Tüm alıştırma soruları

A 28-year-old man comes to the clinic seeking help for severe anxiety. Two months ago, he was the driver in a severe motor vehicle collision where his passenger sustained critical injuries. Since then, he has experienced recurrent, distressing nightmares about the event, actively avoids driving or riding in cars, and feels emotionally detached from his family. He is constantly hypervigilant and has difficulty concentrating. He has a past psychiatric history of bipolar I disorder, but he discontinued his prescribed valproate one year ago because he felt stable. He is currently employed as an accountant and asks the physician to provide a medical note for a leave of absence. However, he explicitly requests that the specific diagnosis and details of the trauma not be disclosed to his employer. During the interview, he mentions that he sometimes hears the screeching of tires when trying to fall asleep, but he recognizes this is just a memory and not a real sound. Which of the following is the most appropriate next step in the management of this patient?

A 58-year-old woman is evaluated in the surgical ward for a new-onset fever and worsening abdominal pain. She is currently on postoperative day 6 following an elective open abdominal hysterectomy for symptomatic uterine fibroids. Her temperature is 38.8°C (101.8°F), blood pressure is 122/78 mmHg, pulse is 98/min, and respirations are 16/min. Physical examination of the abdomen reveals a 10-cm midline surgical incision. The lower half of the incision is markedly erythematous, indurated, and warm to the touch. Gentle palpation of the surrounding skin yields a moderate amount of opaque, purulent fluid from the wound edges. The remainder of her physical examination is unremarkable. Which of the following is the most appropriate next step in management?

A 65-year-old man with a history of severe chronic obstructive pulmonary disease, heart failure with reduced ejection fraction, and stage III chronic kidney disease is evaluated on postoperative day 3 following an open abdominal aortic aneurysm repair. Over the past 12 hours, his urine output has decreased to 15 mL/hr. He is increasingly lethargic and mildly confused.

Vital signs are temperature 38.4°C (101.1°F), heart rate 112/min, blood pressure 90/55 mm Hg, and respiratory rate 24/min. Pulse oximetry is 92% on a 3 L/min nasal cannula. Central venous pressure is 16 mm Hg (normal: 2-8 mm Hg).

Physical examination reveals jugular venous distension. Lung auscultation demonstrates bibasilar crackles and scattered expiratory wheezes. The abdomen is moderately distended, tense, and diffusely tender with decreased bowel sounds.

Laboratory studies show:
Blood urea nitrogen: 52 mg/dL
Serum creatinine: 2.6 mg/dL (baseline 1.5 mg/dL)
Serum lactate: 3.8 mmol/L
Fractional excretion of sodium (FENa): 2.5%

A bedside bladder pressure measurement is 26 mm Hg.

Based on these findings, which of the following are the most appropriate immediate steps in management? (Select all that apply)

A 24-year-old man is brought to the emergency department after a high-speed motorcycle collision. He complains of severe pain in his left leg. Physical examination reveals a deformed left knee with an obvious posterior dislocation. The dislocation is promptly reduced in the emergency department. Afterward, palpation of the left pedal pulses reveals they are diminished compared to the right side. The patient remains hemodynamically stable. To evaluate for potential popliteal artery injury, the physician measures systolic blood pressures using a continuous-wave Doppler ultrasound and a sphygmomanometer. The following systolic pressures are recorded:

What is the Ankle-Brachial Index (ABI) of the injured extremity?

A 70-year-old man is evaluated in the surgical ward on postoperative day 2 following an elective partial gastrectomy. Over the past 4 hours, his recorded urine output has been 15 mL/hr. He has an indwelling Foley catheter in place. His blood pressure is 105/65 mmHg, heart rate is 98/min, and respiratory rate is 16/min. His mucous membranes appear dry, and his capillary refill time is 3 seconds. Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient's postoperative oliguria.

A 44-year-old woman presents to the emergency department with severe, constant right upper quadrant abdominal pain that began 6 hours ago after eating a fast-food meal. She reports nausea and two episodes of bilious vomiting. Her temperature is 38.2°C (100.8°F), heart rate is 102/min, and blood pressure is 118/76 mmHg. Physical examination reveals marked tenderness in the right upper quadrant with sudden inspiratory arrest during deep palpation. Arrange the following management steps in the most appropriate chronological order for this patient.

Match each clinical presentation to the most appropriate neurodevelopmental or behavioral psychiatric diagnosis.

A 45-year-old industrial worker is brought to the emergency department after a chemical vat exploded. He sustained deep partial-thickness burns. Physical examination reveals burns covering his entire anterior trunk (chest and abdomen), his entire right upper extremity (both anterior and posterior surfaces), and his entire right lower extremity (both anterior and posterior surfaces). No other areas of the body are affected.

Based on the Rule of Nines, what is the estimated total body surface area (TBSA) percentage affected by burns in this patient?

Match each gastrointestinal surgical procedure to its classic primary clinical indication.

A 75-year-old man who recently underwent a total hip arthroplasty develops progressive abdominal distension over the past 3 days. He has not passed flatus or stool since the surgery. His current medications include intravenous morphine for pain control. Vital signs are within normal limits. Physical examination shows a massively distended, tympanic abdomen without focal tenderness, guarding, or rigidity. Laboratory studies reveal a serum potassium level of 3.1 mEq/L. Computed tomography of the abdomen and pelvis demonstrates diffuse dilation of the colon with a cecal diameter of 10.5 cm, and no evidence of mechanical obstruction or transition point.

Arrange the following management strategies for this condition in the correct sequential order, from the initial best step to the interventions reserved for refractory or complicated cases.

A 20-year-old male college student is brought to the student health center by his parents due to concerning behavior. His parents report that he has become increasingly socially isolated over the past eight months. During this time, he quit the university soccer team, stopped communicating with his friends, and his academic performance dropped significantly. He spends most of his days in his room with the blinds drawn and displays a distinct lack of emotional expression. For the last six weeks, the patient has firmly believed that the university administration is using the campus wireless network to monitor his thoughts. His parents have also observed him talking animatedly to himself when alone in his room. Vital signs and physical examination are unremarkable. A urine toxicology screen is negative. Which of the following is the most likely diagnosis?

A medical student is reviewing peripheral vascular cases on the surgical ward. For each specific clinical presentation and physical examination finding described below, identify the most accurate corresponding diagnosis or pathological syndrome.

Match each distinct clinical presentation of acute or subacute abdominal pain to its most accurate surgical diagnosis or underlying etiology.

Match each pancreatic cystic lesion with its classic diagnostic finding, histologic characteristic, or indicated management strategy.

A 64-year-old woman is evaluated on postoperative day 6 following an elective right total knee arthroplasty. Her past medical history is significant for moderate chronic obstructive pulmonary disease and diet-controlled type 2 diabetes mellitus. Since the surgery, she has been receiving continuous intravenous piperacillin-tazobactam for surgical site prophylaxis due to a suspected intraoperative contamination event that was later deemed low-risk. Over the last 24 hours, she has developed a new temperature of 38.6°C (101.5°F) and reports five episodes of profuse, watery diarrhea associated with mild lower abdominal cramping. Vital signs include a blood pressure of 118/76 mmHg, a heart rate of 98/min, and a respiratory rate of 16/min. Oxygen saturation is 95% on room air. Physical examination reveals mild diffuse abdominal tenderness without rebound or guarding. Chest auscultation reveals distant breath sounds but no crackles or wheezes. The surgical incision is clean, dry, and intact, and both calves are soft and non-tender. Which of the following is the most appropriate next step in management?

A $55$-year-old man comes to the primary care clinic seeking help to stop drinking alcohol. He reports consuming approximately a pint of vodka daily for the past six years. He says, "I was hospitalized two weeks ago with liver problems, and it really scared me into wanting to quit for good." He has not consumed alcohol for the past three days and currently reports no symptoms of withdrawal. Medical history is significant for major depressive disorder and chronic hepatitis C virus infection. Review of laboratory studies from his recent hospitalization shows an aspartate aminotransferase (AST) of $345 \text{ U/L}$, alanine aminotransferase (ALT) of $160 \text{ U/L}$, and total bilirubin of $4.5 \text{ mg/dL}$. His current medications include sertraline and a daily multivitamin. He requests a medication to help reduce his urge to drink. What is the most appropriate pharmacotherapy for this patient?

Match each clinical presentation of an anxiety, obsessive-compulsive, or trauma-related disorder to the most specific, evidence-based psychotherapeutic intervention indicated for its management.

A 28-year-old male construction worker is brought to the emergency department after a heavy concrete block fell on his right leg. His airway is patent, breathing is unlabored, and he is hemodynamically stable. The primary trauma survey reveals no other life-threatening injuries. Examination of the right lower extremity shows a 5-centimeter laceration over the anterior tibia with exposed, fragmented bone and moderate oozing of blood. The right foot is warm, with palpable dorsalis pedis and posterior tibial pulses. Motor and sensory exams of the foot are intact. Arrange the following management steps in the most appropriate chronological order.

Match each clinical trauma presentation with the most appropriate next step in definitive management or diagnosis.

A 24-year-old man with a history of schizophrenia is brought to the emergency department from a residential psychiatric facility due to profound muscle stiffness, confusion, and diaphoresis. His vital signs show a temperature of 39.8°C (103.6°F), blood pressure of 165/100 mmHg, and heart rate of 122/min. Physical examination reveals generalized "lead-pipe" rigidity and coarse tremors. He was recently transitioned to intramuscular fluphenazine decanoate. Laboratory studies reveal a serum creatine kinase level of 5,200 U/L. Arrange the following steps in the most appropriate chronological sequence for the management of this patient's current condition and his subsequent long-term psychiatric care.