Tüm alıştırma soruları

Match each underlying etiology of male factor infertility with its characteristic clinical and serum laboratory profile.

A 7-year-old girl is brought to the emergency department by her parents due to severe headache, high fever, and progressive confusion over the past 8 hours. Her temperature is 39.6°C (103.3°F), blood pressure is 105/65 mmHg, heart rate is 138/min, and respiratory rate is 24/min. On examination, she is lethargic, spontaneously opens her eyes only to pain, and utters incomprehensible sounds. Pronounced nuchal rigidity is present. Fundoscopic examination reveals bilateral blurring of the optic disc margins. The patient has no history of immunodeficiency and is up to date on all vaccinations. Arrange the following management steps in the most appropriate chronological order for this patient's acute presentation.

A 72-year-old woman is brought to the clinic by her daughter due to progressive forgetfulness, irritability, and unsteadiness on her feet over the past 6 months. Her past medical history is significant for hypothyroidism and type 2 diabetes mellitus, which have been managed with levothyroxine and metformin for the last 8 years. Vital signs are within normal limits. Neurological examination reveals a broad-based gait, decreased vibratory sensation in the distal lower extremities bilaterally, and a positive Romberg sign. Deep tendon reflexes are 1+ at the ankles and 2+ at the patellae. Laboratory studies show:

Hemoglobin: 10.2 g/dL
Mean corpuscular volume (MCV): 108 fL
Platelets: 140,000/mm³
Serum vitamin B12: 245 pg/mL (normal: 200-900 pg/mL)
Serum folate: 14 ng/mL (normal: > 4.0 ng/mL)
Thyroid-stimulating hormone (TSH): 2.4 µU/mL

Which of the following is the most appropriate next step in the diagnosis of this patient's condition?

A 52-year-old woman comes to the clinic due to a 4-month history of progressively worsening shortness of breath and fatigue. She has a 12-year history of limited cutaneous systemic sclerosis, which has primarily manifested as Raynaud phenomenon, sclerodactyly, and cutaneous telangiectasias. She does not have a cough, fever, orthopnea, or lower extremity swelling. Vital signs are within normal limits. On physical examination, the lungs are clear to auscultation bilaterally. Cardiac examination reveals a prominently loud pulmonic component of the second heart sound (P2) and a right ventricular heave. There are no murmurs or gallops. Pulmonary function testing reveals the following:

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

A pediatrician is examining several newborns in the nursery and noting various benign dermatologic findings. Connect the following neonatal clinical vignettes with their most appropriate diagnosis.

An 82-year-old woman is brought to the emergency department from a skilled nursing facility due to a 2-day history of worsening confusion and agitation. She has a medical history of moderate Alzheimer dementia, type 2 diabetes mellitus, hypertension, and urge urinary incontinence. Two weeks ago, she was evaluated for worsening incontinence, and oral oxybutynin was added to her regimen. She cannot provide a reliable history, but the facility staff reports no observed coughing, vomiting, diarrhea, or signs of pain during urination. The staff did note that her urine has been cloudy and malodorous for the past 3 days.

Vital signs are temperature $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure $138/84\text{ mmHg}$, pulse $88/\text{min}$, and respiratory rate $16/\text{min}$. Oxygen saturation is $98\%$ on room air. The patient is disoriented to time and place and frequently picks at her clothing. The abdomen is soft, non-tender, and without suprapubic distension. Bilateral costovertebral angle percussion elicits no reaction.

Laboratory evaluation shows a leukocyte count of $8,500/\text{mm}^3$, serum sodium of $138\text{ mEq/L}$, serum creatinine of $1.0\text{ mg/dL}$, and blood glucose of $115\text{ mg/dL}$. Urinalysis obtained via straight catheterization reveals:

Color: Yellow, cloudy
Specific gravity: $1.018$
Leukocyte esterase: Positive
Nitrites: Positive
WBCs: $30\text{-}40/\text{hpf}$
RBCs: $0\text{-}2/\text{hpf}$
Bacteria: Many

A urine culture is sent to the laboratory. Which of the following is the most appropriate next step in management?

A 24-year-old woman is brought to the endocrinology clinic by her sister due to distressing changes in her appearance over the past three months. She has developed thick, dark hair on her chin and chest, and she notes her voice has become noticeably deeper. Her menstrual periods, previously regular, have been absent for four months. She takes no medications. Her blood pressure is 118/76 mmHg and her body mass index is $23 \text{ kg/m}^2$. Physical examination reveals severe hirsutism, cystic acne on her back, temporal hair thinning, and clitoromegaly. A bedside pelvic ultrasound demonstrates multiple small follicles peripherally arranged in both ovaries. Which of the following is the most appropriate next step in management?

A $21$-year-old woman is evaluated in the primary care clinic for a three-month history of persistent sadness, hypersomnolence, and low energy. She also mentions a strong desire to quit smoking cigarettes but has been unsuccessful with nicotine replacement therapy. Her temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $105/70\text{ mmHg}$, and pulse is $84/\text{min}$. Her body mass index is $18.4\text{ kg/m}^2$. Physical examination is notable for bilateral parotid gland hypertrophy, enamel erosion on her lingual tooth surfaces, and hyperkeratotic calluses on the dorsum of her right hand. Laboratory results show a serum potassium of $3.2\text{ mEq/L}$. The physician is considering a pharmacologic intervention that can address both her mood disorder and tobacco dependence. Which of the following medications is most strongly contraindicated in this patient?

A $42$-year-old man visits the outpatient physician reporting a $4$-month history of profound tiredness, reduced sexual desire, and frequent morning headaches. Over the last several weeks, he has experienced near-miss accidents while driving because he did not see cars in the adjacent lanes. Vital signs are within normal limits. Laboratory studies reveal:

* Thyroid-stimulating hormone (TSH): $1.1$ mU/L (Normal: $0.5$ - $5.0$ mU/L)
* Free thyroxine (T4): $0.4$ ng/dL (Normal: $0.9$ - $1.7$ ng/dL)

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

A 34-year-old man comes to the emergency department reporting a 3-day history of left shoulder pain, intractable hiccups, and persistent fevers. Fourteen days ago, he underwent an exploratory laparotomy, splenectomy, and distal pancreatectomy following severe blunt abdominal trauma sustained in a motorcycle collision. He was discharged on postoperative day 8. His current temperature is $39.0^\circ\text{C}$ ($102.2^\circ\text{F}$), blood pressure is 122/76 mmHg, pulse is 112/min, and respirations are 22/min. Oxygen saturation is 96% on room air. Physical examination reveals decreased breath sounds at the left lung base. The abdomen is soft with mild tenderness in the left upper quadrant, but no rebound guarding is present. The surgical incision is well-healed without erythema or discharge. Laboratory studies show a leukocyte count of $18,200/\text{mm}^3$. A chest radiograph demonstrates a left-sided pleural effusion and atelectatic changes at the left lung base. Which of the following is the most appropriate next step in management?

A 62-year-old man is evaluated on postoperative day 2 following a robotic-assisted radical prostatectomy. He reports mild chest discomfort that worsens with deep breathing. His temperature is $38.3^\circ\text{C}$ ($100.9^\circ\text{F}$), blood pressure is $128/78\text{ mmHg}$, pulse is $92/\text{min}$, and respirations are $20/\text{min}$. Oxygen saturation is $94\%$ on room air. Auscultation reveals decreased breath sounds at the bilateral lung bases without crackles or wheezes. The abdominal incisions are clean, dry, and intact. His indwelling urinary catheter was removed on postoperative day 1, and he is currently voiding without difficulty. Which of the following are the most appropriate next steps in management? (Select exactly 2 correct answers)

A $42$-year-old man comes to the clinic complaining of worsening anxiety, excessive sweating, and a $5$-kg ($11$-lb) weight loss over the past three months despite an increased appetite. He has no significant past medical history and takes no medications. Vital signs show a blood pressure of $142/82$ mmHg and a heart rate of $110$/min. Physical examination reveals a restless patient with a fine resting tremor of the hands, warm and diaphoretic skin, and a palpable, diffusely enlarged, non-tender thyroid gland without discrete nodules. No exophthalmos or pretibial myxedema is noted.

Laboratory evaluation reveals the following:

Based on the clinical and laboratory findings, which of the following is the most appropriate next diagnostic step?

A $34$-year-old woman comes to the clinic for a $6$-week follow-up visit. She was diagnosed with Graves disease after presenting with a $4$-kg ($8.8$-lb) weight loss, frequent palpitations, and heat intolerance. At the time of diagnosis, her thyroid-stimulating hormone (TSH) level was $<0.01$ $\mu$ U/mL and her free thyroxine (T4) level was $3.8$ ng/dL. She was initiated on methimazole and propranolol. Today, the patient reports that she feels much better; her palpitations have resolved, she is sleeping well, and her weight has remained stable for the past three weeks. Vital signs are temperature $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure $118/74$ mm Hg, and pulse $72$/min. Physical examination shows a mild, non-tender thyromegaly. She has no tremors. Laboratory evaluation today shows:

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

A 54-year-old man is evaluated in the hospital for decreased urine output. He was admitted 7 days ago for infective endocarditis and has been receiving intravenous vancomycin and gentamicin. Over the past 24 hours, his urine output has dropped to 300 mL. His vital signs are within normal limits and he appears euvolemic on examination. Laboratory studies show the following:

Microscopic urinalysis reveals muddy brown granular casts.

Based on the provided laboratory findings, what is this patient's fractional excretion of sodium ($Fe_{Na}$)? (Express your answer as a percentage)

A 24-year-old woman arrives at the trauma center via helicopter after losing control while down-hill skiing and forcefully striking a stationary snow-making machine. She complains of severe left flank and abdominal pain. Her temperature is 36.2 °C (97.2 °F), pulse is 135/min, blood pressure is 78/48 mmHg, and respirations are 24/min. On physical examination, her airway is patent, and breath sounds are clear and equal bilaterally. The abdomen exhibits marked tenderness in the left upper quadrant with localized guarding. The pelvis is stable to anteroposterior and lateral compression. A bedside focused assessment with sonography for trauma (FAST) exam reveals an anechoic stripe between the spleen and the left kidney. She is rapidly administered 1 L of warmed lactated Ringer solution and 1 unit of uncrossmatched O-negative packed red blood cells. Reassessment vital signs show a pulse of 128/min and a blood pressure of 82/50 mmHg. Which of the following is the most appropriate next step in the management of this patient?

Correlate the following clinical descriptions of pediatric dermatologic findings and associated symptoms with their respective etiologic agents.

Identify the most likely underlying etiology for each of the following distinct clinical presentations of postpartum hemorrhage.

A 65-year-old man with a history of metastatic prostate cancer presents to the emergency department reporting severe, progressively worsening back pain for the past two weeks. This morning, he developed new-onset bilateral leg weakness and urinary retention. Physical examination reveals 3/5 motor strength in both lower extremities, patellar hyperreflexia, and decreased sensation to pinprick below the umbilicus. Anal sphincter tone is decreased. Arrange the following interventions in the most appropriate chronological sequence for the optimal management of this patient's condition.

A 68-year-old man is evaluated on postoperative day 5 following an elective right hemicolectomy for colon adenocarcinoma. Over the past 12 hours, he has developed a new-onset fever, generalized malaise, and worsening abdominal pain. His medical history is significant for heart failure with preserved ejection fraction and diet-controlled type 2 diabetes mellitus. His temperature is 39.1°C (102.4°F), blood pressure is 128/76 mmHg, pulse is 114/min, and respiratory rate is 22/min. Oxygen saturation is 95% on room air. Physical examination reveals a mildly distended abdomen with focal tenderness in the right lower quadrant, but no involuntary guarding or rebound. The surgical incision is clean, dry, and intact. Auscultation of the lungs reveals fine crackles at the bases bilaterally, which are unchanged from his preoperative assessment. Blood cultures that were drawn 24 hours ago during a transient low-grade temperature elevation are now returning positive for *Escherichia coli* that is susceptible to ceftriaxone. Which of the following are the most appropriate next steps in management? (Select 2)

Match each rheumatologic autoantibody profile with its most characteristic clinical presentation.