Tüm alıştırma soruları

A physician is evaluating a patient who reports intermittent pinkish spotting on her undergarments for the past $3$ weeks. The patient is $58$ years of age, and her last natural menstrual period occurred $7$ years ago. Her medical history is significant for well-controlled type $2$ diabetes mellitus. Her current body mass index is $34 \text{ kg/m}^2$. She takes metformin and daily low-dose aspirin. During the speculum examination, the vaginal mucosa appears pale, thinned, and lacks normal rugation. A scant amount of brownish fluid is pooled in the posterior vaginal fornix, but no active bleeding is observed. The bimanual examination shows a small, mobile uterus and no adnexal masses. Which of the following is the most appropriate next step in the management of this patient?

Match each clinical presentation of a pregnant patient with the most appropriate routine screening test or intervention indicated at that specific gestational age.

A 2-year-old boy is brought to the emergency department by his parents after they found a large amount of maroon-colored stool in his diaper. The parents report that the child has had no episodes of emesis, diarrhea, or apparent abdominal pain. He has been active and playing normally at home today. His medical history is unremarkable, and his immunizations are up to date. His temperature is 36.9°C (98.4°F), heart rate is 112/min, respiratory rate is 22/min, and blood pressure is 92/58 mm Hg. On physical examination, the child appears comfortable and in no acute distress. The abdomen is soft, non-tender, and non-distended, with no palpable masses. Bowel sounds are active. Inspection of the perianal area shows no fissures. Laboratory studies reveal a hemoglobin of 10.2 g/dL and a mean corpuscular volume of 78 fL. Which of the following is the most appropriate next step in evaluating this patient's condition?

A $32$-year-old nulliparous woman comes to the office due to heavy vaginal bleeding for the past $14$ days. She reports that since menarche at age $12$, she has only had three to four menstrual periods per year. Her weight has steadily increased since her early twenties, and she now has a body mass index of $37 \text{ kg/m}^2$. Medical history is significant for severe acne and type 2 diabetes mellitus. She takes metformin and uses condoms for contraception. Vital signs are within normal limits. Physical examination shows dark, velvety hyperpigmentation on the posterior neck and axillae. Pelvic examination reveals active bleeding from the cervical os. Bimanual examination shows a normal-sized, mobile uterus with no adnexal masses. A point-of-care urine pregnancy test is negative. She does not desire pregnancy at this time. Which of the following is the most appropriate next step in management?

Concerned parents bring their 5-month-old son to the acute care clinic in mid-December. They report that for the past 24 hours, the infant has been breathing very rapidly and refusing his formula. His symptoms began 3 days earlier with clear rhinorrhea and a tactile fever. His medical history includes delivery at 31 weeks of gestation. Current vital signs indicate a temperature of 38.1°C (100.6°F), heart rate of 158/min, and respiratory rate of 70/min. Pulse oximetry demonstrates an oxygen saturation of 88% while breathing room air. On examination, the infant exhibits grunting, severe subcostal retractions, and widespread expiratory wheezing mixed with fine crackles on auscultation. Which of the following best describes the predominant underlying mechanism responsible for this patient's respiratory distress?

A 28-year-old woman comes to the office due to a 3-day history of progressively worsening pain and swelling in her genital area. The pain is exacerbated by sitting, walking, and friction from her clothing. She denies having any fever, chills, dysuria, or abnormal vaginal discharge. She has no significant past medical history. Her vital signs are within normal limits. Pelvic examination reveals a 4.5-cm, exquisitely tender, fluctuant, erythematous mass located in the left posterior vaginal introitus at the 7 o'clock position. There is no surrounding induration or erythema extending beyond the margins of the mass, and no inguinal lymphadenopathy is present. Which of the following is the most appropriate next step in management for this patient?

A 31-year-old woman, gravida 1, para 0, at 27 weeks gestation comes to the office for a routine prenatal visit. She mentions feeling "short of breath" over the past two weeks, especially when resting or sitting down. She has no history of asthma or cardiopulmonary disease. She denies chest pain, cough, palpitations, or lightheadedness. Her current medications include a prenatal vitamin and iron supplementation. Vital signs show a blood pressure of $110/68$ mm Hg, a pulse of $84$/min, and respirations of $18$/min. Pulse oximetry is $99\%$ on room air. Physical examination shows a gravid uterus appropriate for gestational age. Lungs are clear to auscultation bilaterally. Cardiac examination shows a normal $S_1$ and $S_2$ with a grade $2/6$ systolic ejection murmur at the left upper sternal border. There is trace bilateral lower extremity edema. The physician reassures the patient that her symptoms are due to normal physiologic adaptations to pregnancy. If an arterial blood gas analysis were performed, which of the following sets of values would most likely be observed?

Match each patient's clinical presentation and biomarker profile with the most likely ovarian neoplasm diagnosis.

Match each pediatric patient's clinical presentation with the most likely corresponding imaging finding.

A 3-month-old infant is admitted to the pediatric intensive care unit with severe respiratory syncytial virus (RSV) bronchiolitis. Over the next 24 hours, the infant's condition progressively deteriorates, demonstrating worsening tachypnea, severe intercostal retractions, and increasing oxygen requirements. The clinical team must escalate respiratory support as the infant progresses toward impending respiratory failure. Arrange the following respiratory interventions in the standard step-wise escalation sequence, starting with the least invasive initial measure and ending with the most advanced rescue therapy.

An ambulance brings a 31-year-old female to the resuscitation bay following the sudden onset of excruciating, diffuse abdominal pain that began two hours prior to arrival. Over the preceding five days, she had experienced progressive lower pelvic discomfort, high fevers, and a foul-smelling vaginal discharge. Her temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $80/45\text{ mm Hg}$, and pulse is $132/\text{min}$. She appears lethargic and is profoundly diaphoretic. Following the rapid intravenous infusion of $2\text{ L}$ of normal saline, her blood pressure remains $84/48\text{ mm Hg}$. Physical examination reveals a rigid, board-like abdomen with severe diffuse tenderness, involuntary guarding, and rebound. Pelvic examination is limited by extreme pain but shows purulent exudate pooling at the cervical os. A bedside transvaginal ultrasound demonstrates a $7\text{-cm}$ complex, multiloculated right adnexal structure with a disrupted capsular margin, accompanied by a large volume of echogenic free fluid in the pelvis and right upper quadrant. Which of the following is the most appropriate next step in the management of this patient?

Match the following classic radiologic findings with the most appropriate pediatric gastrointestinal pathology.

Match each clinical vignette describing an obstetric emergency to the most likely underlying diagnosis. Evaluate the specific risk factors and clinical findings to determine the correct etiology.

A $9$-year-old boy is diagnosed with Burkitt lymphoma after presenting with a rapidly enlarging abdominal mass and abdominal pain. Laboratory studies reveal a white blood cell count of $14,000/\text{mm}^3$, a uric acid level of $11.2 \text{ mg/dL}$, potassium of $5.1 \text{ mEq/L}$, phosphorus of $6.5 \text{ mg/dL}$, and calcium of $7.2 \text{ mg/dL}$. His serum creatinine is $0.8 \text{ mg/dL}$. He is admitted to the pediatric intensive care unit for management. Arrange the following steps in the most appropriate chronological order for the prevention and management of tumor lysis syndrome (TLS) and its potential complications in this patient, starting from the initial intervention upon admission.

Based on the World Health Organization Medical Eligibility Criteria (WHO MEC), which contraceptive method is most appropriate for each patient's clinical presentation?

An 8-week-old male infant is brought to the emergency department by his parents due to a 24-hour history of severe abdominal distension, lethargy, and multiple episodes of explosive, foul-smelling diarrhea. His mother notes he has been feeding poorly and had two episodes of nonbilious emesis this morning. The patient's past medical history is notable for delayed passage of meconium, which required glycerin suppositories during his first week of life, and he has suffered from chronic constipation since discharge. His temperature is $38.9^\circ C$ ($102^\circ F$), blood pressure is $65/35\text{ mm Hg}$, pulse is $188/\text{min}$, and respirations are $62/\text{min}$. On physical examination, the infant appears mottled and lethargic. The abdomen is markedly distended and tense, with sluggish bowel sounds. Digital rectal examination produces a sudden, high-pressure expulsion of liquid stool and gas. A plain abdominal radiograph demonstrates markedly dilated loops of bowel with multiple air-fluid levels, but no free air is visible under the diaphragm. Which of the following is the most appropriate next step in management?

A nulliparous patient at 39 weeks gestation is admitted to the labor unit and receives continuous lumbar epidural analgesia for pain control during the active phase of labor. Fifteen minutes after the epidural is activated, the patient reports feeling dizzy and nauseated. Her temperature is 37.0°C (98.6°F), blood pressure is 82/45 mm Hg, and heart rate is 112/min. The electronic fetal monitor reveals a baseline heart rate of 140/min, moderate variability, and recurrent gradual decreases in the fetal heart rate that reach their nadir after the peak of each uterine contraction. Uterine contractions are occurring every 4 minutes and lasting 60 seconds. The patient is immediately placed in the left lateral decubitus position, and a rapid bolus of intravenous lactated Ringer solution is administered. Five minutes later, her blood pressure is 84/48 mm Hg, and the fetal heart rate pattern remains unchanged. Which of the following is the most appropriate next step in management?

A medical student is reviewing maternal lower extremity neuropathies that can occur as complications of labor, operative positioning, or fetal descent. Match each classic postpartum clinical presentation with the specific compromised nerve.

A 25-year-old primigravida presents to the obstetric clinic at 8 weeks gestation for her initial prenatal visit. She has no significant past medical history, takes no medications other than a daily prenatal vitamin, and her physical examination is unremarkable. She wishes to undergo standard comprehensive prenatal care. Arrange the following routine prenatal screening tests and evaluations in the correct chronological sequence in which they are indicated during a normal pregnancy (from earliest to latest gestational age).

Match each pediatric patient's clinical and laboratory presentation to the most likely underlying diagnosis and its associated pathophysiologic mechanism.