Tüm alıştırma soruları

Emergency medical services arrive at the hospital with a 42-year-old man who was rescued from a structural fire in an enclosed basement. The patient sustained full-thickness burns over his entire anterior torso, both upper extremities, and the anterior aspect of both thighs, yielding an estimated 45% total body surface area involvement. Although awake and agitated, he exhibits a noticeably hoarse voice, and inspection of the oropharynx reveals carbonaceous sputum and soot. Vital signs include a blood pressure of 110/70 mm Hg, heart rate of 118/min, and respiratory rate of 26/min. His oxygen saturation reads 94% while receiving high-flow oxygen. Arrange the following acute management interventions in the most appropriate chronological sequence.

A 45-year-old woman is receiving a packed red blood cell transfusion for symptomatic anemia. Thirty minutes into the infusion, she develops sudden-onset chills, severe flank pain, and dyspnea. Her temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), blood pressure is $85/50\text{ mmHg}$, and heart rate is $122/\text{min}$. Her urine in the Foley catheter tubing has acutely become dark red. Arrange the following steps in the most appropriate chronological order for managing this patient's suspected acute hemolytic transfusion reaction.

A 48-year-old man with a history of severe alcohol use disorder is brought to the emergency department by paramedics after being found obtunded in a park. His temperature is $36.2^\circ\text{C}$ ($97.2^\circ\text{F}$), blood pressure is $110/70\text{ mmHg}$, pulse is $105/\text{min}$, and respiratory rate is $18/\text{min}$. The patient is unarousable and responds only to painful stimuli.

Initial laboratory studies reveal the following:

Based on the provided laboratory results, what is this patient's serum osmolar gap in $\text{mOsm/kg H}_2\text{O}$?

Match each clinical presentation of acute abdominal pain to the most appropriate next step in management.

Match each distinctive clinical presentation or intrapartum event to the most appropriate obstetric complication.

Match each clinical presentation of an opportunistic infection in a patient with advanced HIV to the most appropriate first-line induction or targeted pharmacological therapy.

A $24$-year-old woman with a history of type 1 diabetes mellitus is brought to the emergency department due to altered mental status, nausea, and vomiting that has progressively worsened over the past $24$ hours. She recently had a urinary tract infection and missed several doses of her basal insulin. Her temperature is $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$), blood pressure is $90/60$ mmHg, pulse is $122$/min, and respirations are $28$/min (deep and rapid). Physical examination reveals dry mucous membranes and delayed capillary refill. Laboratory results are as follows:

Arrange the following steps in the correct sequential order for the most appropriate acute management of this patient's condition.

Match each clinical vignette describing a renal or electrolyte complication of pharmacotherapy with the most likely responsible mechanism or drug effect.

A 34-year-old female is brought to the emergency department via helicopter after being rescued from a residential house fire. The burn injury occurred at 14:00, and she arrives at the trauma bay at 17:00. Her weight is $90 \text{ kg}$. Physical examination reveals deep partial-thickness and full-thickness burns involving her entire anterior trunk (chest and abdomen), her entire right arm (circumferential), and the anterior surface of her left leg. The remainder of her skin is uninjured. En route to the hospital, paramedics successfully intubated her for airway protection and administered $740 \text{ mL}$ of lactated Ringer solution intravenously. According to current Advanced Trauma Life Support (ATLS) guidelines ($2 \text{ mL/kg/\%TBSA}$ for adult thermal burns), what should be the intravenous fluid infusion rate in $\text{mL/hr}$ for the remainder of the first 8-hour post-injury period?

A 52-year-old man is brought to the emergency department after experiencing the sudden onset of excruciating, diffuse abdominal pain that began 2 hours ago. He has a history of severe osteoarthritis and takes high doses of naproxen daily. His temperature is 38.3°C (100.9°F), blood pressure is 100/60 mmHg, and pulse is 115/min. On physical examination, he is diaphoretic and lying completely motionless on the stretcher. His abdomen is rigid and board-like, with diffuse rebound tenderness. Arrange the following critical management steps in the most appropriate chronological sequence for this patient.

Paramedics transport a 32-year-old man to the trauma resuscitation bay following an altercation outside a restaurant. The patient sustained a single stab wound to the left lower abdominal quadrant. He is awake, alert, and conversant. Vital signs show a temperature of $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), heart rate of $92/\text{min}$, respiratory rate of $16/\text{min}$, and blood pressure of $128/82 \text{ mm Hg}$. Physical examination reveals a $3\text{-cm}$ laceration in the left lower quadrant with a segment of omentum actively protruding through the defect. The remainder of the abdomen is soft and non-tender. Two large-bore intravenous lines are established. Which of the following is the most appropriate next step in the management of this patient?

A 68-year-old woman is evaluated in the surgical ward due to the sudden onset of shortness of breath and right-sided chest pain that exacerbates with deep inspiration. She is currently on postoperative day 6 following an open radical cystectomy and ileal conduit formation for bladder cancer. The patient has been mostly bedbound since the surgery due to inadequate pain control. Her temperature is 38.1°C (100.6°F), blood pressure is 108/68 mm Hg, pulse is 118/min, and respirations are 26/min. Pulse oximetry shows an oxygen saturation of 88% on room air. Physical examination reveals clear lungs bilaterally. The right calf appears mildly swollen and is tender to palpation. The surgical incision is clean, intact, and shows no erythema or drainage.

Which of the following are the most appropriate initial steps in the management of this patient? (Select 3)

A metropolitan public health department aims to investigate the association between residential proximity to major highways and the presence of childhood asthma. Investigators randomly select 4,500 households within the city limits. Using a single comprehensive questionnaire distributed in early 2026, parents are asked to report their exact home address and whether any child in the household currently has a physician-given diagnosis of asthma. The researchers then use mapping software to calculate the distance from each home to the nearest major highway. Statistical analysis reveals a higher prevalence of asthma among children living within 500 meters of a highway compared to those living further away. Which of the following is the most significant limitation of the epidemiologic study design used in this investigation?

A 74-year-old man comes to the clinic accompanied by his son to discuss recent prostate biopsy results, which confirm early-stage prostate adenocarcinoma. The physician outlines the available treatment options, including radical prostatectomy, radiation therapy, and active surveillance. The patient has a medical history of hypertension and mild Alzheimer dementia, which was diagnosed two years ago. During the discussion, the patient is fully oriented to person, place, and time. He accurately summarizes his diagnosis, the proposed treatment options, and the potential consequences of refusing standard medical care. He then states, "I understand that without conventional treatment, the cancer might spread and shorten my life. However, my brother suffered terrible complications from a similar surgery, and I refuse to undergo any medical procedures. I will rely exclusively on dietary changes." Later that day, the patient's son, who is the legally designated healthcare proxy, contacts the physician privately. The son insists that his father's dementia makes him incapable of making sound decisions and demands that the physician schedule the surgery. Which of the following is the most appropriate next step in management?

An infant boy, now $12$ months of age, is evaluated in the pediatric clinic for a routine health maintenance visit. His past medical history is notable for a truncus arteriosus repair at age $4$ weeks. During his postoperative recovery, he developed tetany associated with a serum calcium level of $6.2 \text{ mg/dL}$. Subsequent evaluation revealed an absent thymic shadow on a chest radiograph, and a confirmatory genetic test showed a microdeletion on chromosome $22\text{q}11.2$. He has been taking oral calcium and vitamin D supplementation since discharge and has experienced no severe infections. His previous immunizations at $2$, $4$, and $6$ months of age consisted only of inactivated vaccines and were administered without complications. The parents are inquiring about the vaccines scheduled for today, which typically include measles-mumps-rubella (MMR), varicella, hepatitis A, and pneumococcal conjugate vaccines. Which of the following is the most appropriate action regarding his immunizations today?

A 7-year-old boy is brought to the emergency department by his parents 30 minutes after falling from a playground structure. He fell onto his outstretched left arm and immediately complained of severe elbow pain. Vital signs include a temperature of 37.0°C (98.6°F), blood pressure of 105/65 mm Hg, heart rate of 112/min, and respiratory rate of 20/min. Physical examination reveals a distressed child holding his left arm. There is marked swelling and an "S-shaped" deformity at the left elbow. There are no open wounds or visible ecchymoses.

Neurovascular assessment demonstrates a palpable radial pulse and a capillary refill time of 1 second in the fingers. When asked to make an "OK" sign with his left hand, the patient is unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Sensation to light touch is intact over the median, ulnar, and radial nerve distributions. Anteroposterior and lateral radiographs of the left elbow show a displaced extension-type supracondylar humerus fracture with posterior displacement of the distal fragment.

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

Physicians must routinely navigate complex boundaries regarding patient autonomy, surrogate authority, and statutory exceptions to standard consent processes. Evaluate the following distinct clinical scenarios and match each patient presentation to the ethical doctrine or legal principle that most accurately governs the appropriate management step.

A 54-year-old man with a 30-year history of treatment-resistant schizophrenia is hospitalized for severe foot necrosis secondary to uncontrolled diabetes mellitus. The surgical team recommends a below-the-knee amputation to prevent fatal sepsis. The patient refuses the surgery. Upon psychiatric evaluation, he correctly states his diagnosis, understands that the infection will likely spread and cause his death without surgical intervention, and accurately describes the proposed procedure. He calmly states, "I know I will likely die without the surgery, but I have lived a hard life and I do not want to live the rest of it without my leg." The patient does not express any delusions regarding his foot or the hospital staff. The patient's sister, who is his closest relative but not a legally appointed healthcare proxy, insists that his psychiatric diagnosis means he cannot make this decision and demands that the surgeons proceed with the amputation. Which of the following is the most appropriate next step in management?

A consortium of neurologists is trying to identify potential risk factors for a newly characterized, atypical early-onset Parkinsonian syndrome. They access clinical registries across several hospital networks to find 60 patients diagnosed with this specific syndrome. For comparison, they select 180 healthy individuals matched for age and gender from the same primary care networks. The researchers then administer a detailed questionnaire to all subjects regarding their history of head trauma, pesticide use, and dietary habits over the past twenty years. Which of the following methodological statements are correct regarding this study design? (Select all that apply)

A 65-year-old man with advanced amyotrophic lateral sclerosis is brought to the emergency department after suffering a massive ischemic stroke. He is profoundly obtunded and requires intubation for airway protection upon arrival. The patient's electronic medical record contains a valid advance directive, completed one year ago when he was cognitively intact, explicitly stating he refuses intubation and mechanical ventilation under any circumstances. The document also legally designates his wife as his healthcare proxy. His wife arrives at the hospital in distress and states, "I know what his living will says, but I cannot bear to lose him today. Please keep him on the breathing machine until our children can fly in this weekend." Which of the following is the most appropriate next step in management?