Tüm alıştırma soruları

A 5-year-old boy with a known history of severe hemophilia A is brought to the pediatric emergency department after falling from a playground structure and striking his head. His parents report that he has vomited twice since the fall and appears unusually lethargic. On primary survey, his airway is patent, breathing is unlabored, and perfusion is adequate. His Glasgow Coma Scale score is 13. Arrange the following management steps in the most appropriate chronological order.

During a busy night shift on the labor and delivery unit, a $32$-year-old multiparous woman (G3P2) at $40$ weeks of gestation successfully delivers a $4100$ g neonate vaginally. Shortly after the third stage of labor concludes with the delivery of an intact placenta, the patient experiences a sudden, massive gush of vaginal blood. Abdominal palpation reveals a soft, poorly contracted uterus extending above the umbilicus. Assuming each intervention fails to arrest the hemorrhage, arrange the following clinical management steps in their standard procedural sequence from least invasive to most definitive.

An 8-year-old boy arrives at the pediatric emergency department via emergency medical services with severe difficulty breathing. The symptoms began abruptly while he was playing outdoors in cold weather. He has a documented history of moderate persistent asthma. En route to the hospital, paramedics administered three back-to-back doses of nebulized albuterol and ipratropium, as well as one dose of intramuscular epinephrine, with minimal clinical improvement.

On arrival, the patient appears visibly exhausted, diaphoretic, and is leaning forward in a tripod position. He is only able to speak in single words. Vital signs are temperature 37.0°C (98.6°F), heart rate 160/min, respiratory rate 48/min, and oxygen saturation 89% on a non-rebreather mask. Physical examination reveals severe suprasternal and subcostal retractions. Lung auscultation demonstrates a 'silent chest' with markedly diminished air entry bilaterally and no audible wheezing. A portable chest radiograph shows bilateral hyperinflation but no focal consolidations or pneumothorax.

Which of the following are the most appropriate immediate steps in the management of this patient? (Select all that apply)

Please pair the following pediatric gastrointestinal conditions with their most characteristic radiological finding on diagnostic imaging.

Match each patient's clinical presentation with the most likely etiologic pathogen and its corresponding expected microscopic findings.

Match each characteristic histological or clinical presentation of a gynecologic neoplasm with its most closely associated serum tumor marker.

Appropriate maternal weight gain during pregnancy is an essential component of routine prenatal care to optimize maternal and fetal outcomes. Based on the Institute of Medicine (IOM) guidelines for singleton pregnancies, match each patient's pre-pregnancy Body Mass Index (BMI) presentation with the most appropriate recommended total gestational weight gain range.

A 3-week-old full-term male is evaluated in the emergency department for sudden onset of bilious (green) vomiting. He has had two episodes in the past four hours. His prenatal course and birth history were unremarkable. On physical examination, the infant is awake and alert. Vital signs are within normal limits for age, and he is hemodynamically stable. The abdomen is soft, non-distended, and non-tender, with normal bowel sounds. Arrange the following steps in the most appropriate chronological order for the evaluation and management of this patient.

A $3$-year-old girl is brought to the pediatric emergency department at 4:00 AM by her parents. For the past $48$ hours, she has had rhinorrhea and a low-grade fever. Tonight, she awoke with a loud, brassy cough and difficulty breathing. Vital signs include a temperature of $38.1^\circ\text{C}$ ($100.6^\circ\text{F}$), a heart rate of $135\text{/min}$, a respiratory rate of $40\text{/min}$, and an oxygen saturation of $94\%$ on room air. Physical examination reveals an anxious but alert child with prominent inspiratory stridor at rest and visible intercostal retractions. Arrange the following clinical steps in the most appropriate chronological sequence for managing this patient's condition.

During a busy winter clinic session, a pediatrician evaluates an infant aged $5$ months who has been exhibiting noisy breathing and nasal congestion for the past $3$ days. The caregiver notes that the child's formula intake remains at baseline, but his breathing appears more rapid than usual. He was born at $39$ weeks of gestation without perinatal complications. Current vital signs include a temperature of $37.6^{\circ}\text{C}$ ($99.7^{\circ}\text{F}$), pulse of $138$/min, respiratory rate of $56$/min, and an oxygen saturation of $94\%$ on ambient air. On examination, the infant is alert with mild subcostal retractions. Auscultation of the lungs reveals widespread expiratory wheezes and fine crackles bilaterally. Which of the following are appropriate components of the initial management for this patient? (Select all that apply)

During a routine health maintenance visit, a thirty-four-year-old patient reports that she has not menstruated for the past nine months. Her menarche occurred at age $12$, and previously she experienced predictable $28$-day cycles. Over the last several months, she has been struggling with unexpected mood fluctuations, poor sleep, and sudden, intense episodes of upper body warmth accompanied by sweating. She is nulligravid, has no history of chronic medical conditions, and does not take any medications. Vital signs are within normal limits, with a BMI of $24 \text{ kg/m}^2$. On physical examination, her secondary sexual characteristics are appropriately developed. Pelvic examination reveals a pale vaginal mucosa with diminished rugae, but no adnexal masses are palpated. The thyroid gland is normal to palpation, and there is no evidence of galactorrhea or hirsutism. Arrange the following clinical interventions in the correct chronological sequence to appropriately evaluate and manage this patient's condition.

A 24-month-old toddler is brought to the pediatric clinic by her parents, who noticed an unusual lump in her abdomen while dressing her. Over the past month, the child has been increasingly fussy, has experienced intermittent bone pain, and has lost a noticeable amount of weight. Vital signs show a temperature of 37.2°C (99.0°F), a heart rate of 115/min, and a blood pressure of 138/88 mmHg. Physical examination reveals a firm, irregular, nodular abdominal mass that extends across the anatomic midline. Additional findings include bilateral periorbital ecchymoses and a right-sided mild ptosis with miosis. Which of the following laboratory studies is most appropriate to help confirm this patient's most likely diagnosis?

A 28-year-old primigravida at $41$ weeks gestation is admitted to the labor and delivery unit for induction of labor. Following cervical ripening, a continuous intravenous oxytocin infusion is started. Twelve hours later, the patient reports intense and continuous abdominal pain. Her temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $122/78\text{ mm Hg}$, and pulse is $92/\text{min}$. A sterile vaginal examination reveals the cervix is $6\text{ cm}$ dilated and $90\%$ effaced, with the fetal vertex at $0$ station. The external tocodynamometer records $7$ uterine contractions in a $10$-minute period, averaged over the last $30$ minutes. The continuous fetal heart rate tracing demonstrates a baseline of $145/\text{min}$, moderate variability, and symmetric decreases in the heart rate that begin after the peak of each contraction and slowly return to baseline after the contraction ends. Repositioning the patient to the left lateral decubitus position and providing a rapid intravenous fluid bolus do not resolve the fetal heart rate findings. Which of the following is the most appropriate next step in management?

A mother brings her 7-month-old female infant to the pediatrician's office in early November for a routine well-child evaluation. The infant was born prematurely at 28 weeks of gestation. Her neonatal course was complicated by respiratory distress syndrome, requiring mechanical ventilation and exogenous surfactant administration. She was successfully extubated and eventually discharged home at 36 weeks corrected gestational age without the need for supplemental oxygen. The mother reports that the infant is feeding well, gaining weight, and has not been hospitalized since birth. Vital signs are temperature 37.1°C (98.8°F), heart rate 120/min, and respiratory rate 30/min. Physical examination reveals a healthy-appearing infant with clear breath sounds bilaterally and no cardiac murmurs. The mother expresses concern about the upcoming winter season and asks what can be done to protect her child's lungs from severe viral infections. Assuming all routine immunizations for her age are up to date, which of the following is the most appropriate additional pharmacological intervention for this patient?

A 39-year-old woman, G0, comes to the clinic due to a three-week history of continuous, heavy vaginal bleeding. She states that she has soaked through a thick maxi pad every 3 hours for the past week. The patient has a history of irregular menstrual cycles, with periods occurring unpredictably every 2 to 6 months since menarche. Medical history is notable for hypertension, for which she takes amlodipine. She does not use tobacco or alcohol. Her blood pressure is $138/88 \text{ mm Hg}$, pulse is $88/\text{min}$, and BMI is $38 \text{ kg/m}^2$. Physical examination reveals dark, velvety patches of skin on the posterior neck and axillae. Pelvic examination shows active bleeding from the cervical os; the uterus is normal in size and non-tender. A urine pregnancy test is negative. Complete blood count shows a hemoglobin of $10.4 \text{ g/dL}$ and a platelet count of $250,000/\text{mm}^3$. Thyroid-stimulating hormone level is within normal limits. Which of the following is the most appropriate next step in management?

A $31$-year-old woman, gravida $2$, para $1$, presents to the clinic for her initial prenatal visit at $11$ weeks gestation. She reports mild nausea and breast tenderness but otherwise feels well. She has no significant past medical history and takes only a daily prenatal vitamin. Her blood pressure is $112/70\text{ mm Hg}$ and pulse is $84/\text{min}$. Physical examination reveals a normal-sized thyroid gland without palpable nodules or tenderness. Pelvic examination is consistent with an $11$-week gestation. Routine initial prenatal laboratory studies are obtained, and the results of a reflexively drawn thyroid panel are as follows:

Thyroid-stimulating hormone (TSH): $0.15\ \mu\text{U/mL}$ (Reference: $0.4\text{--}4.0\ \mu\text{U/mL}$)
Total thyroxine (T4): $14.8\ \mu\text{g/dL}$ (Reference: $5.0\text{--}12.0\ \mu\text{g/dL}$)
Free thyroxine (T4): $1.6\text{ ng/dL}$ (Reference: $0.8\text{--}1.8\text{ ng/dL}$)

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

A 24-year-old primigravida presents to the clinic at 10 weeks gestation reporting severe nausea, vomiting, and dark red vaginal spotting for the past two days. Her blood pressure is 142/90 mmHg, and her heart rate is 105/min. Physical examination reveals a uterus that is palpably enlarged to the level of the umbilicus, which is consistent with a 20-week gestation. A bedside urine pregnancy test is positive. She has no significant past medical history.

Arrange the following steps in the most appropriate chronological sequence for the diagnosis, definitive management, and standard follow-up of this patient's condition.

A healthy 24-year-old primigravida in her second trimester visits the clinic after noticing a painless, indurated ulcer on her labia majora. Her medical history is notable for a severe anaphylactic reaction, characterized by respiratory distress and hypotension, following amoxicillin exposure during childhood. Arrange the following clinical steps in the most appropriate chronological order to accurately diagnose and definitively manage this patient's condition.

Parents bring their $3$-year-old son to the clinic after noticing he has been uncharacteristically lethargic and refusing to walk for the past two weeks. The child has also experienced intermittent subjective fevers. Vital signs show a temperature of $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), heart rate of $115$/min, blood pressure of $92/60$ mmHg, and respiratory rate of $22$/min. On examination, the patient appears pale and tired. There are widespread petechiae on his shins and forearms. Palpation of the abdomen reveals the liver edge $4$ cm below the right costal margin and the spleen tip $5$ cm below the left costal margin. Cervical lymph nodes are enlarged, firm, and non-tender. The physician suspects a primary hematologic malignancy and initiates a comprehensive evaluation. Arrange the following diagnostic and staging steps in the most appropriate chronological sequence.

A 27-year-old multiparous patient at 39 weeks gestation has just delivered a 4,150 g (9 lb 2 oz) neonate vaginally. During the delivery of the placenta, the resident applies continuous umbilical cord traction while the uterus is flaccid. The patient suddenly cries out in severe lower abdominal pain, followed by a massive gush of vaginal blood. Her blood pressure is 76/40 mm Hg, and her pulse is 134/min. Physical examination reveals a beefy red, globular mass protruding through the vaginal introitus. The uterine fundus is not palpable on transabdominal examination. An initial attempt to manually push the mass back into the pelvis is unsuccessful because the lower uterine segment and cervix are firmly contracted around the prolapsed tissue. Arrange the following steps in the most appropriate sequential order to manage this patient's condition.