Tüm alıştırma soruları

A 34-year-old woman is brought to the emergency department due to a sudden, severe, throbbing headache and blurred vision. Her symptoms began approximately one hour after she ingested an over-the-counter oral decongestant for a viral upper respiratory infection. Her medical history is significant for treatment-resistant atypical depression. After failing several medication trials, she was started on a new psychiatric medication four weeks ago, which has significantly improved her mood. Her temperature is 37.1°C (98.8°F), pulse is 118/min, and blood pressure is 225/125 mmHg. Physical examination reveals a diaphoretic, anxious patient in obvious distress. Neurologic examination demonstrates normal muscle tone, 2+ deep tendon reflexes globally, and absent clonus. Which of the following psychiatric medications was most likely prescribed to this patient?

A 42-year-old woman is evaluated in the post-anesthesia care unit 3 hours after a total thyroidectomy for a large multinodular goiter. The nurse urgently calls for evaluation because the patient is agitated and reports increasing difficulty breathing. Her blood pressure is 162/94 mm Hg, pulse is 118/min, and respirations are 28/min. Pulse oximetry shows an oxygen saturation of 88% on room air. Physical examination reveals audible inspiratory stridor. The anterior neck appears significantly swollen, tense, and ecchymotic beneath the surgical dressing. Arrange the following steps in the most appropriate chronological order for the immediate management of this patient's condition.

Match each diagnostic finding from the clinical evaluation of female urinary incontinence to its most appropriate corresponding diagnosis or pathophysiology.

A 28-year-old man is brought to the emergency department via ambulance after being rescued from a house fire. The incident occurred exactly 2 hours prior to arrival. He weighs $80$ kg. Primary survey reveals a patent airway, clear breath sounds bilaterally, and a heart rate of $115$/min. Physical examination shows deep partial-thickness and full-thickness burns covering his entire anterior torso, entire right arm, and the anterior surface of his right leg. Peripheral intravenous access is established. Based on current Advanced Trauma Life Support (ATLS) guidelines for adult thermal burn resuscitation (using $2 \text{ mL/kg/\%TBSA}$), what should be the initial intravenous crystalloid fluid infusion rate programmed for the remainder of the first 8 hours post-injury?

A 35-year-old male construction worker is brought to the emergency department after falling 20 feet (6 meters) from a scaffold. He is secured to a backboard with a rigid cervical collar in place. He is obtunded, opens his eyes only to painful stimuli, and makes incomprehensible sounds. Vital signs are temperature 36.5°C (97.7°F), blood pressure 75/45 mm Hg, pulse 135/min, and respirations 28/min. Pulse oximetry shows 88% on high-flow oxygen. Physical examination reveals copious blood in the oropharynx with audible gurgling. There are absent breath sounds and dullness to percussion over the right hemithorax. The abdomen is grossly distended and rigid. Arrange the following management steps in the most appropriate sequential order according to the Advanced Trauma Life Support (ATLS) protocol.

A 45-year-old male construction worker arrives at the emergency department triage desk complaining of an abrupt onset of excruciating epigastric pain that began 2 hours ago. The pain has now spread throughout his entire abdomen. He appears acutely ill, diaphoretic, and lies completely still on the gurney. Vital signs show a temperature of 38.2°C (100.8°F), blood pressure of 100/60 mm Hg, heart rate of 115/min, and respiratory rate of 22/min. Physical examination demonstrates a rigid, board-like abdomen with severe, diffuse rebound tenderness and involuntary guarding. Arrange the following steps in the most appropriate chronological sequence for the initial evaluation and management of this patient.

A $28$-year-old woman is evaluated for a $12$-month history of secondary amenorrhea and inability to conceive. She had irregular menses since menarche and was diagnosed with polycystic ovary syndrome (PCOS) at age $21$ due to oligomenorrhea and hirsutism. Over the past year, her menses ceased entirely. She also reports progressive fatigue, cold intolerance, and occasional morning headaches. Her BMI is $32 \text{ kg/m}^2$. Physical examination reveals coarse terminal hair on her chin and upper lip, unchanged from previous visits. Neurologic examination shows a visual field defect in the bilateral temporal fields.

Laboratory evaluation reveals:
Follicle-stimulating hormone: $2 \text{ mIU/mL}$ (normal: $4-30 \text{ mIU/mL}$)
Luteinizing hormone: $1 \text{ mIU/mL}$ (normal: $2-20 \text{ mIU/mL}$)
Prolactin: $58 \text{ ng/mL}$ (normal: $<20 \text{ ng/mL}$)
Thyroid-stimulating hormone: $0.2 \text{ mIU/L}$ (normal: $0.4-4.0 \text{ mIU/L}$)
Free thyroxine (T4): $0.4 \text{ ng/dL}$ (normal: $0.9-1.7 \text{ ng/dL}$)

Which of the following is the most likely underlying cause of this patient's current amenorrhea?

A woman in her first pregnancy is brought to the emergency department at 36 weeks and 4 days of gestation complaining of acute difficulty breathing. She reports a two-day history of a severe, unremitting headache and visual scotomas. She has no significant past medical history and takes no medications. Vital signs are temperature 37.0°C (98.6°F), blood pressure 182/114 mmHg, pulse 112/min, and respirations 28/min. Oxygen saturation is 86% on room air. Physical examination reveals generalized facial puffiness and marked pitting edema of both lower extremities extending to the knees. Auscultation of the lungs reveals diffuse bilateral crackles in the lower and middle lung fields. A continuous fetal monitor is placed. The uterine tocodynamometer shows contractions every 4 minutes. The fetal heart rate tracing reveals a baseline of 145/min, moderate variability, and recurrent, gradual decreases in heart rate with nadirs occurring after the peaks of the contractions. Which of the following is the most appropriate initial step in the management of this patient?

A medical genetics team is evaluating several pediatric patients with suspected inborn errors of amino acid metabolism. Based on the findings provided, match each patient's clinical presentation with the specific enzyme defect most likely responsible for their condition.

On postoperative day 8 following an exploratory laparotomy and right salpingo-oophorectomy for a ruptured ectopic pregnancy, a 42-year-old woman requires urgent evaluation for sudden, severe abdominal pain. She had previously been recovering appropriately, with a return of bowel function and tolerance of a soft diet by day 4. However, over the past 12 hours, she has developed colicky pain and recurrent bilious vomiting, and she has not passed flatus or stool. Her temperature is 38.7°C (101.7°F), blood pressure is 100/65 mmHg, pulse is 122/min, and respirations are 22/min. On examination, the patient is in obvious distress. Her abdomen is markedly distended. Palpation elicits diffuse tenderness, involuntary guarding, and severe rebound tenderness. Bowel sounds are absent. Laboratory results indicate a leukocyte count of 16,800/mm³ with 12% bands and a serum lactate level of 3.8 mmol/L. An upright abdominal radiograph demonstrates multiple air-fluid levels within dilated loops of small intestine and a paucity of colonic gas. Which of the following is the most appropriate next step in management?

A 68-year-old man is brought to the emergency department by his wife due to a 24-hour history of severe headache, high fever, and progressive confusion. His temperature is 39.2°C (102.6°F), blood pressure is 145/85 mmHg, heart rate is 112/min, and respiratory rate is 18/min. Neurologic examination reveals a lethargic patient who only opens his eyes to painful stimuli. He demonstrates marked nuchal rigidity and profound weakness of the right upper and lower extremities.

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

Match each clinical presentation of a substance-related medical complication to the substance most likely responsible for the patient's condition.

A 47-year-old G2P2 patient presents to the clinic for her annual preventive health visit. She feels well and reports no pelvic pain, vaginal discharge, or abnormal bleeding. Her menstrual cycles remain regular, occurring every 29 days with 5 days of normal flow. Her last menstrual period ended two weeks ago. Medical history is unremarkable, and she takes no medications. Vital signs are normal. Speculum examination reveals a normal, parous cervix without visible lesions. Bimanual examination demonstrates a mobile, non-enlarged uterus and no adnexal masses. A sample obtained for cervical cancer screening shows "negative for intraepithelial lesion or malignancy" with the presence of "benign endometrial cells." Concurrent testing for high-risk human papillomavirus (HPV) is negative. Which of the following is the most appropriate next step in the care of this patient?

Match each clinical presentation of peptic ulcer disease complications with its most appropriate definitive surgical management.

A 66-year-old G4P4 woman comes to the office due to a 9-month history of a persistent vaginal bulge. She reports that the sensation of fullness worsens after prolonged standing or lifting groceries and improves when she lies down. Additionally, the patient has developed difficulty emptying her bladder over the past 3 months. She notes that she must apply manual upward pressure on the vaginal bulge with her fingers to successfully initiate and complete urination. She denies urinary leakage with coughing, sudden overwhelming urges to urinate, dysuria, or constipation. She has a history of type 2 diabetes mellitus and hypertension. Pelvic examination reveals a soft, reducible mass protruding from the anterior vaginal wall that descends to the introitus during the Valsalva maneuver. The posterior vaginal wall and vaginal apex demonstrate normal support without descent. Which of the following is the most likely anatomic etiology of this patient's current symptoms?

A multiparous patient (G3P2) at 40 weeks of gestation is in the active pushing phase of labor. Her pregnancy was complicated by gestational diabetes. Following the emergence of the fetal head, it promptly retracts against the perineal tissue (turtle sign). Standard downward traction is unsuccessful in delivering the anterior shoulder. The attending clinician immediately calls for assistance.

Arrange the following obstetric interventions in the most appropriate sequential order for managing this complication, starting from the recommended initial maneuver to the procedure of last resort.

A 31-year-old man is evaluated in the clinic due to a one-month history of overwhelming sadness, severe fatigue, and a loss of interest in his usual hobbies. During this time, he has been sleeping up to 12 hours a day and has missed multiple days of work. His wife, who accompanies him, reports that four years ago he experienced a distinct two-week period where his behavior changed dramatically. During that time, he slept only two hours a night without feeling tired, obsessively pursued a chaotic new business venture, and spoke so rapidly that others could not interrupt him. He was not hospitalized during that episode and eventually returned to his baseline. He is currently taking no medications, and his medical history is unremarkable. Which of the following is the most appropriate pharmacologic intervention for this patient's current symptoms?

A 24-year-old medical student is diagnosed with major depressive disorder and prescribed a daily dose of escitalopram. The physician counsels the patient extensively on what to expect over the coming months regarding efficacy and adverse effects. Arrange the following clinical developments in the typical chronological order of their occurrence following the initiation of continuous selective serotonin reuptake inhibitor (SSRI) therapy.

Emergency medical services via helicopter transport a 22-year-old male to the trauma center following a high-speed motorcycle crash. Upon arrival, he has a traumatic partial amputation of the left lower leg. Bright red blood is spurting profusely through the prehospital bandages despite direct pressure. The patient is unresponsive, with a Glasgow Coma Scale score of 6, and is making gurgling respiratory sounds. His abdomen is markedly distended and rigid to palpation. Vital signs are temperature $35.2^\circ\text{C}$ ($95.4^\circ\text{F}$), heart rate $148/\text{min}$, blood pressure $70/40 \text{ mm Hg}$, and respiratory rate $8/\text{min}$. Large-bore intravenous access is currently being established. Arrange the following management steps in the most appropriate chronological order according to current Advanced Trauma Life Support (ATLS) and damage control surgery principles.

Paramedics bring a 31-year-old man to the emergency department after finding him unresponsive in a local park. On arrival, he is deeply obtunded with a respiratory rate of 4 breaths/minute and marked miosis. After successfully resuscitating the patient, the care team manages his subsequent hospital course and eventually discharges him to community-based care. Arrange the following clinical steps in the most appropriate chronological sequence for managing this patient's condition, from his initial emergency presentation through his long-term recovery.