Tüm alıştırma soruları

During a cardiology clinical rotation, a group of medical students is learning to recognize distinct physical examination signs that point to specific underlying cardiac pathologies. Different arterial pulse contours can provide crucial clues to a patient's hemodynamic status. Match the following characteristic arterial pulse findings with their most commonly associated cardiovascular condition.

A 24-year-old man with a history of type 1 diabetes mellitus is brought to the emergency department with nausea, vomiting, and confusion. Blood pressure is 95/60 mm Hg, and heart rate is 120/min. Laboratory studies show:

Arrange the following interventions in the correct chronological sequence for the optimal acute management of this patient's condition.

A 34-year-old man with a recent history of emigration from a tuberculosis-endemic region presents to the emergency department complaining of a 4-week history of productive cough, intermittent hemoptysis, drenching night sweats, and a $5$-kg ($11$-lb) weight loss. His vital signs show a temperature of $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), blood pressure of $120/78\text{ mmHg}$, and oxygen saturation of $96\%$ on room air. Chest auscultation reveals bronchial breath sounds and crackles over the right upper lung field. A subsequent chest radiograph demonstrates a prominent cavitary infiltrate in the apical segment of the right upper lobe. Arrange the following management steps in the most appropriate chronological order to optimize both patient outcomes and infection control.

A 56-year-old woman is evaluated on the medical ward on hospital day 2. She was admitted the previous day for a rapidly spreading, painful, erythematous rash on her right lower leg. Her medical history is notable for type 2 diabetes mellitus and chronic venous insufficiency. On admission, her temperature was $39.1^\circ\text{C}$ ($102.4^\circ\text{F}$), heart rate was $110/\text{min}$, and blood pressure was $118/74\text{ mmHg}$. Physical examination revealed a well-demarcated, intensely red, warm, and tender plaque on the right anterior shin without any underlying fluctuance, purulent drainage, or overlying eschar. Due to the high fever and tachycardia, she was empirically started on intravenous vancomycin and piperacillin-tazobactam in the emergency department.

Today, the patient reports feeling much better. Her temperature is $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$), heart rate is $82/\text{min}$, and blood pressure is $124/80\text{ mmHg}$. The margins of the erythema have not advanced. Blood cultures drawn on admission show no growth to date.

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

During a clinical skills workshop, medical students are reviewing the physiological effects of various dynamic bedside maneuvers on cardiac murmurs. Understanding how preload and afterload alter hemodynamics is critical for distinguishing similar-sounding murmurs. Match each cardiac pathology with its characteristic auscultatory response to these dynamic maneuvers.

Match each classic urinalysis sediment finding with its most likely associated renal pathology.

Match each Hepatitis B virus (HBV) serologic profile to the most accurate corresponding clinical status.

A 45-year-old man with a history of treated pulmonary tuberculosis is brought to the emergency department after coughing up approximately 800 mL of bright red blood over the past 8 hours. On arrival, he is in severe respiratory distress and coughing continuously. His blood pressure is 90/60 mm Hg, heart rate is 122/min, and oxygen saturation is 84% on room air. A bedside chest radiograph reveals a large cavitary lesion in the right upper lobe. Arrange the following interventions in the most appropriate sequential order for managing this patient's condition, starting with the most immediate priority and ending with the treatment of last resort.

A 48-year-old man is hospitalized for severe acute pancreatitis. On admission, he was resuscitated with intravenous lactated Ringer solution and provided with adequate analgesia. On day 5 of his hospitalization, he reports persistent abdominal pain. His temperature is $38.3^\circ\text{C}$ ($100.9^\circ\text{F}$), blood pressure is $122/78\text{ mmHg}$, and pulse is $105/\text{min}$. Physical examination reveals epigastric tenderness without rebound. Laboratory studies show a leukocyte count of $15,200/\text{mm}^3$. A contrast-enhanced computed tomography scan of the abdomen demonstrates an enlarged pancreas with $>30\%$ non-enhancing necrotic tissue and surrounding peripancreatic fluid. No gas bubbles are visualized within the necrotic collections. Which of the following is the most appropriate next step in management?

A $72$-year-old man is evaluated in the intensive care unit for sudden, severe abdominal pain and bilious vomiting that began $4$ hours ago. He was admitted $2$ days ago for a chronic obstructive pulmonary disease (COPD) exacerbation. His past medical history is significant for COPD, heart failure with preserved ejection fraction, and a laparotomy for a perforated appendix $15$ years ago. Since the pain started, he has not passed flatus or stool. His temperature is $38.9^\circ\text{C}$ ($102.0^\circ\text{F}$), blood pressure is $82/50\text{ mmHg}$, pulse is $130/\text{min}$, and respiratory rate is $26/\text{min}$. The jugular venous pressure is $6\text{ cm H}_2\text{O}$. Physical examination reveals a markedly distended, rigid abdomen with diffuse tenderness, involuntary guarding, and rebound tenderness. Bowel sounds are absent. Laboratory studies show a leukocyte count of $23,000/\text{mm}^3$ and a serum lactate of $6.8\text{ mmol/L}$. Arterial blood gas analysis on room air reveals a pH of $7.28$, $\text{PaCO}_2$ of $30\text{ mmHg}$, and $\text{HCO}_3^-$ of $14\text{ mEq/L}$. An upright plain radiograph of the abdomen demonstrates multiple dilated loops of small bowel with air-fluid levels and no free intraperitoneal air. Which of the following is the most appropriate next step in management?

Emergency medical personnel bring a 35-year-old female to the trauma center after she was struck by a fast-moving delivery van while riding her bicycle. She is in severe distress and gasping for air.

Vital signs on arrival are:
Temperature: 36.4°C (97.5°F)
Blood pressure: 78/42 mmHg
Pulse: 142/min
Respirations: 34/min
Oxygen saturation: 86% on room air

Initial evaluation reveals an intact and patent airway. Examination of the chest shows asymmetrical expansion, with absent breath sounds and hyperresonance to percussion over the right hemithorax. The trachea appears deviated toward the left side, and the jugular veins are significantly distended. The abdomen is diffusely tender and distended. A focused assessment with sonography for trauma (FAST) demonstrates a substantial accumulation of free fluid in the hepatorenal recess.

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

Match each clinical exposure scenario with the most appropriate post-exposure prophylaxis (PEP) regimen.

A $62$-year-old woman is brought to the emergency department by her family due to confusion, severe right upper quadrant abdominal pain, and subjective fevers over the past $24$ hours. Her temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $88/54\text{ mmHg}$, heart rate is $118/\text{min}$, and respiratory rate is $22/\text{min}$. Physical examination reveals marked scleral icterus and severe tenderness to palpation in the right upper quadrant with guarding. She is disoriented to time and place. Laboratory studies are notable for a leukocyte count of $18,500/\mu\text{L}$, total bilirubin of $6.8\text{ mg/dL}$, alkaline phosphatase of $450\text{ U/L}$, and aspartate aminotransferase of $112\text{ U/L}$.

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

A 24-year-old woman with a history of type 1 diabetes mellitus presents to the emergency department with nausea, vomiting, and profound weakness for the past 24 hours. She has been unable to tolerate oral intake. Her blood pressure is 90/60 mm Hg, pulse is 122/min, and respirations are 28/min and deep. Laboratory studies show:

- Serum glucose: 580 mg/dL
- Arterial blood gas pH: 7.12
- Serum bicarbonate: 11 mEq/L
- Serum potassium: 3.1 mEq/L
- Serum sodium: 132 mEq/L
- Serum creatinine: 1.4 mg/dL

Arrange the following management steps in the most appropriate chronological order of execution.

Emergency medical services bring a 68-year-old woman to the emergency department after she collapsed in an airport terminal. She had just disembarked from a 12-hour international flight. On presentation, she is lethargic, diaphoretic, and in severe respiratory distress. Vital signs are temperature 36.8°C (98.2°F), blood pressure 76/44 mmHg, pulse 134/min, and respirations 32/min. Pulse oximetry shows 83% on room air. Physical examination reveals marked jugular venous distention when the head of the bed is elevated. The lungs are clear to auscultation bilaterally. Cardiac examination demonstrates a rapid, regular rhythm, a parasternal heave, and a loud pulmonic component of the second heart sound. The right lower extremity is edematous, warm, and tender from the calf to the mid-thigh. A bedside echocardiogram shows a dilated and hypokinetic right ventricle with bowing of the interventricular septum into the left ventricle. Arterial blood gas analysis on room air reveals a $pH$ of 7.22, $pCO_2$ of 28 mmHg, $pO_2$ of 54 mmHg, and $HCO_3^-$ of 11 mEq/L. Which of the following is the most appropriate next step in management?

During a routine follow-up appointment, a 38-year-old female reports a one-month history of progressive muscle weakness and fatigue. Her past medical history is significant for Sjögren syndrome and multiple episodes of calcium phosphate nephrolithiasis. Vital signs show a blood pressure of 118/76 mm Hg and a heart rate of 84/min. Physical examination reveals dry oral mucosa and 4/5 motor strength in the proximal muscles of the upper and lower extremities.

Laboratory evaluation reveals the following:

Based on these findings, what is this patient's calculated urine anion gap in mEq/L?

A $36$-year-old male software engineer visits the clinic complaining of a $3$-month history of constant sweating, a $5$-kg ($11$-lb) unintended weight loss, and frequent bowel movements. He also mentions a new onset of dull, constant headaches and occasionally bumping into doorframes on his sides over the past few weeks. His temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $145/85 \text{ mmHg}$, and pulse is $105/\text{min}$. Physical examination reveals a mild resting tremor, moist skin, and a diffusely enlarged, non-tender thyroid gland without palpable nodules. Extraocular movements are intact, and there is no proptosis.

Laboratory studies are obtained and reveal the following:

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

A $76$-year-old woman is brought to the emergency department by her family due to severe, sudden-onset abdominal pain that started $3$ hours ago. She describes the pain as generalized, constant, and $10/10$ in intensity. She has had one episode of nonbilious emesis. Her medical history is significant for permanent atrial fibrillation, diet-controlled type 2 diabetes mellitus, and hypothyroidism. She admits to running out of her apixaban medication three weeks ago and has not taken it since. She takes levothyroxine daily.

Vital signs:
- Temperature: $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$)
- Blood pressure: $105/65\text{ mm Hg}$
- Heart rate: $118/\text{min}$ and irregularly irregular
- Respiratory rate: $26/\text{min}$

Physical examination reveals a soft, non-distended abdomen. There is mild, diffuse tenderness to deep palpation, but no guarding, rigidity, or rebound tenderness. Bowel sounds are diminished.

Laboratory results:
- Leukocytes: $18,500/\text{mm}^3$
- Serum sodium: $138\text{ mEq/L}$
- Serum potassium: $4.2\text{ mEq/L}$
- Serum bicarbonate: $14\text{ mEq/L}$
- Blood urea nitrogen: $28\text{ mg/dL}$
- Serum creatinine: $1.2\text{ mg/dL}$
- Lactic acid: $5.8\text{ mmol/L}$ (normal: $0.5-2.2\text{ mmol/L}$)
- Thyroid-stimulating hormone (TSH): $0.1\text{ }\mu\text{U/mL}$ (normal: $0.4-4.0\text{ }\mu\text{U/mL}$)
- Free T4: $1.3\text{ ng/dL}$ (normal: $0.9-1.7\text{ ng/dL}$)

Arterial blood gas (room air):
- pH: $7.28$
- pCO2: $32\text{ mm Hg}$
- pO2: $88\text{ mm Hg}$

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

A 42-year-old man is evaluated in the hospital on day 3 of admission for community-acquired pneumonia. He initially presented with a productive cough, high fever, and shortness of breath. Chest radiography on admission showed a right lower lobe infiltrate. He was empirically started on intravenous ceftriaxone and azithromycin. Blood and sputum cultures obtained on admission have now grown Streptococcus pneumoniae. Susceptibility testing reveals the isolate is highly susceptible to penicillin (minimum inhibitory concentration < 0.06 mcg/mL), amoxicillin, ceftriaxone, and levofloxacin. Today, his temperature is 37.0 C (98.6 F), blood pressure is 120/78 mm Hg, pulse is 78/min, and respiratory rate is 14/min. His oxygen saturation is 97% on ambient air. He is tolerating a regular diet and reports feeling much better. Which of the following is the most appropriate next step in management?

Match each clinical presentation of a trauma patient to the most appropriate next step in management based on standard trauma evaluation principles.