Tüm alıştırma soruları

A 50-year-old woman is diagnosed with major depressive disorder following a period of persistent low mood and anhedonia. Over the next year, her condition progressively worsens despite various treatment attempts, culminating in a state of severe melancholia characterized by a life-threatening refusal to eat and drink. Arrange the following clinical management steps in the correct chronological sequence, representing a standard stepped-care escalation for this patient's evolving clinical condition.

A young adult male is brought to the inpatient psychiatric unit by his family due to a profound decline in functioning over the past two weeks. The patient has been entirely mute, persistently holds his arms in rigid, unnatural postures for hours, and refuses all oral intake. His current daily medication regimen includes risperidone and fluoxetine. Vital signs show a heart rate of $105/\text{min}$ and blood pressure of $130/85\text{ mm Hg}$; he is afebrile. The psychiatry team suspects catatonia. Arrange the following management steps in the most appropriate sequential order for evaluating and treating this patient's current condition.

A 34-year-old man presents to the clinic with his partner due to a 1-month history of worsening sadness, anhedonia, and sleeping 12 to 14 hours a day. His partner reports that the patient has stopped going to his job as a software developer, barely eats, and has expressed feelings of worthlessness. Medical history is significant for a hospital admission 5 years ago when the patient was found wandering the streets, claiming he was a "prophet" who did not need to sleep, and talking so rapidly that he was difficult to understand. This previous episode resolved after a 2-week inpatient stay, and he eventually stopped taking his prescribed medications. The patient currently exhibits a flat affect and psychomotor retardation. Vital signs are within normal limits, and physical examination shows no abnormalities. Basic metabolic panel and thyroid-stimulating hormone levels are unremarkable. Which of the following pharmacologic therapies are appropriate for this patient's current episode? (Select all that apply)

During a trauma surgery conference, a team reviews the intraoperative management algorithms for retroperitoneal hematomas discovered during emergency exploratory laparotomies. The attending surgeon emphasizes that the decision to open and explore a hematoma depends critically on its anatomical zone and the mechanism of injury. Match each specific clinical scenario involving a retroperitoneal hematoma with the most appropriate intraoperative management strategy.

A thorough physical examination is critical in evaluating patients presenting with an acute abdomen or jaundice. Match each classic physical examination finding with the most likely associated abdominal pathology.

A $72$-year-old man is evaluated on the surgical floor due to fever and abdominal discomfort. He underwent an open partial colectomy for a large adenomatous polyp four days ago. His indwelling urinary catheter, which was placed during surgery, was removed yesterday morning. The patient now reports new-onset burning with urination and a feeling of incomplete bladder emptying. His temperature is $38.5^\circ\text{C}$ ($101.3^\circ\text{F}$), blood pressure is $128/78\text{ mmHg}$, pulse is $92/\text{min}$, and respiratory rate is $16/\text{min}$. Physical examination reveals a soft abdomen with mild suprapubic tenderness but no guarding or rebound. The surgical incision is clean, dry, and intact with no surrounding erythema or fluctuance. Lung auscultation is clear bilaterally. Examination of the lower extremities shows no edema or calf tenderness. Which of the following is the most appropriate next step in the management of this patient's fever?

A 34-year-old man with a 5-year history of severe heroin use disorder presents to an outpatient addiction clinic seeking treatment. He reports that his last heroin use was 2 hours ago. He is highly motivated to stop using illicit opioids and requests to start buprenorphine/naloxone therapy immediately. To appropriately initiate and maintain his treatment while avoiding iatrogenic complications, arrange the following management steps in the correct chronological sequence.

Emergency medical services bring a 71-year-old retired architect to the emergency department due to progressively worsening difficulty breathing over the last 72 hours. He reports waking up multiple times during the night feeling starved for air and ultimately having to sleep sitting up in a recliner. His medical history is significant for essential hypertension, type 2 diabetes mellitus, and a 40-pack-year smoking history. His temperature is 37.1°C (98.8°F), blood pressure is 158/92 mm Hg, pulse is 96/min, and respirations are 24/min. Pulse oximetry shows 91% on room air. Physical examination reveals elevated jugular venous pressure, visible 9 cm above the sternal angle. Cardiac auscultation reveals a normal S1 and S2 with an additional low-pitched sound heard in early diastole. Pulmonary auscultation demonstrates bilateral crackles extending to the mid-lung fields and trace scattered expiratory wheezing. Arterial blood gas analysis on room air reveals a pH of 7.32, $PaCO_2$ of 46 mm Hg, and $PaO_2$ of 64 mm Hg. Which of the following is the most appropriate initial management for this patient?

Match each clinical presentation of gastrointestinal obstruction or distension with its most likely specific etiology or anatomical mechanism.

A 15-year-old girl is admitted to the inpatient pediatric unit for severe anorexia nervosa, restricting type. She has a body mass index (BMI) of 13.2 kg/m², a heart rate of 42/min, and blood pressure of 88/55 mm Hg. Physical examination shows lanugo, temporal wasting, and acrocyanosis. Arrange the following interventions in the most appropriate clinical sequence for the management of this patient, from initial inpatient evaluation to definitive post-hospitalization care.

Match each patient's clinical presentation following trauma with the most appropriate next step in diagnosis or management.

A 24-year-old man with a recent diagnosis of schizophrenia is admitted to the inpatient psychiatric unit due to worsening paranoia and auditory hallucinations. He is started on high-dose oral haloperidol. As part of patient education, the attending physician discusses the potential adverse extrapyramidal symptoms (EPS) associated with this medication. Arrange the following clinical presentations of EPS in chronological order according to their typical peak onset after initiating the antipsychotic, from earliest (hours/days) to latest (months/years).

Match the following clinical presentations in patients with advanced HIV/AIDS to their most appropriate definitive pharmacotherapy.

A 55-year-old female patient with a body mass index of 34 kg/m² is evaluated during morning rounds on her second day recovering from an elective open abdominal hysterectomy. Her vital signs show a temperature of 38.2°C (100.8°F), blood pressure of 128/82 mmHg, heart rate of 88/min, and respiratory rate of 16/min. Physical examination reveals mildly decreased breath sounds at the lung bases bilaterally without wheezes or crackles. The surgical dressing is clean, and the wound edges are well-approximated with no surrounding warmth or induration. The patient is voiding spontaneously without dysuria, and her calves are soft and non-tender. Which of the following are the most appropriate management steps for this patient? (Select 2)

A 67-year-old woman is evaluated by the rapid response team on the medical-surgical floor due to sudden clinical deterioration. She was admitted 24 hours ago for a partial small bowel obstruction secondary to severe adhesive disease from a prior open colectomy. Initial conservative management included intravenous fluid resuscitation and nasogastric tube decompression, which yielded 800 mL of bilious output. Over the last hour, she developed severe, unrelenting, constant lower abdominal pain, which is a significant change from her previous intermittent, cramping pain. Her vital signs are temperature 38.6°C (101.5°F), blood pressure 92/58 mm Hg, pulse 122/min, and respirations 24/min. Physical examination now reveals a distended, exquisitely tender abdomen with marked rigidity and rebound tenderness in the lower quadrants. Laboratory studies demonstrate a leukocyte count of 18,400/mm³ with 12% bands, and a serum lactate of 4.1 mmol/L. Which of the following is the most appropriate next step in the management of this patient?

A 42-year-old woman is evaluated in the post-anesthesia care unit 4 hours after undergoing a total thyroidectomy for a toxic multinodular goiter. The nursing staff urgently requests assistance because the patient is highly agitated, reporting severe neck pressure, and having significant difficulty breathing. Vital signs show a temperature of 37.1°C, heart rate of 118/min, blood pressure of 152/94 mm Hg, respiratory rate of 28/min, and oxygen saturation of 88% on room air. Physical examination reveals audible inspiratory stridor. The anterior neck incision is intact, but the surrounding tissue is markedly swollen, tense, and ecchymotic. Arrange the following management steps in the correct chronological order.

Match each clinical presentation with the most appropriate definitive surgical intervention.

A 28-year-old man presents to a primary care clinic with a 2-month history of worsening mood, severe fatigue, and lack of motivation. He reports sleeping up to 12 hours a day but still feeling exhausted upon waking. Additionally, he has experienced a significant increase in appetite, resulting in a 6 kg (13.2 lb) weight gain over the past month. He describes a pervasive sensation of extreme heaviness in his arms and legs, making it difficult to get out of bed. His past medical history is notable for a severe depressive episode at age 20. At that time, he was prescribed a medication that he discontinued after 3 weeks because it made him feel "too wired and agitated." He is currently not taking any medications. Vital signs and physical examination are unremarkable. The physician is considering starting an antidepressant. Which of the following is the most appropriate next step in the management of this patient?

A 19-year-old male college student is brought to the psychiatric clinic by his parents. Eight weeks ago, he was admitted to the emergency department with severe agitation, paranoia, and auditory hallucinations after using synthetic cathinones at a party. He was hospitalized, and his acute intoxication resolved over 3 days. However, his parents report that since his discharge 7 weeks ago, he has continued to hear voices and firmly believes that his professors have planted listening devices in his dormitory. For the past 7 weeks, he has been living at home under strict parental supervision with no access to drugs or alcohol, and weekly random urine toxicology screens have been consistently negative. Over the last two weeks, he has also developed a markedly blunted affect and speaks only in short, one-word answers. Which of the following is the most likely diagnosis?

An ambulance brings a 68-year-old resident of an assisted living facility to the acute care clinic due to progressive confusion, rigors, and new-onset jaundice over the past day. Vital signs on arrival show a temperature of 39.5°C (103.1°F), a pulse of 118/min, and a blood pressure of 88/54 mmHg. Abdominal examination is notable for right upper quadrant guarding and tenderness on palpation. Blood tests demonstrate a leukocytosis of 18,500/mm³ and a total bilirubin of 5.8 mg/dL with a direct fraction of 4.2 mg/dL. Suspecting acute severe ascending cholangitis, arrange the following clinical interventions in the most appropriate chronological order.