Tüm alıştırma soruları

A medical student is reviewing the pathophysiology of several pediatric genetic and metabolic disorders during a clinical genetics rotation. Evaluate the clinical vignettes below and match each patient presentation with the most accurate description of its underlying biochemical or genetic defect.

A 4-year-old girl is brought to the clinic by her parents due to a two-week history of worsening fatigue, spontaneous bruising on her legs, and intermittent low-grade fevers. Physical examination reveals generalized lymphadenopathy and mild hepatosplenomegaly. The physician suspects acute lymphoblastic leukemia (ALL). Arrange the following diagnostic steps in the most appropriate chronological order, from initial screening to definitive staging.

Match the following clinical and laboratory findings observed during an uncomplicated normal pregnancy with their primary underlying physiological mechanisms.

A $24$-year-old woman, gravida $1$, para $0$, presents to the clinic at $8$ weeks gestation for her initial prenatal visit. Her medical history is unremarkable, and she takes a daily prenatal vitamin. Her blood pressure is $112/70\text{ mmHg}$, and her body mass index is $22\text{ kg/m}^2$. The patient is eager to ensure a healthy pregnancy and asks the physician to outline the standard schedule of recommended screenings and evaluations she will undergo over the coming months.

Arrange the following routine obstetric interventions for this patient in the correct chronological order from earliest to latest gestational age.

A series of pregnant patients present to the obstetric triage unit during their first trimester for evaluation of potential pregnancy loss. Match each clinical and ultrasonographic presentation to the most accurate diagnosis.

Match each pediatric patient's clinical presentation with the most appropriate targeted vitamin or cofactor supplementation that serves as specific therapy for their likely underlying metabolic condition.

Match each intrapartum clinical scenario to the most likely obstetric diagnosis.

A crucial component of pediatric hematology and oncology is managing the long-term survivorship of patients exposed to cytotoxic chemotherapy. Match the following chemotherapeutic classes commonly used in pediatric malignancies to their precise mechanism of target-organ toxicity or associated secondary malignancy.

A $7$-month-old boy is evaluated in the urgent care center in early January. His mother reports a $3$-day history of copious nasal discharge, low-grade fever, and a progressively worsening cough. Today, he developed difficulty breathing and has been feeding poorly. His $5$-year-old sister has a history of atopic dermatitis and allergic rhinitis, and she recently recovered from a mild upper respiratory infection. Temperature is $37.8^{\circ}\text{C}$ ($100.0^{\circ}\text{F}$), pulse is $155$ /min, respiratory rate is $62$ /min, and oxygen saturation is $91\%$ on room air. Examination reveals a tachypneic infant with nasal flaring and moderate subcostal retractions. Auscultation of the lungs demonstrates diffuse, bilateral expiratory wheezes and scattered crackles. An empiric nebulized albuterol treatment is administered in the clinic; however, a reassessment $30$ minutes later shows no clinical improvement in his respiratory effort or oxygenation. Which of the following best describes the primary pathophysiologic mechanism responsible for this patient's current respiratory distress and lack of response to the administered therapy?

A 29-year-old multiparous patient at 39 weeks gestation undergoes a spontaneous vaginal delivery. During the third stage of labor, excessive traction is applied to the umbilical cord before placental separation. The patient suddenly develops severe lower abdominal pain and profuse vaginal bleeding. On physical examination, a firm, beefy-red mass is protruding from the introitus, and the uterine fundus is not palpable transabdominally. The patient is tachycardic and hypotensive.

Arrange the following management steps in the optimal chronological sequence, assuming each initial intervention is unsuccessful until surgical resolution is required, followed by standard post-correction care.

A pregnant patient, gravida 3, para 2, at 39 weeks gestation is admitted to the labor unit following the spontaneous onset of contractions. Her prenatal course has been entirely uncomplicated. Cervical examination upon admission reveals 5 cm dilation and 90% effacement. The patient requests pain management, and a continuous lumbar epidural is successfully placed. Twenty minutes later, the patient reports feeling sudden onset lightheadedness and nausea. Her blood pressure is now 82/45 mmHg, representing a significant drop from her admission baseline of 118/76 mmHg. Simultaneously, the external fetal heart rate monitor demonstrates a baseline of 125/min with minimal variability and recurrent late decelerations. The nursing staff immediately places the patient in the left lateral decubitus position and initiates a rapid intravenous infusion of lactated Ringer solution. After five minutes of these interventions, her blood pressure remains 84/48 mmHg and the fetal decelerations persist. Which of the following is the most appropriate next step in the management of this patient?

Match each clinical vignette describing a third-trimester obstetric complication with its primary underlying pathophysiologic mechanism.

Match each clinical presentation of a pregnant patient with the most accurate diagnosis regarding her hypertensive disorder.

A $31$-year-old woman is evaluated in the outpatient clinic for secondary amenorrhea. Her last menstrual period was $7$ months ago. Previously, her menstrual cycles were regular, occurring every $28$ days. She also reports a $3$-month history of bilateral milky nipple discharge, worsening fatigue, cold intolerance, and a $5.5$-kg ($12$-lb) weight gain. The patient has a $4$-year history of bipolar I disorder, which has been stable on a regimen of lithium and risperidone.

Physical examination reveals a body mass index (BMI) of $29$ kg/m $^2$. Vital signs show a temperature of $36.4^\circ$ C ($97.5^\circ$ F), blood pressure of $118/78$ mmHg, and a pulse of $56$/min. Cardiopulmonary examination is unremarkable. Breast examination reveals bilateral, non-bloody, milky discharge that is easily expressed from multiple ducts. Pelvic examination is normal.

A urine pregnancy test is negative.

Laboratory studies show the following results:

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

Match each clinical scenario describing an acute intrapartum or puerperal event to the most likely underlying diagnosis.

An 8-month-old female infant is brought to the pediatric clinic by her parents due to a two-week history of abnormal movements. The parents describe sudden, symmetrical, forward-bending jerks of the infant's neck, trunk, and arms. These episodes typically occur in clusters just after the infant wakes up from sleep. The pregnancy and delivery were uncomplicated. The infant had been meeting all early developmental milestones, but the parents note she recently stopped rolling over and babbling. Vital signs are within normal limits. Neurologic examination is notable for generalized hypotonia. Skin examination under Wood lamp illumination reveals three 1.5-cm, elliptical, hypopigmented macules on the infant's trunk. Which of the following are the most appropriate next steps in the evaluation and management of this patient? (Select exactly two answers)

Match each intrapartum fetal heart rate (FHR) tracing description and its accompanying maternal clinical scenario with the most appropriate targeted intervention.

Match each classic pediatric gastrointestinal clinical presentation to its most appropriate definitive management or next best therapeutic step.

A primigravid mother rushes her 12-day-old male newborn to the acute care clinic because he has been persistently vomiting a bright green substance since the morning. The pregnancy and delivery were entirely normal. The mother mentions the infant is usually calm but has been inconsolably fussy and repeatedly drawing his legs up toward his chest. Upon triage assessment, the infant is lethargic with a heart rate of 188/min, respiratory rate of 58/min, and a palpable systolic blood pressure of only 55 mm Hg. Capillary refill time is prolonged at 4 seconds. The abdominal examination is notable for a tense, distended contour with involuntary guarding and absent auscultatory bowel activity. Intravenous access is rapidly secured, and a bolus of normal saline is administered. A bedside abdominal X-ray displays minimal gas in the distal intestine without free intraperitoneal air. Which of the following is the most appropriate next step in the management of this patient?

A primigravid patient at 33 weeks gestation is evaluated in the obstetric clinic due to concerns about her breathing and mild swelling. She reports a frequent sensation of needing to take deeper breaths that began a few weeks ago, but she states that she can still maintain her daily exercise routine of walking a mile without limitation. She denies chest pain, orthopnea, cough, or calf pain. Her pregnancy has been uncomplicated. Her vital signs are temperature 37.0°C (98.6°F), blood pressure 110/68 mm Hg, pulse 88/min, and respiratory rate 16/min. Pulse oximetry is 99% on room air. Physical examination demonstrates clear lungs bilaterally. Cardiovascular examination reveals a regular rate and rhythm with a grade 2/6 systolic ejection murmur at the left upper sternal border. Trace bilateral dependent edema is present.

Laboratory results are as follows:
Leukocyte count: 12,500/mm³
Hemoglobin: 11.2 g/dL
Platelet count: 220,000/mm³

Based on these findings, which of the following is the most appropriate next step in management?