Tüm alıştırma soruları

A $26$-year-old woman comes to the office due to the absence of menstrual periods for the past $7$ months. Previously, she had regular $28$-day cycles with normal bleeding. Over the same $7$-month period, she has noticed worsening acne, increased thick hair growth on her face and abdomen, and a deepening of her voice. She has no significant past medical history and takes no medications. A urine pregnancy test obtained in the clinic is negative. Vital signs are temperature $36.8^\circ\text{C}$, blood pressure $122/78 \text{ mmHg}$, pulse $76/\text{min}$, and respirations $14/\text{min}$. BMI is $24 \text{ kg/m}^2$. Physical examination reveals temporal hair thinning and terminal hair on the upper lip, chin, and linea alba. Pelvic examination shows clitoromegaly and a normal-sized, mobile uterus. Adnexae are difficult to palpate. Which of the following is the most appropriate next step in management?

During a routine prenatal visit at 24 weeks gestation, a primigravid patient reports new-onset, intense vulvar pruritus accompanied by a thick, white vaginal discharge over the past four days. She recently completed a course of cephalexin for an uncomplicated urinary tract infection. She denies any pelvic pain, uterine contractions, or leakage of fluid. Vital signs are within normal limits. Pelvic examination reveals marked vulvar erythema and a thick, adherent, curd-like discharge in the vaginal vault. The vaginal pH is 4.2. Microscopic evaluation of the vaginal secretions mixed with 10% potassium hydroxide demonstrates budding yeasts and branching tubular structures. Which of the following is the most appropriate management for this patient's current symptoms?

A $31$-year-old woman comes to the clinic for evaluation of amenorrhea. She has not had a menstrual period since the vaginal delivery of her first child $14$ months ago. Her pregnancy was complicated by placental abruption and severe postpartum hemorrhage that required emergency fluid resuscitation and a blood transfusion. The patient reports she was never able to produce breast milk despite multiple attempts to breastfeed. Over the past six months, she has also noted significant fatigue, a $10$-lb ($4.5$-kg) weight loss, and feeling cold all the time. On physical examination, blood pressure is $90/60$ mmHg and pulse is $58$/min. She has dry skin, sparse pubic hair, and delayed relaxation of deep tendon reflexes. A urine pregnancy test is negative.

Which of the following sets of laboratory test results is most likely in this patient?

Match each underlying pathophysiological or embryological mechanism with the corresponding pediatric gastrointestinal disorder.

Match each intrapartum fetal heart rate (FHR) tracing description with its primary pathophysiologic mechanism.

A 7-year-old girl with a known history of moderate persistent asthma is brought to the emergency department by her parents due to rapidly worsening shortness of breath over the past 4 hours. At home, she received three doses of her albuterol inhaler with no improvement. On examination, the patient is agitated, speaking in single words, and leaning forward. Vital signs reveal a temperature of 37.1°C (98.8°F), heart rate of 145/min, respiratory rate of 42/min, and oxygen saturation of 87% on room air. Physical examination demonstrates marked suprasternal and intercostal retractions, diminished breath sounds bilaterally, and faint expiratory wheezes. Arrange the following therapeutic interventions in the most appropriate sequential order for managing this patient's acute severe status asthmaticus, from the most immediate initial step to the most advanced rescue therapy.

A 26-year-old primigravida presents to the clinic for her initial prenatal visit at 6 weeks gestation. She is currently asymptomatic and has no significant past medical history. As part of her prenatal education, the physician discusses the expected anatomical and physiological changes she will experience. Arrange the following physiological adaptations and clinical findings in the chronological order they typically occur or reach their peak or nadir during a normal, uncomplicated pregnancy.

A pediatric oncology team is reviewing pathology, laboratory, and imaging reports for several newly admitted patients. Match each patient's characteristic diagnostic profile to the most accurate underlying solid tumor diagnosis.

A multiparous patient at 38 weeks gestation with a history of poorly controlled asthma and chronic hypertension is admitted for induction of labor. Her cervical exam is 4 cm dilated, 80% effaced, and at -1 station. Fetal heart rate monitoring is reassuring. Following a successful vaginal delivery of a macrosomic infant, the patient develops heavy vaginal bleeding consistent with uterine atony. The physician must select an appropriate uterotonic agent while avoiding exacerbation of her underlying conditions. Match the following medications considered for postpartum hemorrhage to their distinct pharmacological properties, adverse effects, or absolute contraindications.

A 31-year-old G2P2 patient is evaluated in the emergency department for sudden, severe left lower quadrant abdominal pain and profound chills that started 24 hours ago. Her most recent menstrual period ended three weeks ago, and she had a copper intrauterine device inserted four weeks ago. Vitals include a temperature of 38.9°C (102.0°F), a heart rate of 112/min, and a blood pressure of 110/70 mmHg. She is in visible distress. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological sequence for managing this patient's condition.

A $34$-year-old woman comes to the clinic for evaluation of severe vaginal itching and a thick, white vaginal discharge. She reports that this is her fourth such episode in the past $10$ months. For her prior episodes, she was treated with either an over-the-counter vaginal clotrimazole cream or a single dose of oral fluconazole, which completely resolved her symptoms each time. She has no history of diabetes mellitus, HIV, or immunosuppressant use. Her only medication is a combined oral contraceptive pill. Pelvic examination shows marked vulvar and vaginal erythema with adherent, cottage cheese-like discharge. Vaginal fluid analysis is performed:

Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

A 16-year-old girl is brought to the outpatient clinic due to the absence of menarche. She reports no cyclical pelvic or lower abdominal pain. Her medical history is unremarkable, and she takes no medications. On physical examination, her height is at the 60th percentile and weight is at the 55th percentile. Breast development and pubic hair are both at Tanner stage 4. Pelvic examination reveals normal external female genitalia, but there is a shortened, blind-ending vaginal pouch and the cervix cannot be visualized. Arrange the following steps in the most appropriate sequential order for the diagnostic evaluation and management of this patient.

A 31-year-old woman, gravida 2, para 1, presents to the office for a scheduled prenatal evaluation at 32 weeks gestation. She reports feeling well, with appropriate fetal movement and no abdominal pain, itching, nausea, or vomiting. Her prior pregnancy was uncomplicated and resulted in a spontaneous vaginal delivery at term. Vital signs are within normal limits. Physical examination reveals a gravid uterus consistent with dates and normal fetal heart tones. She recently participated in an employer-sponsored health screening program and brings the laboratory report for review. The results show:

Which of the following is the most appropriate management regarding these laboratory findings?

Parents bring their 22-month-old son to the urgent care clinic late at night because he suddenly developed a harsh, 'seal-like' cough and noisy breathing. For the past two days, he has experienced clear nasal discharge and a low-grade temperature. On evaluation, the child appears anxious. His temperature is $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), heart rate is $145/\text{min}$, respiratory rate is $42/\text{min}$, and oxygen saturation is $95\%$ on ambient air. Physical examination reveals an audible, high-pitched noise during inspiration even when the child is calmed and resting on his mother's lap. This is accompanied by pronounced suprasternal and subcostal retractions. Auscultation of the lungs demonstrates equal air entry bilaterally without expiratory wheezing. Which of the following is the most appropriate next step in the management of this patient?

An adolescent girl, aged $10$, is evaluated in the outpatient hematology clinic due to recurrent epistaxis and progressive fatigue over the past three months. Her adoptive parents report she has always been significantly smaller than her peers. Vital signs are within normal limits for her age. Physical examination reveals short stature (below the $3$ rd percentile), microcephaly, an absent right thumb, and several flat, hyperpigmented macules across her abdomen and back. Laboratory testing shows a hemoglobin of $7.2 \text{ g/dL}$, a mean corpuscular volume of $112 \text{ fL}$, a leukocyte count of $1,800/\text{mm}^3$, and a platelet count of $22,000/\text{mm}^3$. Which of the following is the most likely underlying mechanism for this patient's clinical and laboratory findings?

A 30-month-old male is evaluated at an urgent care center due to a sudden onset of breathing difficulty. According to his caregiver, the toddler was eating mixed nuts in the kitchen when he experienced a severe choking episode. Although the violent choking subsided after several minutes, a persistent, dry cough and rapid breathing have continued. The patient has no significant past medical history and his immunizations are up to date. On physical examination, the child appears mildly distressed but is alert and appropriately interactive. His temperature is 37.1°C (98.8°F), pulse is 138/min, and respirations are 42/min. Oxygen saturation is 94% on room air. Pulmonary auscultation reveals diminished breath sounds over the right hemithorax and localized expiratory wheezing. An expiratory anteroposterior chest radiograph demonstrates hyperlucency of the right lung field and deviation of the mediastinal structures to the left. Which of the following is the most appropriate next step in the management of this patient?

An expectant mother at 22 weeks gestation is evaluated in the obstetric clinic. The 28-year-old nulliparous patient mentions newly noticed ankle swelling that worsens by the evening and feeling slightly winded when walking up the stairs to her apartment. She denies paroxysmal nocturnal dyspnea, chest pain, syncope, or palpitations. Her past medical history is unremarkable, and she takes only a daily prenatal vitamin. Vital signs show a temperature of 37.0°C (98.6°F), blood pressure of 108/68 mm Hg, pulse of 86/min, and respirations of 16/min. Cardiac auscultation reveals a grade 2/6 early systolic ejection murmur heard best at the left upper sternal border and a distinct S3 gallop. Pulmonary auscultation is clear bilaterally. There is trace pitting edema of both ankles. Which of the following is the most appropriate next step in management?

Paramedics bring a $1.5$-year-old boy to the emergency department after his parents found him lethargic in his crib. According to the parents, the child developed sudden, intense abdominal pain $12$ hours ago, which was followed by multiple episodes of dark green vomiting. He has not passed stool or gas since the symptoms began. On examination, the child is obtunded. Temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), heart rate is $175/\text{min}$, respiratory rate is $50/\text{min}$, and blood pressure is $68/38\text{ mm Hg}$. Auscultation of the lungs reveals bilateral crackles and scattered wheezes, which the paramedics report began after he choked on his vomit during transport. The abdomen is markedly distended, rigid, and diffusely tender with involuntary guarding. Bowel sounds are absent. An upright abdominal radiograph displays prominent, dilated small bowel loops with multiple air-fluid levels and an absence of distal gas. Following initiation of intravenous fluid resuscitation, which of the following is the most appropriate next step in management?

A clinical pathway coordinator is updating the standard operating procedures for a community obstetrics practice. They are mapping out the anticipated schedule of evaluations for healthy patients presenting with an uncomplicated singleton pregnancy in the first trimester. Arrange the following routine prenatal screening evaluations in the correct chronological order from earliest gestational age to latest gestational age.

A 59-year-old nulliparous female presents to her gynecologist with new-onset vaginal bleeding. She has a history of type 2 diabetes mellitus and a body mass index of 42. Arrange the following steps in the standard chronological sequence for the evaluation and definitive management of her most likely condition, from initial diagnostic testing to post-surgical care.