Tüm alıştırma soruları

A 67-year-old male is recovering on the orthopedic unit following an uncomplicated right hip arthroplasty. On postoperative day four, the patient develops profound hypotension, wheezing, and a diffuse urticarial rash shortly after receiving an intravenous dose of cefazolin. A review of the patient's intake documentation reveals a clearly recorded history of severe anaphylaxis to cephalosporins. Further investigation demonstrates that the electronic health record generated a pop-up allergy warning when the medication was ordered. However, the prescribing physician bypassed the alert due to the high volume of daily, clinically insignificant warnings. The patient is successfully stabilized with prompt medical management. The hospital's risk management department is notified to address this sentinel event. Which of the following is the most appropriate next step to prevent recurrence of this type of error?

A hospital's quality improvement committee is reviewing several documented patient safety incidents to classify them according to established safety terminology. Match each clinical scenario with the most accurate error classification.

Parents bring their 8-month-old male infant to the pediatric clinic due to worsening noisy breathing and new-onset feeding difficulties. The infant has had a "raspy" breathing sound since he was approximately 2 months old. The parents note that the noise occurs constantly during both inspiration and expiration, and it becomes significantly louder when the infant cries. Over the past four weeks, since the introduction of pureed solid foods, he has frequently gagged and regurgitated during meals. The parents report that he seems to breathe most comfortably when he sleeps with his head arched backward, and his breathing worsens if his chin is pushed toward his chest. He has no history of fever, cough, or sick contacts. His immunizations are up to date. Temperature is 37.0°C (98.6°F), pulse is 128/min, respirations are 32/min, and oxygen saturation is 98% on room air. Physical examination reveals a well-nourished infant with biphasic stridor. Auscultation of the lungs reveals clear breath sounds bilaterally with no wheezing or crackles. The stridor does not improve when the infant is placed in the prone position.

Which of the following is the most appropriate next step in the evaluation or management of this patient?

A first-year internal medicine resident notices that her senior resident has slurred speech, a slight tremor, and the smell of alcohol on his breath just as he is preparing to place a central venous catheter in a patient. According to professional guidelines for managing impaired physicians, arrange the following actions and institutional responses in the correct chronological sequence.

A 64-year-old female patient with advanced stage IV ovarian cancer is admitted to the oncology ward for the management of severe, intractable abdominal pain. She is fully alert, oriented, and explicitly states she understands her poor prognosis. She possesses decision-making capacity and has a documented do-not-resuscitate (DNR) order in her chart. Despite receiving escalating doses of scheduled and as-needed oral opioids, she continues to experience excruciating pain. The palliative care team recommends starting a high-dose continuous intravenous morphine infusion. Her husband, who is her legally designated healthcare proxy, is extremely anxious and states, "Please do not start the IV drip. I know that high doses of morphine can cause respiratory depression and make her die faster. I cannot lose her yet." The patient tells the physician, "I understand the risks completely, but I cannot bear this pain for another minute. Please give me the IV medication." Which of the following is the most appropriate next step in management?

For each clinical scenario describing an adverse reaction to a psychiatric medication, select the most likely causative antipsychotic agent.

Match each clinical and laboratory profile of a patient presenting with primary amenorrhea to the most likely underlying diagnosis.

Match each pediatric clinical vignette to the microbiologic description of its most likely causative pathogen.

A 54-year-old female pedestrian is transported to the trauma bay after being struck by a public transit bus. Upon arrival, she is lethargic and pale. Her blood pressure is 75/40 mmHg, heart rate is 138/min, and respiratory rate is 26/min. The airway is patent, and breath sounds are equal bilaterally. Physical examination reveals extensive ecchymoses over the lower abdomen and flanks. There is a palpable diastasis of the pubic symphysis, and the pelvis is mechanically unstable to anteroposterior compression. An initial point-of-care ultrasound of the chest and abdomen shows no evidence of pericardial, pleural, or intraperitoneal fluid. An anteroposterior pelvic radiograph confirms a severely displaced open-book pelvic fracture. A circumferential non-invasive pelvic binder is promptly placed over the greater trochanters. Following the administration of two units of uncrossmatched type O-negative packed red blood cells, her blood pressure remains 78/42 mmHg and heart rate is 135/min. Which of the following is the most appropriate next step in the management of this patient?

A $72$-year-old male is in the intensive care unit eight days after endovascular repair for a ruptured descending thoracic aortic aneurysm. His recovery was complicated by severe hypovolemic shock requiring high-dose vasopressors for $72$ hours. Over the past $12$ hours, he has developed a fever and lethargy. Temperature is $39.2^\circ C$ ($102.6^\circ F$), blood pressure is $105/65$ mm Hg, and heart rate is $118$/min. Abdominal examination reveals moderate distension, and palpation of the right upper quadrant elicits localized guarding. Laboratory studies show a leukocyte count of $19,500/mm^3$ with $14\%$ bands. Liver function tests show a mildly elevated alkaline phosphatase with normal transaminases. Bedside ultrasonography demonstrates a markedly distended gallbladder with a wall thickness of $6$ mm, distinct pericholecystic fluid, and no sonographic evidence of gallstones. The common bile duct measures $4$ mm in diameter. Which of the following is the most appropriate next step in management?

A $68$-year-old man presents to the clinic complaining of an aching, cramping pain in his right calf that consistently occurs after walking approximately two blocks. The pain forces him to stop and is completely relieved after $5$ minutes of rest. His medical history is significant for hypertension, hyperlipidemia, and a $45$-pack-year smoking history. His blood pressure is $138/86$ mmHg and heart rate is $72$/min. Physical examination reveals diminished right dorsalis pedis and posterior tibial pulses. There are no ulcers, rest pain, or signs of critical limb ischemia.

Assuming each intervention is indicated based on the results or failure of the preceding step, arrange the following clinical actions in the most appropriate chronological sequence for the evaluation and management of this patient's condition.

A 24-year-old man is brought to the emergency department due to a 2-day history of generalized weakness, excessive urination, and diffuse abdominal pain. He was diagnosed with type 1 diabetes mellitus 10 years ago and recently missed several doses of his insulin regimen. On physical examination, he appears lethargic and his mucous membranes are dry. Laboratory studies reveal a serum bicarbonate level of 12 mEq/L and an arterial blood pH of 7.28. Which of the following is the expected arterial partial pressure of carbon dioxide ($PaCO_2$) in this patient if appropriate respiratory compensation has occurred?

Match each clinical vignette describing a zoonotic or vector-borne infection with its most appropriate targeted antimicrobial therapy.

Match each clinical presentation with its most characteristic urinalysis finding.

Match each post-renal transplant clinical scenario and associated biopsy finding with the primary pathophysiologic mechanism responsible for the graft dysfunction.

A 45-year-old man is evaluated in the emergency department for severe, constant abdominal pain that began 12 hours ago. He states the pain is located in the upper abdomen and radiates directly to his mid-back. He has had three episodes of non-bilious emesis since the pain started. The patient has a history of alcohol use disorder, consuming approximately six beers daily for the past decade. Vital signs show a temperature of $37.6^\circ\text{C}$ ($99.7^\circ\text{F}$), blood pressure of $142/88\text{ mm Hg}$, heart rate of $112/\text{min}$, and respiratory rate of $18/\text{min}$. Physical examination reveals a diaphoretic man in acute distress. The abdomen is non-distended but exquisitely tender to palpation in the epigastric region; there is no guarding or rebound tenderness. Bowel sounds are sluggish. Laboratory studies reveal:

An abdominal ultrasound demonstrates a normal-appearing gallbladder without cholelithiasis, a normal common bile duct diameter, and obscured views of the pancreas due to overlying bowel gas.

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

Match each classic esophageal disorder with its characteristic finding on esophageal manometry or upper endoscopy.

A 49-year-old man is evaluated in the clinic for persistently elevated blood pressure despite adherence to a three-drug antihypertensive regimen, including a thiazide diuretic. Recent laboratory results reveal a serum potassium level of 2.9 mEq/L (spontaneous hypokalemia). The physician strongly suspects primary hyperaldosteronism. Arrange the steps of the diagnostic workup and management for this condition in the correct sequential order from initial screening to final pre-surgical evaluation.

A medical rapid response team evaluates a 72-year-old female resident of a skilled nursing facility who developed profound lethargy after 3 days of intractable emesis and poor oral intake. Upon transfer to the emergency department, her blood pressure is 82/50 mm Hg, pulse is 124/min, and respirations are 24/min. Physical examination reveals dry mucous membranes, flat neck veins, and delayed capillary refill. Laboratory testing reveals the following:

Which of the following best describes this patient's acid-base status?

A 68-year-old man who was intubated and mechanically ventilated 5 days ago for severe acute respiratory distress syndrome (ARDS) develops a new fever of 38.9°C (102.0°F). His oxygen requirements have increased over the past 24 hours, and thick, purulent secretions are suctioned from the endotracheal tube. A portable chest radiograph reveals a new right lower lobe consolidation. Arrange the following steps in the most appropriate chronological sequence for managing this patient's suspected ventilator-associated pneumonia (VAP).