Tüm alıştırma soruları

A 30-year-old woman presents to the clinic for evaluation of secondary amenorrhea. Her last menstrual period was 10 months ago, shortly after she stopped breastfeeding her first child. Her pregnancy was complicated by a severe postpartum hemorrhage requiring an emergent suction curettage. She denies headaches, visual disturbances, hot flashes, or galactorrhea. Her body mass index is 23 kg/m². Physical examination reveals normal breast development and a normal-appearing vagina and cervix. Arrange the following steps in the most appropriate sequential diagnostic algorithm to evaluate this patient's amenorrhea, from the initial test to the final definitive diagnostic procedure.

An 18-year-old nulligravid female is brought to the emergency department by her roommate due to excruciating lower abdominal pain that began yesterday. She has been unable to eat or drink due to severe nausea and three episodes of bilious emesis. Her last menstrual period was 6 weeks ago, which she states is 'normal for her irregular cycles.' Her temperature is 39.2°C (102.6°F), blood pressure is 105/68 mm Hg, and pulse is 112/min. Abdominal examination demonstrates marked guarding and rebound tenderness in both lower quadrants. A speculum examination reveals abundant yellow cervical exudate and mucosal friability. Bimanual examination elicits exquisite cervical motion tenderness and reveals a palpable, exquisitely tender, fluctuant 6-cm fullness in the left adnexa.

Arrange the following clinical interventions in the most appropriate chronological sequence for the diagnostic workup and management of this patient.

Following a prolonged induction of labor for severe preeclampsia, a patient at $39$ weeks gestation experiences a spontaneous vaginal delivery of a $4100$ g infant. She is $31$ years old and this is her first pregnancy. Ten minutes after the placenta is delivered, she develops brisk, steady vaginal hemorrhage. Her blood pressure is $155/100$ mm Hg, and her pulse is $112$/min. On physical examination, the uterine fundus is soft, boggy, and palpated at the level of the umbilicus. A continuous intravenous oxytocin infusion and bimanual uterine massage are immediately initiated, but the excessive bleeding persists. Two large-bore intravenous lines are secured, and aggressive fluid resuscitation is underway.

Arrange the following interventions in the most appropriate sequential order for the continued management of this patient's hemorrhage, proceeding from the most immediate next step to the final definitive measure.

A 65-year-old G3P3 woman presents to the clinic with a 2-month history of progressive abdominal bloating, early satiety, and vague pelvic fullness. Physical examination reveals a firm, irregular, fixed mass in the right adnexa and shifting dullness on abdominal percussion. Arrange the following steps in the most appropriate sequential order for the standard diagnostic evaluation and definitive management of this patient's condition.

A 29-year-old primiparous woman at $40$ weeks gestation undergoes a spontaneous vaginal delivery. The infant weighs $4100$ g. Active management of the third stage of labor is performed using controlled cord traction. Shortly after the placenta delivers, a firm, smooth, red mass is observed protruding from the vaginal introitus, accompanied by profuse hemorrhage. The patient becomes lethargic, and her blood pressure drops to $70/40$ mm Hg with a heart rate of $135$/min. Arrange the following steps in the correct chronological order for the optimal management of this complication.

An overweight 71-year-old female is brought to the clinic by her daughter for a routine wellness check. During the system review, the patient casually mentions noticing pink-tinged spots on her undergarments on three separate occasions over the prior month. She underwent natural menopause two decades ago and takes no hormone replacement therapy. Her medical history includes well-controlled hypertension and type 2 diabetes mellitus. Arrange the following interventions in the strictly correct chronological sequence for the definitive workup and comprehensive management of this patient's most likely diagnosis.

A 27-year-old G1P1 experiences a sudden gush of vaginal bleeding and severe lower abdominal pain immediately following the delivery of the placenta. The patient is tachycardic at 122/min, and her blood pressure is 85/50 mmHg. On physical examination, the uterine fundus is absent from the periumbilical region, and a smooth, round, beefy red mass is visualized protruding through the vaginal introitus. An initial attempt at immediate manual replacement is unsuccessful due to a tightly contracted lower uterine segment.

Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 29-year-old multiparous patient develops heavy vaginal bleeding shortly after an uncomplicated vaginal delivery of a macrosomic infant. Examination reveals a boggy uterus positioned above the umbilicus. Arrange the following management steps for this patient's condition in the correct escalating sequence, from first-line intervention to the definitive final treatment.

A 24-year-old nulligravid woman presents to the emergency department with severe, progressively worsening bilateral lower abdominal pain and fever for 3 days. Her temperature is 39.1°C (102.4°F), blood pressure is 105/65 mmHg, and pulse is 112/min. Physical examination reveals exquisite bilateral lower quadrant tenderness with involuntary guarding. Pelvic examination demonstrates purulent cervical discharge, pronounced cervical motion tenderness, and a palpable, exquisitely tender, 7-cm fluctuant mass in the right adnexa. A urine pregnancy test is negative.

Assuming standard protocols and a lack of clinical improvement following initial medical interventions, arrange the following management steps in the correct chronological sequence, from initial emergency department evaluation to ultimate definitive intervention.

A 24-year-old primigravida at 10 weeks gestation presents to the emergency department with heavy vaginal bleeding and severe vomiting. Her blood pressure is 150/90 mmHg. Pelvic examination reveals a uterus sized consistent with a 16-week gestation. Transvaginal ultrasonography demonstrates a heterogeneous, complex intrauterine mass with multiple cystic spaces and no fetal parts. Quantitative serum $\beta$-hCG is 250,000 mIU/mL. Assuming this patient's clinical course subsequently progresses to non-metastatic gestational trophoblastic neoplasia, arrange the following management and surveillance steps in the optimal chronological order.

A healthy 25-year-old female visits the gynecology clinic for a routine wellness check. She underwent insertion of a levonorgestrel-releasing intrauterine device (IUD) twelve months ago. She reports feeling well with no pelvic pain, and she has experienced expected light spotting. However, she notes that she cannot palpate the device's strings, which she previously checked monthly. The patient's vital signs are stable. During speculum examination, the threads are not visualized protruding from the cervical os. Arrange the following diagnostic and management steps in the correct chronological sequence to evaluate this finding.

A 23-year-old nulligravid woman presents to the emergency department with severe, worsening right-sided pelvic pain. Three days ago, she was diagnosed with pelvic inflammatory disease (PID) at an urgent care clinic, where she received a single dose of intramuscular ceftriaxone and was prescribed oral doxycycline and metronidazole. She reports worsening pain, subjective fevers, and an inability to tolerate the oral medications due to severe nausea. Her temperature is 39.0°C (102.2°F). Pelvic examination reveals exquisite cervical motion tenderness and a palpable, tender 5-cm mass in the right adnexa. A point-of-care urine pregnancy test is negative. Arrange the following steps in the most appropriate, evidence-based sequence for the ongoing management of this patient.

A 25-year-old nulliparous woman at 40 weeks gestation presents in spontaneous labor. Following an uncomplicated first stage, she is fully dilated, effaced, and at +1 station. The patient begins active maternal expulsive efforts. During this phase, the fetus must perform specific biomechanical adaptations to successfully navigate the maternal pelvis. Arrange the following cardinal movements of labor in the correct chronological sequence for a fetus in a standard vertex presentation.

A 35-year-old premenopausal woman, gravida 2, para 2, presents to her gynecologist for routine health maintenance. She has no active complaints, and her past medical history is unremarkable. Speculum examination reveals a normal-appearing cervix with no gross lesions. Arrange the following events in the standard sequential clinical pathway, from her initial screening abnormality to the definitive management of high-grade cervical dysplasia.

A 15-year-old girl is brought to the gynecology clinic by her mother for evaluation of absent menses. On physical examination, she is at the 5th percentile for height. She has Tanner stage 1 breast development and normal external female genitalia. Arrange the following steps in the correct chronological order for the standard algorithmic diagnostic evaluation and subsequent workup of this patient.

Following a prolonged second stage of labor, a multipara delivers a macrosomic infant vaginally. Shortly after placental expulsion, she develops massive vaginal hemorrhage. Abdominal examination reveals a flaccid, boggy uterus extending above the umbilicus. Despite aggressive intravenous fluid resuscitation, a continuous high-dose oxytocin infusion, and vigorous fundal massage, the patient remains hypotensive at 88/50 mm Hg and tachycardic at 122/min with ongoing brisk bleeding. Arrange the following interventions in the correct escalating sequence for managing this patient's refractory postpartum hemorrhage, starting with the most appropriate immediate next step and ending with the definitive final resort.

A 22-year-old nulligravid woman is evaluated in an urgent care center due to a two-day history of worsening, bilateral lower pelvic discomfort and an abnormal, yellowish vaginal discharge. She reports no nausea, emesis, or fever. Her vital signs are stable. Arrange the following actions in the most appropriate chronological sequence for the standard diagnostic workup and outpatient management of this patient's suspected pelvic inflammatory disease.

A 35-year-old man is diagnosed with major depressive disorder in the outpatient clinic. Over the next year, he experiences persistent symptoms despite good medication adherence, requiring a progressive escalation of his treatment plan. Arrange the following management steps in the standard chronological order for escalating treatment of major depressive disorder, proceeding from initial pharmacological therapy to the management of highly refractory disease.

A 62-year-old postmenopausal woman presents to the gynecologist reporting a new onset of vaginal spotting. She has a history of estrogen receptor-positive breast cancer, for which she has been taking tamoxifen for the past four years. Her last menstrual period was 12 years ago. Pelvic examination reveals no vaginal lacerations and a normal-appearing cervix. Arrange the following steps in the most appropriate chronological order for the evaluation and definitive management of this patient's condition.

A 20-year-old woman is brought to the emergency department with acute-onset confusion, high fever, and intractable vomiting. She is currently on day 4 of her menstrual cycle. Vital signs are temperature 39.9°C (103.8°F), blood pressure 76/40 mmHg, and heart rate 142/min. Physical examination reveals generalized non-pitting edema and a diffuse, blanching, erythematous macular rash resembling a sunburn. Pelvic examination reveals a foul-smelling, retained highly absorbent tampon. Arrange the following steps in the correct chronological sequence for the comprehensive management of this patient, from immediate life-saving emergency stabilization to long-term preventive outpatient care.