Tüm alıştırma soruları

Match each third-trimester obstetric clinical presentation with its corresponding underlying pathophysiology.

A 42-year-old woman is admitted to the intensive care unit with confusion, petechiae, and dark urine. Laboratory testing reveals a hemoglobin of $7.2 \text{ g/dL}$, a platelet count of $18,000/\mu\text{L}$, an elevated indirect bilirubin, and an elevated lactate dehydrogenase (LDH). Her prothrombin time and activated partial thromboplastin time are normal. You strongly suspect thrombotic thrombocytopenic purpura (TTP). Arrange the following steps in the most appropriate sequential order for the immediate diagnostic and therapeutic management of this patient.

Match each suspected endocrine disorder with the most appropriate confirmatory dynamic diagnostic test used to definitively establish the diagnosis.

Various chronic liver and biliary diseases have distinct clinical presentations and are confirmed using specific diagnostic tests or markers. Match each clinical description to the most appropriate diagnostic marker or imaging finding.

A 62-year-old woman is evaluated on the third day of hospitalization for a central line-associated bloodstream infection. She has been receiving total parenteral nutrition through a central venous catheter for short bowel syndrome. Three days ago, she experienced the sudden onset of rigors, a temperature of 39.2°C (102.6°F), and a blood pressure of 90/60 mmHg. Blood cultures drawn from both the central catheter and a peripheral vein revealed Gram-positive cocci in clusters. The catheter was promptly removed, and empiric intravenous vancomycin and cefepime were started. Today, she feels well and is afebrile with normal hemodynamics. Final blood culture results confirm the presence of Staphylococcus aureus in all bottles. Susceptibility testing indicates the isolate is resistant to penicillin but susceptible to oxacillin, cefazolin, and vancomycin. Which of the following is the most appropriate modification to her antimicrobial therapy?

Match the following clinical and serological profiles of patients with viral hepatitis to their most accurate diagnostic phase or infection state.

A 59-year-old woman is evaluated on postoperative day 7 following an open hysterectomy and lysis of adhesions. She had been tolerating a liquid diet and passing flatus until 24 hours ago, when she developed progressive, crampy abdominal pain and obstipation. Over the past 4 hours, the pain has become severe and constant. Her temperature is $39.1^\circ\text{C}$ ($102.4^\circ\text{F}$), pulse is $126/\text{min}$, respirations are $26/\text{min}$, and blood pressure is $86/52\text{ mmHg}$. Physical examination reveals a markedly distended abdomen with diffuse rigidity, rebound tenderness, and involuntary guarding. Laboratory studies show a leukocyte count of $21,000/\text{mm}^3$ and a serum lactate level of $5.1\text{ mmol/L}$. An abdominal radiograph demonstrates multiple dilated loops of small bowel with air-fluid levels and a lack of gas in the colon. Which of the following are the most appropriate next steps in this patient's management? (Select two)

A 26-year-old primigravid woman at 40 weeks gestation is evaluated in the labor and delivery unit. She was admitted earlier today for induction of labor due to oligohydramnios. The patient is currently receiving a continuous intravenous oxytocin infusion. Her cervix is 6 cm dilated, 100% effaced, and the fetal presenting part is at 0 station. Maternal temperature is 37.1°C (98.8°F), blood pressure is 122/78 mm Hg, and pulse is 88/min. Uterine contractions are occurring every 3 minutes. Continuous fetal heart rate monitoring demonstrates a baseline of 140/min with moderate variability. Over the past 20 minutes, there are recurrent, gradual decreases in the fetal heart rate; the nadir of each decrease consistently occurs after the peak of the associated uterine contraction, with a slow return to baseline. Which of the following is the most appropriate next step in the management of this patient?

A 62-year-old man is brought to the emergency department by his family due to sudden-onset confusion, severe right upper quadrant abdominal pain, and high fever that began earlier today. His temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $88/54\text{ mmHg}$, pulse is $118/\text{min}$, and respiratory rate is $22/\text{min}$. Physical examination reveals marked scleral icterus and significant right upper quadrant tenderness with guarding. Laboratory studies demonstrate a leukocyte count of $18,500/\text{mm}^3$, total bilirubin of $6.2\text{ mg/dL}$, direct bilirubin of $4.8\text{ mg/dL}$, and alkaline phosphatase of $450\text{ U/L}$. A right upper quadrant ultrasound shows a dilated common bile duct measuring $11\text{ mm}$ and multiple echogenic foci with posterior acoustic shadowing within the gallbladder. Arrange the following management steps in the most appropriate chronological order for this patient.

An inpatient infectious disease consultation is requested for a $54$-year-old man who has been hospitalized for the past $3$ weeks following an extensive bowel resection for acute mesenteric ischemia. Due to short bowel syndrome, he has been dependent on total parenteral nutrition administered via a right upper extremity peripherally inserted central catheter (PICC). Yesterday, the patient experienced a sudden onset of rigors and a temperature spike to $39.1^\circ\text{C}$ ($102.4^\circ\text{F}$). His blood pressure dropped to $105/65$ mm Hg with a pulse of $110$/min. Examination of the PICC insertion site revealed focal erythema and tenderness. The catheter was promptly removed, and empiric intravenous vancomycin and piperacillin-tazobactam were initiated. Today, the patient is afebrile and hemodynamically stable. Preliminary blood cultures from both the PICC tip and a peripheral draw are positive for *Staphylococcus aureus* in $4$ out of $4$ bottles. Final susceptibility results show the isolate is resistant to penicillin but susceptible to oxacillin, cefazolin, clindamycin, and vancomycin. Which of the following is the most appropriate next step in pharmacotherapy?

A 22-year-old man is brought to the emergency department by his roommate due to progressive lethargy, diffuse abdominal pain, and repeated vomiting for the past 24 hours. He has a history of type 1 diabetes mellitus but ran out of his insulin prescriptions three days ago. On examination, he is obtunded. Temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $86/54\text{ mm Hg}$, pulse is $128/\text{min}$, and respirations are $28/\text{min}$ and deep. Mucous membranes are extremely dry.

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

A $48$-year-old patient who was admitted $3$ weeks ago with severe acute pancreatitis secondary to cholelithiasis now exhibits sudden clinical deterioration. The patient's temperature is $39.2^\circ \text{C}$ ($102.6^\circ \text{F}$) and white blood cell count is $22,000/\mu \text{L}$. An abdominal contrast-enhanced computed tomography scan demonstrates a large, encapsulated complex fluid collection replacing the pancreatic body, measuring $10 \times 8 \text{ cm}$, and notably containing multiple small gas bubbles. Arrange the following interventions in the most appropriate chronological sequence for managing this patient's current condition and preventing future recurrences.

A 52-year-old man is evaluated in the hospital on day 4 of admission. He originally presented with a 5-day history of high fever, chills, and severe right upper quadrant abdominal pain. His past medical history is notable for poorly controlled type 2 diabetes mellitus. On admission, a CT scan of the abdomen revealed a 6.2-cm solitary, rim-enhancing fluid collection in the right hepatic lobe. He immediately underwent CT-guided percutaneous catheter drainage and was started on empiric intravenous piperacillin-tazobactam.

Today, the patient feels significantly better. His temperature is 37.1°C (98.8°F), blood pressure is 128/82 mmHg, and pulse is 78/min. His leukocyte count has decreased from 21,000/mm³ on admission to 10,500/mm³. The percutaneous drain is outputting a small amount of serosanguinous fluid. Blood cultures from admission show no growth. The abscess fluid culture results have finalized as shown below:

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

An $82$-year-old woman is evaluated in the progressive care unit due to sudden-onset difficulty breathing. She was admitted yesterday for a lower gastrointestinal bleed secondary to diverticulosis. Her medical history is significant for hypertension and heart failure with preserved ejection fraction. Two hours ago, her hemoglobin was noted to be $6.4 \text{ g/dL}$, and a transfusion of two units of packed red blood cells was initiated. She is currently receiving the second unit. Her temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $172/92 \text{ mmHg}$, heart rate is $112/\text{min}$, and respiratory rate is $28/\text{min}$. Pulse oximetry shows $87\%$ on ambient air. Physical examination reveals distended jugular veins and bounding peripheral pulses. Auscultation of the lungs demonstrates bibasilar crackles extending to the mid-lung fields. A new S3 gallop is appreciated on cardiac auscultation. Which of the following is the most appropriate next step in the management of this patient's respiratory distress?

During a scheduled 15-month health maintenance visit, the parents of a toddler report that she has been acutely ill for the past 3 days. Her symptoms include a "wet-sounding" cough, rapid breathing, and sustained high fevers. The patient has no significant past medical history and previously received all immunizations recommended for her first year of life. Current vital signs show a temperature of 39.1°C (102.4°F), a pulse of 145/min, and a respiratory rate of 48/min. Pulse oximetry displays 96% saturation on room air. On physical examination, the toddler is fussy but easily consolable, and she readily drinks from a sippy cup. Auscultation of the chest reveals decreased breath sounds and focal crackles over the right lower lung field, without any wheezing or intercostal retractions. Cardiovascular and abdominal examinations are unremarkable. Which of the following is the most appropriate next step in management?

Match the following causes of primary and secondary amenorrhea with their defining pathophysiologic mechanism.

Following an uncomplicated, precipitous vaginal delivery of a 4,300-g (9-lb 8-oz) neonate, a multiparous patient develops massive vaginal bleeding. The placenta was delivered intact 15 minutes ago. Physical examination reveals a maternal heart rate of 115/min and a blood pressure of 92/58 mm Hg. The uterus feels enlarged, soft, and poorly contracted on abdominal palpation. Arrange the following management steps for this patient's condition in the correct sequential order of escalation, from the most appropriate initial intervention to the definitive final procedure.

Match the following specific clinical presentations of infectious diseases with their most appropriate first-line targeted antimicrobial therapy.

A 52-year-old man presents to the emergency department with a 24-hour history of generalized, colicky abdominal pain, intractable nausea, and multiple episodes of bilious emesis. He states he has not had a bowel movement or passed flatus for the past day. His medical history is significant for an open appendectomy 15 years ago. His temperature is $37.1^{\circ} \text{C}$ ($98.8^{\circ} \text{F}$), blood pressure is $135/82 \text{ mmHg}$, heart rate is $88/\text{min}$, and respiratory rate is $16/\text{min}$. Physical examination reveals a markedly distended abdomen with high-pitched, hyperactive bowel sounds. The abdomen is mildly tender to palpation diffusely, but there is no guarding, rigidity, or rebound tenderness. Laboratory studies show a leukocyte count of $8,500/\text{mm}^3$. An upright abdominal radiograph demonstrates multiple dilated loops of small bowel with prominent air-fluid levels and a paucity of air in the colon. Which of the following is the most appropriate next step in the management of this patient?

A 62-year-old man comes to the clinic due to progressive fatigue, generalized weakness, and decreased libido over the past 4 months. He has also noticed a loss of body hair and occasional morning headaches. His medical history is significant for type 2 diabetes mellitus and hyperlipidemia. Over the past month, his basal insulin dose was reduced due to recurrent episodes of fasting hypoglycemia. Vital signs show a temperature of 36.8°C (98.2°F), blood pressure of 102/64 mm Hg, and pulse of 58/min. Physical examination reveals pale, cool skin and a delayed relaxation phase of the deep tendon reflexes. Visual field testing by confrontation reveals decreased peripheral vision bilaterally.

Laboratory results are as follows:

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