Tüm alıştırma soruları

Campus security brings a 19-year-old male university student to the emergency department after he was found destroying furniture in his dormitory. The student's friends report that he went to an off-campus warehouse party three days ago and has been awake ever since. He has been barricaded in his room, loudly claiming that hidden cameras are broadcasting his thoughts. Vital signs show a temperature of 38.6°C (101.5°F), blood pressure of 172/105 mmHg, and heart rate of 138/min. Physical examination reveals profound diaphoresis, mydriasis, and psychomotor agitation. There is no horizontal or vertical nystagmus, and muscle tone is normal. Routine urine drug immunoassay is negative for all tested substances. The patient requires multiple doses of chemical restraints over the next four days to manage ongoing severe combativeness and hallucinations. Which of the following is the most likely diagnosis?

During a routine wellness visit, the parents of a 9-year-old boy express deep concern regarding his increasingly difficult behavior. For the past 9 months, he has consistently refused to follow household rules and argues excessively with adults. The parents note that he deliberately annoys his younger sister and quickly blames her whenever he gets into trouble. A written report from his third-grade teacher describes identical defiant behavior during class, noting that he often loses his temper when asked to transition between activities. Despite these challenges, he has never engaged in physical fights, property destruction, or theft. His sleep patterns and appetite are normal, and he maintains friendships with a small group of neighborhood peers. His physical examination is unremarkable. Which of the following is the most appropriate next step in management?

Match each patient's clinical presentation of a psychotropic adverse effect with the medication most likely responsible.

A 35-year-old male construction worker is brought to the emergency department by his wife due to sudden-onset severe agitation, fever, and muscle stiffness. His medical history is significant for major depressive disorder, for which he has been taking sertraline for the past 2 years. Two days ago, the patient underwent a complex root canal procedure and was prescribed a short course of a centrally acting analgesic. On physical examination, his temperature is 39.4°C (102.9°F), blood pressure is 165/100 mmHg, and heart rate is 118/min. He is diaphoretic, flushed, and noticeably disoriented. Neurologic examination reveals bilateral ankle clonus, marked shivering, and generalized hyperreflexia that is most prominent in the lower extremities. Which of the following describes the mechanism of action of the analgesic that most likely precipitated this patient's current condition?

A 26-year-old woman presents to the psychiatric clinic accompanied by her husband. She gave birth to her first child 3 months ago. Over the past month, she has been experiencing recurrent, terrifying mental images of deliberately dropping her infant down the staircase. She finds these images deeply disturbing and recognizes them as products of her own mind. She has no desire to harm her child. To cope, she absolutely refuses to carry the infant near any stairs and repeatedly asks her husband to confirm she is a capable mother, occupying several hours of their day. Her psychiatric history is significant for bipolar II disorder, currently well-controlled on lithium. At age 21, following a severe stressor, she experienced auditory hallucinations that lasted for 2 weeks and resolved completely without long-term medication. Currently, in addition to lithium, she takes over-the-counter St. John's wort for mild fatigue. Which of the following is the most appropriate next step in management?

Match each postoperative clinical presentation to the anatomical structure most likely injured during the cardiothoracic procedure.

Paramedics bring a 35-year-old male to the emergency department after he was rescued from a residential fire. The patient weighs 75 kg. According to the paramedics, the burn injury occurred exactly 2 hours prior to arrival. Physical examination reveals deep partial-thickness and full-thickness burns covering his entire posterior trunk and both of his entire upper extremities. The remainder of his skin is intact. Two large-bore intravenous lines are established.

Using the traditional Parkland formula ($4$ mL/kg/% total body surface area), what should be the intravenous fluid administration rate (in mL/hr) prescribed for the remaining time to complete the first 8-hour post-injury resuscitation goal?

Match each patient's clinical scenario and specific medication requirement with the most appropriate second-generation antipsychotic.

A $58$-year-old man is brought to the emergency department by emergency medical services due to the sudden onset of severe, 'tearing' chest pain that radiates to his back between the scapulae. The pain started abruptly $45$ minutes ago while he was doing yard work. He has a history of poorly controlled essential hypertension. On arrival, he is diaphoretic and appears in acute distress. His temperature is $37.1^\circ$ C ($98.8^\circ$ F), blood pressure is $195/110$ mmHg in the right arm and $180/105$ mmHg in the left arm, heart rate is $108$/min, and respiratory rate is $22$/min. Oxygen saturation is $96\%$ on room air. A bedside chest radiograph reveals a widened mediastinum. Arrange the following management steps in the most appropriate chronological order for this patient.

Pair the following acute clinical presentations with their most likely underlying substance-related diagnosis.

Select the most appropriate initial pharmacological or procedural intervention for each of the following patients presenting with distinct clinical features of major depressive disorder.

Match each thoracic trauma clinical presentation to the most appropriate next step in diagnosis or definitive management based on Advanced Trauma Life Support (ATLS) principles.

A 58-year-old female patient is evaluated in the emergency room due to a $2$-day history of severe right upper quadrant abdominal pain, shaking chills, and progressively worsening yellowing of her skin. Her temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $98/60$ mm Hg, pulse is $112$/min, and respirations are $20$/min. Physical examination reveals marked scleral icterus and significant right upper quadrant tenderness, but no rebound or guarding.

Laboratory studies show:
Leukocyte count: $18,500/\text{mm}^3$
Total bilirubin: $6.4 \text{ mg/dL}$
Alkaline phosphatase: $480 \text{ U/L}$
Aspartate aminotransferase (AST): $150 \text{ U/L}$
Alanine aminotransferase (ALT): $165 \text{ U/L}$
Amylase: $85 \text{ U/L}$

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

Match each patient's clinical presentation of an adverse drug reaction to the psychotropic medication most likely responsible for their symptoms.

A 22-year-old woman is brought to the emergency department by her roommate due to increasingly bizarre behavior. The roommate reports that for the past 3 weeks, the patient has been locking herself in her room, claiming that foreign intelligence agents are transmitting messages into her brain through the electrical outlets. She has also been observed whispering to unseen entities and has stopped attending her college classes. The patient was previously healthy and highly functional until she experienced a sudden, traumatic breakup with her fiancé one month ago. She has no prior psychiatric or medical history. Vital signs are within normal limits, and a comprehensive physical examination is unremarkable. Urine toxicology screening is negative for illicit substances. The patient is admitted to the psychiatric unit and started on oral risperidone. Four days later, her psychotic symptoms completely resolve, and she is discharged with a full return to her baseline level of functioning. Which of the following is the most likely diagnosis?

A 24-year-old woman comes to the outpatient psychiatric clinic due to a 4-week history of feeling severely depressed, lacking energy, and sleeping 12 to 14 hours a day. She reports a loss of interest in her usual hobbies and a 5-kg (11-lb) weight gain over this period. The patient has no significant past medical history. Upon further questioning, the patient's roommate states that 8 months ago, the patient had a 10-day episode where she was extremely energetic, required only 3 hours of sleep per night, and spoke so rapidly it was difficult to interrupt her. During that time, she spontaneously booked an expensive, non-refundable trip to Europe that she could not afford. She was not hospitalized and eventually returned to her baseline. Which of the following is the most appropriate pharmacotherapy for this patient's current condition?

For each of the following clinical situations, identify the most appropriate action regarding the patient's privacy by pairing the scenario with its corresponding ethical or legal guideline.

The quality improvement committee at a large community hospital has identified a recent increase in central line-associated bloodstream infections (CLABSIs) within the intensive care unit. The committee decides to implement a new daily central line maintenance checklist to standardize care and reduce infection rates. They plan to use the Plan-Do-Study-Act (PDSA) cycle to guide this quality improvement initiative.

Arrange the following actions taken by the committee in the correct chronological sequence according to the PDSA methodology.

A 72-year-old woman is admitted to the cardiac intensive care unit with a non-ST-segment elevation myocardial infarction. The physician orders a continuous intravenous infusion of unfractionated heparin at 1,000 units/hour. Two hours later, the patient develops severe epistaxis and hematemesis. Stat laboratory results show an activated partial thromboplastin time of >150 seconds. A root cause analysis reveals that the nurse manually programmed the infusion pump, accidentally typing the numeric value '1000' into the pump's 'mL/hour' field instead of the required 'units/hour' parameter. This resulted in a massive, rapid overdose. The hospital's quality improvement committee is tasked with implementing an intervention to prevent similar transcription and programming errors in the future. According to the hierarchy of intervention effectiveness, which of the following is the most robust strategy to mitigate this type of error?

A 65-year-old man is admitted to the intensive care unit following a massive ischemic stroke. He is unresponsive and completely lacks decision-making capacity. The primary care team determines that a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube will be necessary if life-prolonging measures are to be continued. Multiple individuals arrive at the hospital, each claiming the right to make medical decisions on the patient's behalf. Arrange the following potential decision-makers from highest priority (first) to lowest priority (last) according to the standard legal hierarchy of surrogate decision-makers.