Tüm alıştırma soruları

A 72-year-old woman is admitted to the intensive care unit with acute respiratory distress syndrome secondary to severe community-acquired pneumonia. She is currently intubated and requires vasopressor support for hemodynamic stability. Her medical history is significant for hypertension. There is no personal or family history of endocrine disorders. On hospital day 3, a routine metabolic evaluation includes thyroid function testing with the following results:

Which of the following is the most likely explanation for this patient's thyroid function test abnormalities?

A 34-year-old G1P0 woman at $37$ weeks of gestation is currently hospitalized and receiving an intravenous magnesium sulfate infusion for the management of severe preeclampsia. During a routine clinical assessment, the nurse notes that the patient has become increasingly somnolent and difficult to arouse. Her vital signs show a blood pressure of $152/98\text{ mmHg}$, a heart rate of $88\text{ /min}$, a respiratory rate of $8\text{ /min}$, and an oxygen saturation of $86\%$ on room air. Continuous fetal heart rate monitoring demonstrates a baseline of $130\text{ /min}$ with minimal variability and no decelerations. Neurological examination reveals bilaterally absent patellar reflexes. Urine output has been $40\text{ mL}$ over the last $4$ hours. Arrange the following acute management steps in the most appropriate chronological sequence for this patient.

Match each clinical presentation of a neonate with respiratory compromise to the most likely corresponding diagnosis.

An evaluation is requested for a 15-year-old adolescent who has not yet experienced menarche or any breast development. She is significantly shorter than her peers, with her height charting at the 2nd percentile for age. Examination demonstrates a broad chest with widely spaced nipples and a low posterior hairline. Pelvic examination reveals normal prepubertal female external genitalia. Arrange the following diagnostic and management steps in the most appropriate chronological order for this patient.

A 65-year-old male with poorly controlled type 2 diabetes mellitus presents to the emergency department following 3 days of intractable vomiting, diffuse abdominal pain, and an inability to tolerate oral intake. He reports that he stopped taking his prescribed insulin regimen 48 hours ago due to his lack of appetite. On physical examination, he appears lethargic and mildly confused. His mucous membranes are completely dry, and he has markedly decreased skin turgor. His temperature is 37.1°C (98.8°F), blood pressure is 90/60 mm Hg, pulse is 112/min, and respiratory rate is 24/min.

Laboratory studies show the following:
Sodium: $142 \text{ mEq/L}$
Potassium: $3.8 \text{ mEq/L}$
Chloride: $94 \text{ mEq/L}$
Bicarbonate: $16 \text{ mEq/L}$
Blood urea nitrogen: $45 \text{ mg/dL}$
Serum creatinine: $2.2 \text{ mg/dL}$
Glucose: $550 \text{ mg/dL}$
Serum ketones: large

Assuming a normal serum anion gap of $12 \text{ mEq/L}$ and a normal serum bicarbonate of $24 \text{ mEq/L}$, what is the delta ratio ($\Delta\text{AG} / \Delta\text{HCO}_3^-$) for this patient?

Match each patient's clinical presentation and laboratory profile with the most likely underlying etiology of her infertility or amenorrhea.

Match each of the following thyroid function test (TFT) laboratory profiles with the most likely underlying pathophysiologic diagnosis.

A 68-year-old man is evaluated in the intensive care unit for worsening oxygenation and a new-onset fever. He was admitted 8 days ago for severe acute respiratory distress syndrome secondary to influenza A, requiring endotracheal intubation and mechanical ventilation. Over the past 48 hours, his fraction of inspired oxygen (FiO2) requirement has increased from 40% to 60%. His temperature is 39.1°C (102.4°F), blood pressure is 110/65 mm Hg, and pulse is 108/min. Physical examination reveals coarse rhonchi bilaterally and copious, purulent secretions from the endotracheal tube. A chest radiograph demonstrates a new consolidation in the left lower lobe. Endotracheal aspirate and blood cultures are obtained. The patient is empirically started on intravenous piperacillin-tazobactam, vancomycin, and amikacin. Three days later, his clinical condition has significantly improved, and his oxygen requirements have decreased. The endotracheal aspirate culture yields heavy growth of Pseudomonas aeruginosa. Susceptibility testing indicates the isolate is sensitive to piperacillin-tazobactam, ceftazidime, cefepime, and ciprofloxacin, but resistant to amikacin. Blood cultures show no growth after 72 hours. Which of the following is the most appropriate next step in pharmacotherapy?

A 24-year-old woman with a history of type 1 diabetes mellitus presents to the emergency department with nausea, vomiting, and diffuse abdominal pain. She reports missing her insulin doses for the past two days due to illness. On physical examination, she appears lethargic. Her blood pressure is 105/65 mm Hg, heart rate is 118/min, and respiratory rate is 26/min with deep, rapid breaths. Laboratory studies show the following:

What is the patient's calculated serum anion gap? (Provide the numerical value in mEq/L).

A 29-year-old woman, gravida 0, seeks medical advice for a 9-month history of secondary amenorrhea and infertility. During the past 4 months, she has also noted severe cystic acne, increased terminal hair growth on her face and chest, and a noticeable deepening of her voice. She has no history of medical conditions and takes no medications. Her blood pressure is 126/80 mm Hg, pulse is 76/min, and BMI is 24 $kg/m^2$. Physical examination demonstrates temporal balding, pronounced facial hirsutism, and clitoromegaly. Pelvic examination is limited by patient guarding, and no distinct adnexal masses are palpated. A urine $\beta$-hCG test is negative. Laboratory evaluation reveals the following:

Total testosterone: 195 $ng/dL$ (normal: 15-70 $ng/dL$)
Dehydroepiandrosterone sulfate (DHEAS): 210 $\mu g/dL$ (normal: 35-430 $\mu g/dL$)
Prolactin: 14 $ng/mL$ (normal: 4-23 $ng/mL$)
Thyroid-stimulating hormone: 2.1 $\mu U/mL$

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

A 28-year-old individual with a history of type 1 diabetes mellitus presents to the acute care clinic with 48 hours of relentless nausea and forceful emesis. The patient reports being unable to retain oral fluids and consequently withheld their scheduled insulin doses. On physical assessment, the patient is lethargic with dry mucous membranes and delayed capillary refill. Vital signs show a temperature of 37.1°C (98.8°F), blood pressure of 96/58 mm Hg, heart rate of 115/min, and respiratory rate of 24/min.

Laboratory analysis reveals:
Serum sodium: 140 mEq/L
Serum potassium: 3.4 mEq/L
Serum chloride: 94 mEq/L
Serum bicarbonate: 16 mEq/L
Serum creatinine: 1.8 mg/dL
Blood glucose: 625 mg/dL

Arterial blood gas obtained on room air shows:
pH: 7.32
pCO₂: 32 mm Hg
pO₂: 94 mm Hg

Based on these findings, which of the following represents the most accurate characterization of this patient's acid-base status?

A 42-year-old woman presents to the clinic with progressive weight gain, easy bruising, and proximal muscle weakness over the past 8 months. Physical examination reveals facial plethora, prominent supraclavicular fat pads, and purple abdominal striae. Her blood pressure is 155/95 mmHg. The physician suspects Cushing syndrome and plans to initiate a diagnostic workup. Arrange the following diagnostic steps in the correct chronological sequence, from the initial action to the final localizing step.

Match each of the following comprehensive thyroid function laboratory profiles to the most likely underlying pathophysiological diagnosis. Assume all patients are adult individuals without current acute severe illness unless the laboratory pattern specifically indicates otherwise.

A 42-year-old woman comes to the emergency department complaining of profound muscle weakness and generalized fatigue that has worsened over the past two weeks. She reports intermittent difficulty swallowing dry foods and feeling like she constantly has "sand in her eyes." Her past medical history is unremarkable, and she takes no medications. Vital signs are within normal limits.

Laboratory studies are obtained and reveal the following:

Which of the following is the primary pathophysiologic mechanism underlying this patient's electrolyte abnormalities?

A 38-year-old woman comes to the outpatient clinic due to worsening fatigue, weight gain, and cold intolerance over the last 4 months. She also reports that she has not had a menstrual period for 6 months. Her past medical history is notable for a severe postpartum hemorrhage 4 years ago requiring a blood transfusion. Physical examination reveals dry skin and delayed relaxation of the deep tendon reflexes. Laboratory evaluation shows:

Free T4: $0.4\text{ ng/dL}$ (normal: $0.9-1.7\text{ ng/dL}$)
TSH: $1.2\text{ }\mu\text{U/mL}$ (normal: $0.5-5.0\text{ }\mu\text{U/mL}$)

Based on these findings, which of the following is the most likely diagnosis?

Match each of the following patient clinical presentations with the most likely corresponding renal biopsy findings on light, immunofluorescence, or electron microscopy.

A 48-year-old man comes to the clinic reporting progressive fatigue, weight gain, and decreased libido over the past six months. He also mentions experiencing intermittent frontal headaches and notes that he frequently bumps into doorframes on his left and right sides. Vital signs include a heart rate of 58/min and a blood pressure of 110/70 mm Hg. Physical examination is notable for delayed relaxation of deep tendon reflexes. Visual field testing by confrontation reveals a loss of peripheral vision in both eyes.

Laboratory studies show the following:

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

A $42$-year-old man is admitted to the hospital with newly diagnosed Burkitt lymphoma. He has a massive tumor burden and is scheduled to receive intensive induction chemotherapy. Baseline laboratory studies reveal a serum uric acid of $10.2$ mg/dL, potassium of $5.1$ mEq/L, phosphorus of $4.8$ mg/dL, and creatinine of $1.3$ mg/dL.

Arrange the following steps in the most appropriate chronological order for the prevention and stepwise management of tumor lysis syndrome in this patient.

A 9-day-old male infant is brought to the pediatric emergency department by his parents due to a new rash on his head and decreased oral intake over the past 24 hours. The infant was born at 39 weeks gestation via vaginal delivery. Birth weight was 3,400 g (7 lb 8 oz) and APGAR scores were 8 and 9 at 1 and 5 minutes, respectively. Labor was complicated by fetal heart rate decelerations necessitating the placement of a fetal scalp electrode. Maternal group B Streptococcus screening was negative. Vital signs show a temperature of 38.1°C (100.6°F), heart rate of 165/min, and respiratory rate of 45/min. Physical examination reveals a cluster of 2- to 4-mm fluid-filled vesicles on an erythematous base located on the vertex of the scalp. The anterior fontanelle is flat, but the infant appears lethargic and is slow to respond to examination. Which of the following is the most appropriate next step in management?

Immunosuppressive and disease-modifying therapies used in rheumatologic conditions are associated with distinct adverse effect profiles requiring specific monitoring strategies. Match each medication below with its most characteristic adverse effect profile.