Tüm alıştırma soruları

For her annual well-woman examination, a twenty-seven-year-old female is evaluated in the ambulatory care center. She is seeking advice on initiating a highly reliable form of birth control, having recently entered a new sexual relationship. Her medical background is notable for polycystic ovary syndrome (PCOS), currently managed solely through lifestyle modifications, with menses occurring unpredictably every 6 to 8 weeks. Additionally, eight weeks ago, she developed an unprovoked right lower extremity deep vein thrombosis (DVT) and is presently anticoagulated with oral apixaban. Her vital signs are within normal limits, though her body mass index is 31.5 kg/m². A bimanual pelvic exam demonstrates a normal-sized, mobile uterus with no adnexal masses. A urine pregnancy test is negative. In light of her complex medical history, which of the following represents the optimal choice for preventing pregnancy in this individual?

Match each patient's clinical presentation to the most likely underlying breast disorder.

An $11$-month-old boy is evaluated in the outpatient clinic in late January for a cough and rapid breathing. His symptoms began $3$ days ago with clear rhinorrhea and a low-grade temperature. His $4$-year-old sister recently missed school due to a mild respiratory infection. The patient was born at $39$ weeks gestation and has no significant past medical history. His temperature is $37.5^\circ\text{C}$ ($99.5^\circ\text{F}$), pulse is $138/\text{min}$, respiratory rate is $50/\text{min}$, and oxygen saturation is $95\%$ on room air. Physical examination reveals an infant who appears mildly fussy but consolable. Auscultation demonstrates prolonged expiration, diffuse polyphonic wheezes, and mild subcostal retractions bilaterally. Which of the following is the most appropriate next step in the management of this patient?

A 29-year-old woman, gravida 1, para 0, at 40 weeks gestation is admitted to the labor and delivery unit in spontaneous labor. Her pregnancy has been uncomplicated. Four hours after admission, her cervical examination reveals 6 cm dilation, 90% effacement, and -1 station. She is currently receiving an intravenous oxytocin infusion for labor augmentation due to inadequate cervical progression. Her temperature is 37.1°C (98.8°F), blood pressure is 120/78 mm Hg, and pulse is 88/min. Continuous fetal monitoring shows a baseline heart rate of 145/min with moderate variability. Over the last 30 minutes, there is an average of 7 contractions in a 10-minute window. The fetal heart rate tracing demonstrates symmetric, gradual decreases in the fetal heart rate that begin after the peak of the contraction and return to baseline after the contraction ends. These decelerations are occurring with nearly every contraction. Which of the following is the most appropriate next step in management?

Correlate the following classic neonatal clinical presentations with their most likely causative congenital infectious agent.

A 44-year-old woman presents to the emergency department on postoperative day 8 following an uncomplicated total abdominal hysterectomy for symptomatic adenomyosis. She reports a 2-day history of worsening lower abdominal pain, severe chills, and foul-smelling vaginal discharge. Her temperature is 39.2°C (102.6°F), blood pressure is 102/68 mm Hg, heart rate is 112/min, and respiratory rate is 18/min. Physical examination reveals localized lower abdominal tenderness with guarding and purulent discharge pooling at the vaginal cuff. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 32-year-old woman, gravida 1, para 0, abortus 1, presents to the clinic with an 8-month history of amenorrhea. Ten months ago, she underwent a surgical dilation and curettage for a first-trimester incomplete abortion. Over the past year, she has also been training for a marathon and runs approximately 40 miles per week. Her BMI is 18.2 kg/m². Vital signs are within normal limits. Physical examination reveals normal secondary sexual characteristics and no galactorrhea, hirsutism, or acne. Pelvic examination is unremarkable. The physician decides to initiate a comprehensive workup for secondary amenorrhea.

Arrange the following diagnostic steps in the most appropriate sequential order for evaluating this patient's condition.

A 64-year-old man is evaluated on the medical ward on hospital day 3. He was initially admitted for a two-day history of productive cough, right-sided pleuritic chest pain, and fever. At the time of admission, his temperature was 38.9°C (102.0°F), and a chest radiograph revealed a right lower lobe consolidation. He was started on empiric intravenous ceftriaxone and azithromycin.

Today, the patient reports feeling much better and asks when he can be discharged. He is tolerating his meals without difficulty.

Vital signs are:
Temperature: 37.2°C (99.0°F)
Blood pressure: 128/82 mm Hg
Pulse: 84/min
Respirations: 16/min
Oxygen saturation: 96% on room air

Physical examination reveals diminished crackles at the right lung base, which are significantly improved compared to admission.

A sputum culture obtained on admission has grown Streptococcus pneumoniae. Susceptibility testing results are as follows:
Penicillin: Susceptible
Amoxicillin: Susceptible
Ceftriaxone: Susceptible
Levofloxacin: Susceptible
Azithromycin: Resistant

Which of the following is the most appropriate modification to this patient's antimicrobial therapy?

A $4$-month-old female infant is evaluated in the pediatric emergency department for a $2$-day history of worsening respiratory distress and poor feeding. Her parents state she has always been a "floppy" baby. On physical examination, the infant is tachypneic with intercostal retractions. She exhibits profound generalized hypotonia, a weak cry, and an enlarged, protruding tongue. The parents mention she is unable to sit without support or transfer objects from hand to hand. Auscultation reveals a gallop rhythm and diffuse expiratory wheezing. Chest radiograph demonstrates massive cardiomegaly. Laboratory findings include a serum TSH of $2.1\ \mu\text{U/mL}$ (normal: $0.5-5.0$) and Free T4 of $1.4\ \text{ng/dL}$ (normal: $0.9-1.7$). An arterial blood gas on room air shows:

pH: $7.25$
$\text{pCO}_2$: $60\ \text{mmHg}$
$\text{HCO}_3^-$: $26\ \text{mEq/L}$

Which of the following statements regarding this patient's clinical picture is most accurate?

An infant is delivered at 34 weeks of gestation to a 28-year-old primigravida. The mother experienced a mild febrile illness with myalgias three weeks prior to delivery, shortly after consuming unpasteurized dairy products at a farm stand. Following birth, the infant initially appears well but develops progressive lethargy, apneic episodes, and temperature instability by 24 hours of life. Vital signs show a temperature of $35.8^\circ\text{C}$ ($96.4^\circ\text{F}$), heart rate of 170/min, and respiratory rate of 65/min. Skin examination reveals scattered 1-2 mm pale yellow papules on an erythematous base over the chest and trunk, sparing the palms and soles. A lumbar puncture is performed, and cerebrospinal fluid analysis demonstrates a leukocyte count of $850/\text{mm}^3$ with $80\%$ neutrophils, glucose of $20\text{ mg/dL}$, and protein of $150\text{ mg/dL}$. Gram stain of the fluid reveals intracellular and extracellular Gram-positive bacilli. Which of the following is the most appropriate antimicrobial regimen for this patient?

Match each pediatric infectious disease clinical scenario with the most appropriate antimicrobial management strategy, taking into account age-specific pharmacological safety profiles and treatment guidelines.

A 9-year-old boy is brought to the emergency department via ambulance for severe difficulty breathing. His parents report that his symptoms began $12$ hours ago with a cough and wheezing, and worsened significantly over the past $6$ hours. He has a history of moderate persistent asthma and has been using his albuterol inhaler every hour for the past $6$ hours without relief. He is fully immunized. On arrival, the patient is agitated, diaphoretic, and speaking in single words. His temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $110/70\text{ mm Hg}$, pulse is $148/\text{min}$, and respirations are $44/\text{min}$. Pulse oximetry shows $86\%$ on room air. Physical examination reveals marked suprasternal and subcostal retractions. Lung auscultation reveals diminished air entry bilaterally with a prolonged expiratory phase and faint, high-pitched expiratory wheezing. Arrange the following interventions in the most appropriate sequence of administration for this patient's acute management.

A 58-year-old female is admitted to the progressive care unit with worsening confusion, severe fatigue, abdominal pain, and polyuria over the past two weeks. She has a history of breast cancer treated with mastectomy and localized radiation five years ago. Vital signs show a blood pressure of 98/60 mm Hg and a heart rate of 110/min. Physical examination demonstrates dry mucous membranes and diminished skin turgor. Laboratory analysis reveals a serum calcium level of 14.8 mg/dL (normal: 8.4-10.2 mg/dL), a low parathyroid hormone level, and elevated parathyroid hormone-related peptide (PTHrP).

Arrange the following management steps in the most appropriate sequential order for this patient's acute severe hypercalcemia, from the immediate initial intervention to definitive long-term management.

A $65$-year-old woman comes to the clinic reporting a single episode of bright red blood on her undergarments two days ago. She has not had a menstrual period in fourteen years. Her medical history is notable for obesity, type 2 diabetes mellitus, and severe genitourinary syndrome of menopause. Three weeks ago, she began using a low-dose estradiol vaginal ring for her genitourinary symptoms. Her body mass index is $33\text{ kg/m}^2$. Vital signs are within normal limits. Pelvic examination reveals a correctly positioned vaginal ring, improved mucosal hydration, and no visible lacerations or active bleeding in the vaginal vault. Ultrasound imaging of the pelvis demonstrates a homogeneously thickened uterine stripe measuring $7\text{ mm}$ and bilateral normal-appearing adnexa. Which of the following is the most appropriate next step in management?

A $9$-day-old female infant arrives at the emergency department presenting with worsening lethargy, recurrent vomiting, and poor feeding over the past $24$ hours. She has been exclusively breastfed since birth. Physical examination demonstrates marked scleral icterus, hypotonia, and a liver edge palpable $3$ cm below the right costal margin. Initial point-of-care blood glucose is $38$ mg/dL. A urinalysis is negative for glucose but strongly positive for reducing substances. Arrange the following management and diagnostic steps in the most appropriate sequential order for this patient.

A 7-year-old girl is brought to the emergency department experiencing an acute severe asthma exacerbation. She is visibly distressed with supraclavicular retractions, scattered wheezing, and an oxygen saturation of 89% on room air. Arrange the following interventions in the most appropriate stepwise order of priority and escalation, from the immediate first step to the appropriate step for refractory symptoms.

An obstetrician is managing the vaginal delivery of a macrosomic fetus in a patient with gestational diabetes. After the fetal head is delivered, it immediately retracts tightly against the maternal perineum. Routine downward traction fails to deliver the anterior shoulder. Arrange the following clinical interventions in the correct sequential order, from the immediate first steps to the maneuver of absolute last resort, for managing this obstetric emergency.

A 45-year-old woman is diagnosed with severe major depressive disorder without psychotic features. Place the following therapeutic interventions in the most appropriate chronological sequence of standard stepped-care escalation, assuming the patient exhibits an inadequate or partial response at each preceding step.

During a routine evaluation, a 54-year-old teacher describes increasingly disruptive episodes of spontaneous, large-volume urinary leakage that occur immediately following a sudden, overwhelming urge to urinate. Her pelvic examination reveals normal anterior and posterior vaginal support, a negative cough stress test, and a post-void residual volume of 35 mL. Urinalysis is unremarkable. Assuming the patient remains highly symptomatic and fully adheres to each prescribed intervention without experiencing intolerable side effects, arrange the following therapeutic interventions in the correct chronological sequence of escalation according to established urogynecology guidelines.

A 19-year-old male college student is currently undergoing psychiatric evaluation following a recent hospitalization for his first psychotic break, during which he experienced severe auditory hallucinations and persecutory delusions. The psychiatrist is reviewing the patient's longitudinal history with his parents to establish a comprehensive, long-term care plan. According to the classic natural history of schizophrenia, arrange the following clinical periods in the correct chronological order from the earliest developmental stage to the late-stage post-acute period.