Tüm alıştırma soruları

A 14-month-old boy is brought to the clinic for a health maintenance visit. He missed his 12-month checkup due to a prolonged hospitalization for severe abdominal pain and bloody diarrhea, which led to a diagnosis of very early-onset inflammatory bowel disease. He was initiated on infliximab therapy three weeks ago, and his parents report an excellent clinical response. He has no other medical problems and takes no other medications. Vital signs are within normal limits. Growth curves show him at the 15th percentile for weight and 40th percentile for length. Physical examination reveals a well-appearing child with a soft, non-tender abdomen. His immunization record shows he received all age-appropriate vaccines at 2, 4, and 6 months of age. The physician plans to update his immunizations today. Which of the following vaccines should be omitted from his schedule at this time?

Emergency medical services arrive at the trauma bay with a 28-year-old roofing contractor who fell from a residential building. The fall distance was approximately $4.5$ meters ($15$ feet). The patient is fully conscious and reports agonizing pain in his left leg. Vital signs show a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), heart rate of $105/\text{min}$, blood pressure of $130/80\text{ mm Hg}$, and a respiratory rate of $18/\text{min}$. The initial trauma assessment confirms a patent airway, normal breathing, and no clinical evidence of intra-abdominal hemorrhage. Attention to the left lower extremity reveals a visibly angulated mid-shaft tibia. A $5\text{-cm}$ skin tear is present over the medial aspect, oozing dark blood, with underlying bone fragments exposed. The distal foot is noticeably pale and cold compared to the contralateral limb. Palpation of the dorsalis pedis and posterior tibial arteries yields no pulse, and capillary refill in the toes is absent. Neurological evaluation of the foot is limited secondary to extreme pain. Which of the following is the most appropriate initial step in the management of this patient's left extremity?

A team of global public health analysts investigates the relationship between the strictness of national indoor smoking bans and the incidence of acute asthma exacerbations. They obtain 2025 public health records from 25 different countries. For each country, they quantify the strictness of the indoor smoking ban on a standardized 1-to-10 scale. They then compare this score to each country's national rate of asthma-related emergency department visits per 100,000 population. The analysis demonstrates a strong inverse correlation between the two variables. Which of the following best describes the study design used in this investigation?

A 22-year-old male is brought to the emergency department after a high-speed motorcycle collision. He complains of severe right leg pain. On physical examination, his right knee is grossly deformed with a prominent medial femoral condyle. The patient's right foot is cold and pale, and the dorsalis pedis and posterior tibial pulses are not palpable. Capillary refill is delayed. Arrange the following management steps in the most appropriate chronological order for this patient, assuming that an arterial injury is present and requires definitive treatment.

An attending physician is managing a critically ill patient who has acutely lost decision-making capacity and requires an urgent, non-emergent surgical intervention. The patient's chart contains no advance directive, designated healthcare proxy, or record of a court-appointed legal guardian. The clinical social worker has managed to contact several individuals in the patient's life who are willing to participate in discussions. According to standard United States statutory guidelines for surrogate decision-making, arrange the following individuals in the correct hierarchical order of priority to provide informed consent, from highest priority (first) to lowest priority (last).

Evaluate the following international travelers and match each patient's clinical scenario with the most strongly indicated specific travel vaccine or prophylactic series. Assume all travelers have completed routine childhood and domestic adult immunization schedules.

A 32-year-old primigravid woman at 40 weeks gestation is admitted to the labor and delivery unit in active labor. During her admission, continuous fetal heart rate monitoring demonstrates recurrent late decelerations with absent beat-to-beat variability, and her cervix is 6 cm dilated. The physician determines that the fetus is in significant distress and strongly recommends an immediate cesarean delivery to prevent intrauterine fetal demise. The patient is alert, oriented to time, place, and person, and clearly articulates her understanding that without the surgery, her baby will likely die. However, she firmly declines the procedure, stating she has a deep personal conviction against any surgical intervention and accepts the risks of continuing labor. Her husband, who is present in the room, is distressed and urges the physician to perform the surgery to save the baby. Which of the following is the most appropriate next step in management?

A team of obstetric researchers is planning a study to investigate the association between maternal use of a recently approved atypical antipsychotic during the first trimester and the risk of a rare congenital malformation, Ebstein anomaly. Because Ebstein anomaly occurs in only about 1 in 20,000 live births, the researchers decide to utilize a case-control study design. They plan to select infants with Ebstein anomaly from a national birth defects registry and compare them to healthy infants without the anomaly from the same registry. Which of the following statements regarding this study design are correct? (Select all that apply)

Match the following specific orthopedic injuries with their most commonly associated neurological deficit or physical examination finding.

Match each clinical scenario involving informed consent or refusal of care to the correct ethical determination and management principle.

Investigators are evaluating the potential association between baseline Epstein-Barr virus (EBV) antibody titers and the subsequent development of systemic lupus erythematosus (SLE). They utilize an existing longitudinal database that initially enrolled $50,000$ healthy female nurses. Over a $10$-year follow-up period, $150$ participants developed SLE. The investigators retrieve the frozen blood samples collected at the beginning of the study from these $150$ individuals. They also retrieve the baseline blood samples from $600$ randomly selected participants from the same study who did not develop SLE, ensuring they are matched for age and race. The baseline EBV antibody titers are then measured and compared between the two groups. Which of the following best describes this specific epidemiologic study design?

A 15-month-old girl is brought to the clinic for a routine health maintenance visit. Her medical history is notable for a hospitalization at 11 months of age due to a 6-day history of high fever, bilateral nonexudative conjunctivitis, erythema of the oral mucosa, and a polymorphous rash. She was diagnosed with Kawasaki disease and treated successfully with high-dose intravenous immunoglobulin (IVIG) and aspirin. A follow-up echocardiogram performed last week showed normal coronary arteries. She is currently asymptomatic and takes no medications. Her last immunizations were administered at 6 months of age. Her vital signs and physical examination today are normal. Which of the following is the most appropriate approach to this patient's immunizations at this visit?

A mother brings her 3-year-old son to an urgent care clinic because he has been crying inconsolably whenever she tries to change his diaper or move his right leg. Since yesterday morning, the child has refused to stand or walk. He had a runny nose and low-grade fever two weeks ago, which resolved without medication. Today, his temperature is $38.8^\circ\text{C}$ ($101.8^\circ\text{F}$), pulse is $110/\text{min}$, and blood pressure is $90/60\text{ mmHg}$. Physical examination reveals a distressed child who holds his right leg flexed, abducted, and externally rotated at the hip joint. Any attempt to internally rotate the right leg causes severe guarding and screaming. Laboratory analysis reveals a leukocyte count of $17,500/\text{mm}^3$ and an erythrocyte sedimentation rate of $52\text{ mm/h}$. Plain radiographs of the pelvis and bilateral lower extremities demonstrate no fracture, dislocation, or evidence of avascular necrosis. Which of the following is the most appropriate next step in the evaluation and management of this patient?

Match the following upper extremity musculoskeletal conditions with their classic physical examination findings or provocative test results.

An institutional review board (IRB) at an academic medical center is categorizing submitted research protocols. Match each of the following methodological outlines with the specific epidemiologic study design it represents.

A 5-year-old boy presents to the clinic for a pre-kindergarten health assessment. He was diagnosed with acute lymphoblastic leukemia three months ago and is actively undergoing induction chemotherapy. According to his electronic health record, he completed his primary infant vaccination series appropriately but has not received any vaccine doses since 24 months of age. His parents are requesting that his pre-school immunizations be updated today so he can eventually attend school. Which of the following vaccines are absolutely contraindicated for this patient at this time? (Select all that apply)

An 18-month-old female toddler is evaluated in the pediatric infectious disease clinic for a routine health assessment. She was diagnosed with perinatally acquired human immunodeficiency virus (HIV) infection and was recently placed in foster care. The patient is currently receiving combination antiretroviral therapy. She has no history of opportunistic infections and appears active and well-nourished. Physical examination is unremarkable. Recent laboratory studies show an absolute CD4+ T-lymphocyte count of 450 cells/mm³ and a CD4 fraction of 12%. Her immunization records indicate she is missing several recommended doses. Which of the following immunizations must be strictly withheld from this patient at this time?

Public health officials are investigating a rare cluster of angiosarcoma of the liver among workers at a large plastics manufacturing facility. Because the disease is exceedingly rare and has a long latency period, the investigators design a case-control study to identify potential occupational risk factors. Which of the following principles regarding the selection and management of the control group in this study are correct? (Select all that apply)

During a routine appointment, a physician discusses advance care planning with a patient recently diagnosed with early-onset Alzheimer disease. As the condition progresses, the patient will predictably lose cognitive capacity. Arrange the following decision-making frameworks in the correct ethical and legal hierarchy that providers must follow, ordering from the highest priority (most respectful of autonomy) to the lowest priority (used as a last resort).

A team of pediatric oncologists is investigating the long-term cardiovascular effects of a specific induction chemotherapy regimen used for acute lymphoblastic leukemia. The researchers access a regional oncology registry containing detailed treatment records from 2005 to 2015. Through this database, they identify 400 patients who received the standard anthracycline-based induction regimen and 200 patients who received an alternative, anthracycline-sparing regimen during that 10-year period. The researchers then review the subsequent medical records and echocardiogram reports of these patients up to the present day to compare the incidence of dilated cardiomyopathy between the two treatment groups. Which of the following best describes the study design used in this investigation?