Tüm alıştırma soruları

Continuous, involuntary leakage of clear vaginal fluid is the chief complaint of a parous female evaluated in the outpatient gynecology clinic. Her surgical history is significant for a difficult total laparoscopic hysterectomy performed fourteen days prior due to an enlarged fibroid uterus. The patient states she is constantly damp despite using absorbent pads, yet she maintains the ability to voluntarily urinate small amounts into the toilet. Vital signs and basic laboratory results are unremarkable. Based on the suspected diagnosis, arrange the following clinical interventions in the correct chronological sequence from initial evaluation to definitive management.

Match each pediatric clinical presentation to its most likely causative pathogen.

Neonatal rashes and skin findings are common and typically benign, but distinguishing between them based on timing and clinical morphology is essential to prevent unnecessary invasive diagnostic workups. Match each described neonatal clinical presentation with the most accurate dermatologic diagnosis.

A 34-year-old woman comes to the urogynecology clinic complaining of chronic, severe suprapubic pelvic pain that worsens as her bladder fills and is temporarily relieved by voiding. She reports urinating up to 15 times during the day and 4 times at night. Over the past year, she has received three courses of antibiotics for suspected cystitis, but her symptoms persisted and urine cultures were consistently negative. Pelvic examination demonstrates tenderness at the bladder base but no anterior or posterior vaginal wall prolapse.

Assume a clinical diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS). Arrange the following diagnostic and management steps in the correct sequential order according to standard escalating treatment guidelines, from initial presentation to refractory disease.

Emergency medical services personnel bring a 29-year-old man to the emergency department after he was found shouting erratically outside a nightclub. The patient is highly agitated, pacing the room, and repeatedly scratching his forearms, claiming that "insects are trying to burrow into my veins." His medical history includes bipolar I disorder, for which he is prescribed lithium. Vital signs are temperature 38.1°C (100.6°F), blood pressure 172/108 mm Hg, pulse 128/min, and respirations 20/min. Physical examination reveals mydriasis, profuse diaphoresis, and multiple linear excoriations on both upper extremities. The patient is uncooperative with a detailed neurological examination but moves all extremities spontaneously. Which of the following is the most appropriate initial step in the management of this patient?

During a mid-December clinic visit, a physician evaluates a 5-month-old infant due to three days of nasal congestion and a worsening cough. The parents report the infant has been breathing more rapidly since this morning but continues to breastfeed well and produce normal wet diapers. The patient was born at 39 weeks gestation and has no significant past medical history. Vital signs show a temperature of 37.6°C (99.7°F), heart rate of 138/min, respiratory rate of 52/min, and oxygen saturation of 97% on room air. Examination shows copious clear nasal discharge, mild subcostal retractions, and diffuse bilateral wheezing with scattered coarse crackles. Which of the following is the most appropriate next step in management?

A 4-week-old boy is evaluated in the pediatric clinic after his parents noticed a new facial eruption. The parents report that the lesions began developing three days ago and seem to be increasing in number. The infant was born at 39 weeks gestation via uncomplicated vaginal delivery to a 28-year-old primigravid mother. He is exclusively breastfed, stooling normally, and gaining weight appropriately. Vital signs are within normal limits. Physical examination reveals an alert, well-appearing infant. There are multiple small, erythematous papules and pustules scattered across the patient's forehead, cheeks, and chin. No true comedones are observed. The remainder of the skin examination, including the trunk and extremities, is unremarkable. Which of the following is the most appropriate next step in management for this patient?

A 27-year-old woman is brought to the psychiatric clinic by her wife due to concerning behavioral changes. The patient has a history of intermittent profound sadness, anhedonia, and hypersomnia that first began 8 months ago. During these periods of low mood, she frequently reports hearing derogatory voices commenting on her actions. Medical records indicate that she was treated with an antidepressant 4 months ago, which completely resolved her low mood, anhedonia, and sleep disturbances for a period of 5 weeks. However, during that 5-week period of normal, euthymic mood, she continued to hear the same derogatory voices and developed a new fixed belief that her neighbors were planting cameras in her walls. For the past 3 months, her severe low mood and hypersomnia have returned alongside the persistent auditory hallucinations and delusions. A urine toxicology screen is negative, and her physical examination is unremarkable. Which of the following is the most likely diagnosis?

An unimmunized 3-year-old girl is brought to the emergency department due to a rapid onset of high fever, severe sore throat, and progressive difficulty breathing over the past 4 hours. Her temperature is $39.8^\circ\text{C}$ ($103.6^\circ\text{F}$), heart rate is $155/\text{min}$, and respiratory rate is $42/\text{min}$. The child is highly anxious, sitting upright, leaning forward, and drooling. Inspiratory stridor is clearly audible without a stethoscope. Arrange the following acute management steps in the most appropriate sequential order for this patient.

A 24-year-old nulliparous woman presents to the clinic after discovering a firm, mobile, and painless lump in her left breast. Arrange the following steps in the correct sequential order for the standard evaluation and management of this patient's new breast mass, from the initial encounter to the final disposition.

A 42-year-old female patient is evaluated in the outpatient surgical clinic on her third postoperative day. She reports new-onset, right-sided lower back pain accompanied by subjective fevers. Three days prior, she underwent an uncomplicated laparoscopic hysterectomy to treat symptomatic, large uterine leiomyomas. Her past medical history is notable only for mild asthma. Her current temperature is 38.3°C (100.9°F), blood pressure is 122/76 mm Hg, and heart rate is 94/min. Physical examination demonstrates marked tenderness to percussion over the right costovertebral angle. Her abdomen is soft and non-distended, with well-healing laparoscopic port sites without erythema or induration. Urinalysis reveals 1 to 2 leukocytes per high-power field, negative nitrites, and no red blood cells. Which of the following is the most appropriate next step in the management of this patient?

A $27$-year-old nulliparous woman at $40$ weeks gestation presents to the obstetric unit with spontaneous onset of painful uterine contractions. Her pregnancy has been uncomplicated. Six hours after admission, she is in active labor. Maternal vital signs are within normal limits. The fetal heart rate tracing demonstrates a baseline of $135$/min with moderate variability. However, the tracing displays recurrent, rapid drops in the fetal heart rate down to $75$/min. These drops last for $40$ to $60$ seconds before abruptly returning to baseline, and they do not consistently align with the peak of uterine contractions. Uterine contractions are occurring every $3$ minutes.

In response to these findings, the attending nurse assists the patient into the left lateral decubitus position, initiates a $500$ mL intravenous fluid bolus, and applies supplemental oxygen via face mask. Despite these measures, the fetal heart rate pattern persists over the next $30$ minutes. A sterile vaginal examination shows the cervix is $6$ cm dilated and completely effaced, with the fetal head at $-1$ station. No pulsating tissue is felt through the dilated cervix. Which of the following is the most appropriate next step in the management of this patient?

A 52-year-old man with a known history of severe alcohol use disorder is brought to the emergency department by bystanders who found him unresponsive on the street. Initial vital signs show a heart rate of 115/min and blood pressure of 145/90 mm Hg. Point-of-care blood glucose is 42 mg/dL. As he slowly regains consciousness in the emergency department, he becomes visibly tremulous, anxious, and profusely diaphoretic. Arrange the following management steps in the most appropriate chronological order for this patient, proceeding from immediate acute stabilization to long-term outpatient care.

For each of the following clinical scenarios involving a depressive presentation or its treatment, select the most appropriate next step in management.

Match each pediatric clinical presentation with the most likely underlying genetic or metabolic disorder.

A 22-year-old male university student is escorted to the urgent care clinic by campus security after he was observed shouting at pedestrians and claiming that invisible drones were tracking his movements. His roommate mentions that the patient attended a rave three days ago and has not slept since. The patient's past medical records show a diagnosis of major depressive disorder, for which he is prescribed daily fluoxetine. Vital signs include a heart rate of 128/min, respiratory rate of 20/min, and blood pressure of 162/98 mm Hg. Physical assessment reveals profuse sweating, bilateral mydriasis, and extensive scratch marks on both arms. The patient states he is trying to remove "parasites" from his skin. Assessment of his reflexes shows 2+ patellar responses bilaterally with no evidence of rigidity or clonus. Which of the following is the most likely diagnosis?

A 5-year-old girl is brought to the pediatric emergency department due to severe headache, high fever, and progressive confusion over the past 12 hours. Upon arrival, her temperature is 39.5°C (103.1°F), heart rate is 155/min, blood pressure is 80/45 mmHg, and respiratory rate is 32/min. She is obtunded, opening her eyes only to painful stimuli. Physical examination reveals nuchal rigidity, a non-blanching purpuric rash on her lower extremities, and new-onset right-sided hemiparesis.

Assuming the patient's hemodynamic status stabilizes and neuroimaging does not reveal signs of impending herniation, arrange the following critical management steps in the most appropriate chronological sequence.

A previously healthy 33-year-old female is evaluated in the clinic for a tender mass in her right breast, first noticed 5 days ago. The pain is described as a localized ache that worsens with physical pressure. Her menstrual cycles are regular, and her last menstrual period was 2 weeks ago. She has no personal or family history of breast disease. Vital signs are within normal limits. Physical examination reveals a 3.5-cm, smooth, firm, and tender mobile mass in the upper outer quadrant of the right breast. There is no overlying skin erythema, dimpling, or nipple discharge. A targeted breast ultrasound is performed, which demonstrates a well-circumscribed, thin-walled, anechoic structure with posterior acoustic enhancement.

Which of the following is the most appropriate next step in management to alleviate this patient's symptoms?

Match each characteristic presentation of nipple discharge to its most likely underlying etiology.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity. Identifying the underlying etiology rapidly through physical examination is critical for directing appropriate intervention. Pair each distinct clinical presentation of severe postpartum bleeding with its corresponding primary etiology.