery unit in active labor. Her prenatal course was uncomplicated. She receives epidural anesthesia and progresses to complete cervical dilation. For the past two hours, she has been actively pushing. Her blood pressure is $112/72$ mm Hg, pulse is $88$/min, and temperature is $37.1^\circ$ C ($98.8^\circ$ F). Uterine contractions occur every $3$ to $4$ minutes and are of adequate intensity. Fetal presentation is cephalic, and the position is direct occiput anterior. The fetal station is $+3$, with the fetal scalp visible at the introitus between contractions. Continuous electronic fetal monitoring previously showed a baseline of $135$/min with moderate variability and early decelerations. However, over the past $15$ minutes, the baseline has decreased to $105$/min, variability has become absent, and there are recurrent late decelerations with every contraction. Which of the following is the most appropriate next step in management?

The parents of a 6-month-old boy of Mediterranean descent bring him to the clinic for a routine evaluation. They report that he has been increasingly fussy, easily fatigued, and feeding poorly over the past month. The parents also express two additional concerns: they are worried because he cannot sit up independently, and they request he receive his measles, mumps, and rubella (MMR) vaccine today to finish his immunizations early. He was born at full term, and his growth has consistently tracked along the 50th percentile. His temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), heart rate is $155/\text{min}$, and respiratory rate is $36/\text{min}$. On physical examination, the infant appears notably pale. A grade 2/6 systolic ejection murmur is auscultated at the left lower sternal border. The liver edge is palpated $3\text{ cm}$ below the right costal margin, and the spleen is palpable $4\text{ cm}$ below the left costal margin. Neurologic examination reveals normal symmetric tone; he sits with truncal support and successfully rolls from front to back.

Laboratory testing reveals:
Hemoglobin: $6.2\text{ g/dL}$
Mean corpuscular volume (MCV): $62\text{ fL}$
Reticulocyte count: $7\%$
Thyroid-stimulating hormone (TSH): $2.5\text{ \mu U/mL}$ (normal: $0.5-5.0\text{ \mu U/mL}$)
Free T4: $1.4\text{ ng/dL}$ (normal: $0.9-2.3\text{ ng/dL}$)

A peripheral blood smear shows microcytic, hypochromic red blood cells with numerous target cells.

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