Tüm alıştırma soruları

Match each clinical presentation of an obstetric complication with its most likely diagnosis.

A 54-year-old woman is evaluated in the oncology ward for a new-onset fever. She is currently on day 10 of induction chemotherapy for acute myeloid leukemia. Her temperature is 38.8°C (101.8°F), blood pressure is 105/65 mmHg, and heart rate is 112/min. Laboratory analysis shows a white blood cell count of 400/mm³ with an absolute neutrophil count (ANC) of 150/mm³. She has a central venous port in her right internal jugular vein.

Arrange the following interventions in the most appropriate chronological sequence for managing this patient's condition.

A pulmonology consultation is requested for a hospitalized patient who was admitted two days ago for an acute exacerbation of chronic obstructive pulmonary disease. The patient has a history of type 2 diabetes mellitus and has developed severe nausea and intractable emesis over the last 24 hours after starting a new medication regimen. Current vital signs show a temperature of $37.8^\circ C$ ($100^\circ F$), blood pressure of $110/68$ mm Hg, pulse of $115$/min, and respirations of $28$/min. Physical examination reveals distant breath sounds with prolonged expiration and dry mucous membranes. A comprehensive metabolic panel and arterial blood gas analysis are obtained on room air.

Based on the laboratory data provided, which of the following accurately describes the primary and concurrent acid-base processes occurring in this patient?

A 65-year-old woman is evaluated in the clinic for progressive fatigue and generalized weakness over the past month. Her past medical history is significant for type 2 diabetes mellitus, essential hypertension, and heart failure with preserved ejection fraction. Two months ago, a new medication was added to her regimen to improve fluid balance and blood pressure control. Her current medications include metformin, amlodipine, empagliflozin, and the newly prescribed drug.

Her temperature is 37.0°C (98.6°F), blood pressure is 128/78 mm Hg, pulse is 72/min, and respirations are 16/min. Physical examination reveals clear lungs and no lower extremity edema.

Laboratory studies are obtained:

An arterial blood gas on room air shows:

Which of the following best explains the underlying pathophysiology of this patient's current acid-base and electrolyte abnormalities?

A $52$-year-old man presents for a routine follow-up appointment due to progressive fatigue, a $4\text{-kg}$ ($8.8\text{-lb}$) weight gain, and an inability to tolerate cold environments over the past $5$ months. Three years ago, he underwent surgical resection of a large pituitary adenoma. His temperature is $36.4^\circ\text{C}$ ($97.5^\circ\text{F}$), blood pressure is $115/75\text{ mmHg}$, and pulse is $56/\text{min}$. Physical examination reveals dry skin and delayed relaxation of the deep tendon reflexes. Laboratory testing shows:

Serum free $\text{T}_4$: $0.4\text{ ng/dL}$ (normal: $0.9-1.7\text{ ng/dL}$)
Serum $\text{TSH}$: $1.1\text{ }\mu\text{U/mL}$ (normal: $0.5-5.0\text{ }\mu\text{U/mL}$)

Which of the following is the most likely diagnosis?

A 71-year-old man presents to the emergency department with a 4-day history of productive cough, chills, and progressive dyspnea. On physical examination, he appears lethargic and is using accessory respiratory muscles. Vital signs are:

Temperature: 38.8°C (101.8°F)
Blood pressure: 92/58 mm Hg
Heart rate: 115/min
Respiratory rate: 28/min

Arterial blood gas analysis on room air reveals:
pH: 7.18
pCO2: 38 mm Hg
pO2: 54 mm Hg

Serum laboratory studies reveal:
Sodium: 139 mEq/L
Potassium: 4.6 mEq/L
Chloride: 101 mEq/L
Bicarbonate: 14 mEq/L
Blood urea nitrogen: 32 mg/dL
Creatinine: 1.6 mg/dL
Lactate: 5.4 mmol/L

Based on the patient's laboratory findings, which of the following is the most accurate description of his current acid-base status?

During bedside rounds, the medical team evaluates a patient who was admitted four days ago for lower extremity edema and exertional dyspnea. The patient has a longstanding history of severe emphysema and right ventricular failure. Over the course of the hospitalization, aggressive intravenous furosemide has been administered, resulting in a $6\text{ kg}$ weight loss and significant symptomatic improvement. Current medications include inhaled tiotropium, oral amlodipine, and intravenous furosemide. Vital signs are within normal limits.

Laboratory studies are obtained:

Arterial blood gas (room air):

Which of the following is the most accurate interpretation of this patient's current acid-base status?

A 62-year-old man is currently in the intensive care unit on day 4 of admission for severe sepsis secondary to a perforated diverticulum. He remains intubated, sedated, and requires continuous norepinephrine infusion to maintain his mean arterial pressure. According to his family, he had no chronic medical conditions prior to this admission and did not take any medications. Routine morning laboratory studies are obtained, and the intensive care team decides to send a thyroid panel due to mild bradycardia. The results are as follows:

Thyroid-stimulating hormone (TSH): $0.2 \text{ mU/L}$ (Normal: $0.4\text{--}4.0 \text{ mU/L}$)
Total thyroxine (T4): $4.1 \text{ } \mu\text{g/dL}$ (Normal: $4.5\text{--}11.2 \text{ } \mu\text{g/dL}$)
Free triiodothyronine (T3): $1.2 \text{ pg/mL}$ (Normal: $2.3\text{--}4.2 \text{ pg/mL}$)

Based on these laboratory findings, which of the following is the most appropriate next step in the management of this patient's thyroid profile?

Match each set of laboratory results from a water deprivation test (followed by desmopressin administration) to the most likely pathophysiologic diagnosis.

A previously healthy $9$-month-old female infant presents to an urgent care center with a five-day history of persistent high temperatures, a harsh barking-like cough, and a severely runny nose. Her parents note that she has been rubbing her excessively red, tearing eyes. The family recently moved from a rural region in a developing country, and the infant has not received any childhood immunizations. On triage, her temperature is $39.7^\circ\text{C}$ ($103.5^\circ\text{F}$), pulse is $158\text{/min}$, and respirations are $48\text{/min}$. Pulse oximetry is $96\%$ on room air. Examination of the oropharynx reveals tiny white lesions on the inner cheeks that resemble grains of salt on a red background. Additionally, a non-pruritic, erythematous, maculopapular exanthem is visible starting at the forehead and extending downward to the neck and upper shoulders. Auscultation of the chest demonstrates coarse breath sounds bilaterally without wheezing. Which of the following is the most appropriate next step in management?

Match each laboratory profile of serum calcium, phosphorus, and intact parathyroid hormone (PTH) to the most likely underlying clinical diagnosis.

During a winter clinical visit, a physician evaluates a patient who reports progressive exhaustion and episodic darkening of her urine over the past three months. The patient also notes that her fingers turn bluish and become painful when she is exposed to chilly morning air. She has no significant past medical history and takes no daily medications. Vital signs are within normal limits. Physical examination reveals conjunctival pallor and mild cervical lymphadenopathy. Laboratory studies show the following:

Hemoglobin: 7.8 g/dL
Mean corpuscular volume: 104 fL
Reticulocyte count: 7.5%
Lactate dehydrogenase: 650 U/L
Haptoglobin: < 10 mg/dL (normal: 41-165 mg/dL)

A direct antiglobulin test is strongly positive for C3 but negative for IgG. A peripheral blood smear demonstrates red blood cell clumping that resolves upon warming the slide.

Which of the following is the most appropriate definitive pharmacologic therapy for this patient's hematologic condition?

A 4-year-old boy is brought to the emergency department by ambulance due to altered mental status and fever. The parents state that he complained of a severe headache and photophobia yesterday before becoming progressively lethargic. His immunizations are incomplete. On examination, the patient is obtunded and grimaces only to painful stimuli. Temperature is $39.6^\circ\text{C}$ ($103.3^\circ\text{F}$), pulse is $152/\text{min}$, blood pressure is $82/48\text{ mm Hg}$, and respirations are $26/\text{min}$. Physical examination reveals nuchal rigidity. The right pupil is $5\text{ mm}$ and sluggish, while the left pupil is $3\text{ mm}$ and briskly reactive. Papilledema is present on fundoscopy. Arrange the following next steps in management in the most appropriate chronological order.

Match each patient's clinical presentation with the most likely corresponding coagulation profile.

A male neonate is born at $38$ weeks of gestation via induced vaginal delivery at a tertiary care center. Prenatal ultrasonography at $22$ weeks revealed a left-sided congenital diaphragmatic hernia. At birth, the infant has a scaphoid abdomen and a barrel-shaped chest. He exhibits significant respiratory distress with severe intercostal retractions and central cyanosis. The heart rate is $145$/min. Arrange the following management steps in the correct chronological sequence for this patient.

A 32-year-old woman, gravida 1, para 0, abortus 1, comes to the clinic to be evaluated for a 15-month history of inability to conceive. She reports that her menstrual cycles occur at regular 28-day intervals but consist of only very light spotting for 1 to 2 days. Prior to her pregnancy, her menses lasted 5 to 6 days with normal flow. Her obstetric history is significant for an elective termination of pregnancy 3 years ago at 9 weeks gestation. The procedure was complicated by heavy bleeding requiring a repeat dilation and curettage. She subsequently developed a fever and was successfully treated with intravenous antibiotics for postabortal endometritis. She takes a daily prenatal vitamin and has no other medical conditions. Her body mass index is $22 \text{ kg/m}^2$. Pelvic examination reveals a normal-appearing cervix and a mobile, normal-sized uterus without adnexal masses.

Laboratory studies show:
Follicle-stimulating hormone: $6.2 \text{ mIU/mL}$
Luteinizing hormone: $5.8 \text{ mIU/mL}$
Estradiol: $90 \text{ pg/mL}$
Thyroid-stimulating hormone: $1.8 \text{ \mu U/mL}$
Prolactin: $14 \text{ ng/mL}$

A 10-day course of oral medroxyprogesterone acetate is administered, but the patient experiences no vaginal bleeding upon cessation of the medication. Which of the following is the most likely pathophysiologic mechanism of this patient's current condition?

A 72-year-old man is evaluated in the hospital on day 3 of admission for community-acquired pneumonia. He initially presented to the emergency department with a 2-day history of fever, productive cough, and shortness of breath. His medical history is significant for hypertension and mild chronic obstructive pulmonary disease. On admission, his temperature was $38.9^\circ\text{C}$ ($102^\circ\text{F}$), blood pressure was $118/76\text{ mmHg}$, pulse was $102/\text{min}$, and respiratory rate was $22/\text{min}$. Oxygen saturation was $92\%$ on room air. Chest radiography revealed a right lower lobe consolidation. He was empirically started on intravenous ceftriaxone and intravenous azithromycin. Today, the patient is afebrile, his pulse is $82/\text{min}$, and his respiratory rate is $16/\text{min}$. He is resting comfortably and eating a regular diet. Blood cultures drawn on admission are now growing *Streptococcus pneumoniae*. Susceptibility testing shows the organism is highly susceptible to penicillin, amoxicillin, ceftriaxone, and levofloxacin, but resistant to azithromycin. Which of the following is the most appropriate next step in antibiotic management?

A 42-year-old woman is evaluated for a 6-month history of progressive weight gain, facial rounding, and worsening hypertension. She also reports easy bruising, newly developing dark hairs on her chin, and muscle weakness when climbing stairs. She takes amlodipine and lisinopril, but her blood pressure remains poorly controlled at $162/98\text{ mmHg}$. Physical examination shows central obesity, facial plethora, supraclavicular fat pads, and wide, violaceous abdominal striae.

Laboratory findings:
- Serum potassium: $3.3\text{ mEq/L}$
- 24-hour urine free cortisol: $420\ \mu\text{g}$ (Normal: $< 45\ \mu\text{g}$)
- Overnight 1-mg dexamethasone suppression test: Serum cortisol is $15\ \mu\text{g/dL}$ (Normal: $< 1.8\ \mu\text{g/dL}$)
- Plasma ACTH: $110\text{ pg/mL}$ (Normal: $10-60\text{ pg/mL}$)

An MRI of the brain with contrast reveals a $4\text{ mm}$ focal hypointense lesion in the anterior pituitary gland.

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

A 28-year-old male with type 1 diabetes mellitus arrives at the acute care clinic complaining of severe nausea, diffuse abdominal cramping, and frequent emesis for the past 72 hours. He states he has been unable to tolerate oral intake and has missed his last four insulin doses. On physical examination, he appears lethargic with markedly dry mucous membranes and poor skin turgor. Blood pressure is $100/60 \text{ mmHg}$, heart rate is $118\text{/min}$, and respiratory rate is $24\text{/min}$.

Laboratory results:
Sodium: $142 \text{ mEq/L}$
Potassium: $3.2 \text{ mEq/L}$
Chloride: $90 \text{ mEq/L}$
Bicarbonate: $16 \text{ mEq/L}$
Blood urea nitrogen: $38 \text{ mg/dL}$
Creatinine: $1.8 \text{ mg/dL}$
Glucose: $450 \text{ mg/dL}$

Assuming a normal anion gap of $12 \text{ mEq/L}$, what is the patient's calculated corrected bicarbonate (also known as the expected starting bicarbonate or delta-delta) in mEq/L?

A 29-year-old nulligravid woman presents to the gynecology clinic for evaluation of an inability to conceive over the past 16 months. She reports that her menstrual cycles have become progressively infrequent, with her last menstrual period occurring 4 months ago. She also recently noticed a spontaneous, milky bilateral nipple discharge. Her past medical history is unremarkable, and she takes no medications. Vital signs are within normal limits. Pelvic examination is normal, and breast examination confirms bilateral galactorrhea. Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for the evaluation and management of this patient.