Tüm alıştırma soruları

Emergency medical personnel transport an unresponsive 27-year-old male to the resuscitation bay after bystanders discovered him collapsed in a public restroom. Upon initial assessment, the patient is deeply obtunded and making no spontaneous movements. Hemodynamic monitoring reveals a blood pressure of 105/60 mm Hg and a heart rate of 55/min. His respiratory rate is markedly depressed at 5/min with shallow, irregular excursions, and pulse oximetry indicates an oxygen saturation of 78% on room air. Physical examination is notable for symmetric, 1-mm miotic pupils and cyanosis of the lips. Paramedics note that an empty syringe and a bent spoon were recovered at the scene. Arrange the following clinical interventions in the most appropriate chronological sequence for managing this patient's acute presentation and subsequent transition to recovery.

Emergency medical services bring a 22-year-old male to the trauma bay following an ejection from a moving vehicle. The patient is semi-conscious, with visible facial trauma and a deformed right lower extremity with surrounding ecchymosis. Arrange the following initial management steps in the correct chronological sequence according to the Advanced Trauma Life Support (ATLS) primary survey protocol.

A 35-year-old woman is brought to the psychiatric clinic by her husband due to behavioral changes over the past 3 months. Her husband reports that she recently took a sudden leave of absence from her job as a middle school teacher. During the interview, the patient states she had to stop teaching because the school's intercom system was intercepting her private thoughts and broadcasting them to the students. She also reports hearing two distinct male voices discussing her daily activities. These symptoms began precisely 3 months ago, shortly after she moved to a new neighborhood, and have been present continuously since. She has no history of depressive or manic episodes, and her medical history is unremarkable. A urine toxicology screen is negative. Which of the following is the most likely diagnosis?

A 21-year-old college junior is brought to the student health clinic by his roommate. The roommate reports that for the past 6 weeks, the patient has been behaving unusually, such as wrapping his laptop in aluminum foil and claiming that foreign intelligence agents are tracking his brainwaves. During the interview, the patient appears visibly guarded, avoids eye contact, and frequently pauses mid-sentence as if listening to an unseen presence. When contacted, the patient's parents state that he was an outgoing and high-achieving student until approximately 8 months ago. At that time, he abruptly quit the university track team, withdrew from social activities, and began speaking in a monotonous tone with minimal facial expressivity. The parents note his sleep and appetite have remained normal, and he has consistently denied feeling sad or hopeless. A comprehensive metabolic panel and a urine toxicology screen show no abnormalities. Which of the following is the most likely diagnosis?

A surgical clerkship director is teaching medical students about the evaluation of postoperative fever. To help students prioritize their differential diagnoses, she asks them to recall the classic timeline for various complications. Arrange the following common etiologies of postoperative fever in typical chronological order, from earliest expected onset to latest expected onset.

A 64-year-old man is evaluated in the surgical intensive care unit on postoperative day 8 following a pancreaticoduodenectomy. His postoperative course was complicated by delayed gastric emptying, requiring bowel rest and total parenteral nutrition (TPN) via a right internal jugular central venous catheter. Today, he develops sudden chills. His temperature is 39.4°C (102.9°F), blood pressure is 92/58 mm Hg, heart rate is 124/min, and respiratory rate is 22/min. Physical examination reveals mild erythema at the central line insertion site. The surgical drains continue to output a small amount of non-purulent, clear fluid, and his abdomen is soft and non-tender. His leukocyte count has increased from 10,500/mm³ yesterday to 19,500/mm³ today.

Which of the following are the most appropriate initial steps in the evaluation and management of this patient's acute change in condition? (Select exactly two)

Match each polysomnography (PSG) or Multiple Sleep Latency Test (MSLT) finding to the most appropriate sleep-wake disorder diagnosis.

Accompanied by her daughter, a 61-year-old female is evaluated in the surgical assessment unit due to three days of worsening left lower abdominal pain, chills, and anorexia. Her past medical history is notable for hypertension and hyperlipidemia. Vital signs show a temperature of 38.8°C (101.8°F), heart rate of 102/min, blood pressure of 128/78 mm Hg, and respiratory rate of 16/min. Physical examination reveals focal tenderness and voluntary guarding in the left lower quadrant, but no generalized rigidity or diffuse rebound tenderness. Laboratory studies demonstrate a leukocyte count of 16,500/mm³ with a left shift. A contrast-enhanced computed tomography scan of the abdomen and pelvis reveals severe sigmoid diverticulitis accompanied by a 6.5-centimeter unilocular fluid collection adjacent to the inflamed bowel segment. Based on current surgical guidelines, arrange the following steps in the most appropriate sequential order for the comprehensive management of this patient.

Seeking relief from pervasive, uncontrollable worry, a 38-year-old female executive presents to a new psychiatrist. For the last eight months, she has been continuously anxious about her career stability, her children's academic performance, and her personal health. This worry has led to chronic muscle tension, fatigue, and disrupted sleep. Her past medical records reveal a psychiatric hospitalization in her twenties for a discrete episode characterized by euphoric mood, hypersexuality, and a complete lack of sleep for eight consecutive days. Three weeks ago, a different provider prescribed her phenelzine for her anxiety. She took the medication for two weeks but abruptly stopped it three days prior to this appointment due to intolerable orthostatic hypotension. The current physician establishes a diagnosis of generalized anxiety disorder. Which of the following are appropriate components of this patient's management plan? (Select 2 answers)

An 81-year-old woman is transported to the trauma bay via ambulance after sustaining a ground-level fall, striking her left flank against a heavy wooden bench. She has a history of essential hypertension and hyperlipidemia. On initial evaluation, her temperature is 36.4°C (97.5°F), blood pressure is 82/46 mmHg, pulse is 126/min, and respiratory rate is 24/min. Her airway is patent and breath sounds are equal bilaterally. Her abdomen is distended and exhibits severe guarding over the left upper and lower quadrants. Pelvic compression does not elicit instability. She is given 1 L of warmed lactated Ringer fluid via two large-bore peripheral intravenous catheters. Reassessment shows a blood pressure of 80/44 mmHg and a pulse of 130/min. A bedside ultrasound examination demonstrates a large amount of free anechoic fluid in the hepatorenal and splenorenal spaces. Which of the following is the most appropriate next step in management?

Match each of the following clinical presentations of childhood psychiatric and neurodevelopmental conditions with the cellular mechanism of action of its indicated first-line pharmacotherapy.

Match each patient's clinical presentation to the most accurate psychiatric diagnosis.

A 72-year-old man is evaluated for a new-onset fever on postoperative day 4 following an open repair of a ventral hernia. He has been recovering well, tolerating a regular diet, and ambulating with assistance in the surgical ward hallways. An indwelling urethral catheter was placed prior to surgery and removed on postoperative day 2. Today, his temperature is $38.6^\circ\text{C}$ ($101.5^\circ\text{F}$). Blood pressure is $128/76\text{ mm Hg}$, pulse is $96/\text{min}$, and respirations are $16/\text{min}$. Oxygen saturation is $96\%$ on room air. The patient reports feeling slightly fatigued but denies shortness of breath, cough, nausea, or calf pain. He notes that he has been urinating more frequently than usual since the catheter was removed, which he attributes to his postoperative intravenous fluids. Examination shows a soft abdomen with mild tenderness near the surgical incision. The incision is clean and intact with no erythema, induration, or purulent discharge. The lungs are clear to auscultation bilaterally. Which of the following is the most appropriate next step in management?

A 32-year-old male utility worker is brought to the emergency department after sustaining a high-voltage electrical injury while repairing a power line. The incident occurred exactly 2 hours prior to his arrival. On presentation, he is awake, alert, and complains of severe pain in his extremities. His temperature is $36.8^\circ \text{C}$ ($98.2^\circ \text{F}$), heart rate is $112/\text{min}$, and blood pressure is $110/70 \text{ mm Hg}$. Physical examination reveals deep, full-thickness burns involving his entire anterior trunk and his entire right lower extremity. There are also deep, charred entry and exit wounds on his right hand and left foot, though these cover a negligible surface area. His body weight is estimated at $75 \text{ kg}$. A Foley catheter is inserted to monitor urine output, and large-bore intravenous access is obtained. According to the Advanced Trauma Life Support (ATLS) guidelines for high-voltage electrical injuries, what is the appropriate initial intravenous fluid infusion rate (in $\text{mL/hour}$) for this patient?

A 52-year-old man is brought to the emergency department complaining of sudden-onset, excruciating epigastric pain that started 2 hours ago. He has a history of chronic knee osteoarthritis for which he takes high-dose ibuprofen daily. His temperature is 38.2°C (100.8°F), pulse is 118/min, and blood pressure is 92/58 mmHg. The patient is lying completely still on the stretcher. Physical examination reveals a rigid, board-like abdomen with severe diffuse rebound tenderness. An upright chest radiograph demonstrates a crescent of radiolucency under the right hemidiaphragm. Which of the following is the most appropriate next step in management?

Match each clinical presentation involving anxiety, stress, or fear-based symptoms to the most appropriate DSM-5 diagnosis based on symptom duration and characteristics.

A $72$-year-old man is evaluated on postoperative day $4$ following an urgent open repair of a perforated anterior duodenal ulcer. He reports rapidly increasing shortness of breath and a cough productive of clear, frothy sputum. His medical history is significant for ischemic cardiomyopathy with a left ventricular ejection fraction of $35\%$ and severe chronic obstructive pulmonary disease. His temperature is $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), blood pressure is $158/88\text{ mmHg}$, pulse is $112/\text{min}$, and respirations are $28/\text{min}$. Pulse oximetry shows $88\%$ on $4\text{ L/min}$ of oxygen via nasal cannula. Physical examination reveals an elevated jugular venous pressure of $11\text{ cm H}_2\text{O}$. Lung auscultation demonstrates scattered expiratory wheezes and prominent bibasilar crackles. Cardiovascular examination reveals a regular tachycardia with an S3 gallop. The abdomen is soft, mildly distended, and tender only at the midline incision, with no rebound or guarding. Complete blood count shows a leukocyte count of $10,500/\text{mm}^3$. A portable chest radiograph reveals an enlarged cardiac silhouette, bilateral perihilar haziness, and cephalization of the pulmonary vessels, without subdiaphragmatic free air. Which of the following are the most appropriate next steps in the management of this patient? (Select 2)

Match each clinical presentation or medication adverse effect with the corresponding dopaminergic pathway involved in its pathophysiology.

A 45-year-old woman is evaluated on postoperative day 1 following an uncomplicated open cholecystectomy. She reports mild pain at the incision site but otherwise feels well. Her temperature is 38.2°C (100.8°F), blood pressure is 122/78 mmHg, pulse is 88/min, and respirations are 16/min. Physical examination reveals decreased breath sounds at both lung bases. The surgical incision is clean, dry, and intact with no erythema, induration, or purulent drainage. The patient's calves are non-tender. Which of the following is the most appropriate next step in management?

A 42-year-old woman is evaluated in the post-anesthesia care unit 90 minutes following a total thyroidectomy for a large multinodular goiter. The nurse urgently requests an evaluation as the patient has become increasingly agitated and is clutching her neck. Vital signs show a blood pressure of 155/90 mm Hg, a heart rate of 115/min, and a respiratory rate of 28/min. Pulse oximetry demonstrates an oxygen saturation of 88% on room air. Physical examination reveals audible inspiratory stridor and a tense, expanding ecchymotic mass over the anterior neck. Arrange the following interventions in the most appropriate chronological sequence for the management of this patient.