Tüm alıştırma soruları

Following an uncomplicated pregnancy, a healthy patient presents to the labor and delivery unit at $39$ weeks of gestation in active spontaneous labor. Over the next several hours, her cervical examination reveals progression to $8$ cm of dilation, $100\%$ effacement, and the fetal vertex at a $+1$ station. External electronic fetal monitoring demonstrates a baseline fetal heart rate of $140$/min with moderate variability. The tracing also shows symmetric, gradual decreases in the fetal heart rate that begin precisely as the uterine contractions start. The nadir of each deceleration is $115$/min and aligns exactly with the peak of the concurrent contraction. The fetal heart rate returns to baseline just as the contraction concludes. Uterine contractions are occurring every $3$ minutes. Which of the following is the most appropriate next step in management for this patient?

During an uncomplicated pregnancy, the maternal body undergoes profound systemic adaptations to support fetal development. Match each underlying physiologic mechanism with its corresponding expected maternal clinical or laboratory finding.

A 2-month-old male infant is brought to the clinic for evaluation of frequent, forceful regurgitation after almost every feed. His parents report that he frequently arches his back, cries during feedings, and seems generally irritable. Review of his growth chart shows he has dropped from the 50th percentile for weight at birth to the 10th percentile currently. Physical examination is unremarkable, with a soft, non-tender abdomen and normal bowel sounds. There are no signs of acute infection. Arrange the following steps in the most appropriate sequential order for the evaluation and management of this patient's condition, from the initial intervention to the final option for severe, refractory disease.

A $4$-year-old boy is evaluated in the pediatric oncology clinic for an urgent follow-up. He was diagnosed with standard-risk B-cell acute lymphoblastic leukemia (ALL) eight months ago and is currently in the maintenance phase of chemotherapy. Today, he has mild rhinorrhea but is otherwise active and playful. His mother reports that the patient spent the weekend with his $6$-year-old cousin. Three days after the exposure, the cousin developed a low-grade fever and a diffuse vesicular rash that was subsequently diagnosed as chickenpox by a pediatrician. The patient has never had chickenpox and missed his routine preschool immunizations due to his cancer diagnosis. The patient's temperature is $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure is $95/60 \text{ mmHg}$, heart rate is $100/\text{min}$, and respiratory rate is $20/\text{min}$. Physical examination reveals clear lungs, normal heart sounds, and no skin lesions. Laboratory studies show a leukocyte count of $3,200/\text{mm}^3$ with an absolute neutrophil count of $1,600/\text{mm}^3$. The mother asks how to protect her son from the exposure. Which of the following is the most appropriate next step in management?

A primigravid patient at $12$ weeks gestation presents for an initial prenatal evaluation. She feels well aside from mild morning nausea and breast tenderness. Her medical history is unremarkable, and she takes a daily prenatal vitamin. Vital signs include a blood pressure of $110/70$ mm Hg, pulse of $84$/min, and respiratory rate of $16$/min. Cardiovascular examination reveals a regular rhythm with a grade $2/6$ systolic ejection murmur at the left upper sternal border. The lungs are clear to auscultation. The uterus is palpable just above the pubic symphysis. Initial laboratory and diagnostic evaluations are obtained. Which of the following test results in this patient most strongly indicates an underlying pathological process rather than a normal physiologic adaptation to pregnancy?

A 3-year-old boy is brought to the pediatrician by his parents due to worsening behavioral outbursts and a decline in his communication skills. Over the past year, he has stopped using two-word phrases and has become increasingly hyperactive and aggressive. The parents also report that he has "noisy breathing," chronic nasal discharge, and recurrent wheezing that has not improved with multiple trials of inhaled albuterol. His medical history is notable for bilateral inguinal hernia repairs at age 1. Vital signs are within normal limits. Physical examination reveals a macrocephalic child with prominent supraorbital ridges, a broad nose, and a large tongue. Abdominal examination demonstrates a firm liver edge 4 cm below the right costal margin and a palpable splenic tip. Skin examination reveals distinct, grouped, ivory-colored papules over the scapular region. Slit-lamp examination of the eyes shows perfectly clear corneas. Laboratory studies show a serum thyroid-stimulating hormone (TSH) of 2.1 µU/mL (normal: 0.5–5.0 µU/mL). Which of the following is the most likely underlying etiology of this patient's condition?

The triage nurse calls a physician to evaluate a newly arrived patient in the emergency department. The patient, a 34-year-old woman with no significant past medical history, describes a rapidly progressive, profound exhaustion over the last 72 hours, accompanied by intermittent episodes of confusion and 'purple spots' appearing on her legs.

Vital signs include a heart rate of 108/min, blood pressure of 142/88 mmHg, temperature of 37.8°C (100.0°F), and oxygen saturation of 98% on room air. Examination shows widespread lower extremity petechiae, mild scleral icterus, and temporal disorientation without focal neurological deficits.

Based on the clinical presentation and initial laboratory data, arrange the following diagnostic and therapeutic steps in the strictly required chronological sequence to properly manage this patient's suspected hematologic emergency.

Match each patient presentation of hyperparathyroidism with the most appropriate surgical management strategy.

A public health department is evaluating a newly developed screening test for a viral infection. The test has a sensitivity of 95% and a specificity of 90%. Initially, the test is deployed in Region A, where the prevalence of the viral infection is 20%. Six months later, the department expands testing to Region B, where the prevalence of the viral infection is only 2%. Assuming the test is performed exactly the same way in both regions, which of the following test parameters will be lower in Region B compared to Region A?

A 19-year-old male is brought to the emergency department after a skateboarding accident in which he struck the right side of his head on a concrete curb. Witnesses report that he lost consciousness for approximately one minute, then awoke and conversed normally. Over the past hour, however, he has become increasingly lethargic and complains of severe nausea. His temperature is 36.8°C (98.2°F), blood pressure is 175/95 mm Hg, pulse is 48/min, and respirations are 12/min. Physical examination shows a right pupil that is 7 mm and nonreactive to light, while the left pupil is 3 mm and reactive to light. A noncontrast CT scan of the head demonstrates a lens-shaped, hyperdense collection over the right frontoparietal convexity. Which of the following is the most appropriate next step in management?

A 24-year-old man is brought to the emergency department by paramedics following a street altercation where he sustained a stab wound to his left anteromedial thigh. On presentation, he appears pale, diaphoretic, and confused. His temperature is 36.5°C (97.7°F), blood pressure is 82/46 mmHg, heart rate is 128/min, and respiratory rate is 24/min. Pulse oximetry shows 97% on room air. Two large-bore intravenous lines are placed, and fluid resuscitation is initiated. Physical examination reveals a 4-cm laceration over the left medial thigh. There is a rapidly expanding hematoma around the wound and active pulsatile bleeding. The left foot is cold to the touch. Capillary refill is delayed in the left toes, and both the left dorsalis pedis and posterior tibial pulses are absent to palpation and Doppler ultrasound. The right lower extremity has normal pulses. Which of the following is the most appropriate next step in the management of this patient?

Following a head-on motor vehicle collision, a $34$-year-old female driver is evaluated in the trauma bay. She complains of worsening diffuse abdominal discomfort and pain radiating to her right shoulder. Her temperature is $37.3^\circ\text{C}$ ($99.1^\circ\text{F}$), blood pressure is $110/70$ mmHg, pulse is $112$/min, and respiratory rate is $18$/min. Physical examination reveals a lap-belt mark across the lower abdomen, generalized abdominal tenderness with guarding, and suprapubic rebound tenderness. After ensuring the urethral meatus is normal, a urinary catheter is inserted and immediately drains frankly bloody urine. A computed tomography (CT) cystography is performed and demonstrates contrast dye extravasation into the peritoneal cavity, outlining the loops of the small bowel. Based on the clinical and imaging findings, which of the following is the most appropriate next step in management?

Match each traumatic clinical presentation and its associated physical exam findings to the most likely specific vascular injury.

Match each pediatric gastrointestinal emergency clinical presentation with its most appropriate definitive surgical management.

A $7$-year-old male child presents to the outpatient clinic accompanied by his mother due to an altered gait that began approximately $8$ weeks ago. The mother describes a progressive limp that worsens towards the end of the day. The child occasionally mentions mild aching in his left groin and distal anterior thigh. He has not had any recent infections, and there is no history of preceding trauma. Vital signs show a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), pulse of $84/\text{min}$, and blood pressure of $102/64\text{ mm Hg}$. On physical examination, the patient has a noticeable Trendelenburg gait. Inspection reveals $1\text{ cm}$ of muscle atrophy in the left quadriceps compared to the right. When the patient is supine, the left hip exhibits limited abduction and restricted internal rotation. Examination of the left knee reveals no swelling, erythema, or pain with movement. Laboratory analysis demonstrates a leukocyte count of $7,200/\text{mm}^3$, an erythrocyte sedimentation rate of $10\text{ mm/h}$, and a C-reactive protein of $2.0\text{ mg/L}$. Which of the following is the most appropriate initial step in the evaluation of this patient?

Immediately following an uncomplicated spontaneous vaginal delivery of a macrosomic neonate, a multiparous patient develops heavy, continuous vaginal bleeding. The placenta was delivered spontaneously and appears grossly intact. Her blood pressure is 95/60 mm Hg and her heart rate is 115/min. Abdominal palpation reveals a soft, boggy uterus resting above the level of the umbilicus. Speculum examination demonstrates an intact lower genital tract with no lacerations. Arrange the following management interventions in the correct sequential algorithm for this patient's complication, starting with the immediate initial response and progressing step-by-step to definitive surgical care if hemorrhage remains uncontrolled.

A 6-year-old boy is newly diagnosed with Burkitt lymphoma. He presents with a large abdominal mass, and laboratory studies reveal a significantly elevated serum lactate dehydrogenase (LDH) and uric acid level. The oncology team is preparing to begin his treatment but must first address his high risk for developing tumor lysis syndrome (TLS). Arrange the following management steps in the most appropriate sequential order, starting from the most critical initial preventive measure to the intervention reserved for severe, refractory complications.

Match each gestational age timeline during an uncomplicated pregnancy with the most appropriate routine maternal or fetal screening test.

An 8-year-old girl is evaluated in the emergency department due to rapidly worsening shortness of breath. She has a known history of moderate persistent asthma. Two days ago, she developed rhinorrhea, a mild cough, and a low-grade fever. Over the past hour in the emergency department, she has received three consecutive nebulized albuterol-ipratropium treatments and a dose of intravenous methylprednisolone, but her work of breathing continues to increase. She is up to date on all childhood immunizations. Vital signs show a temperature of $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$), a heart rate of $152/\text{min}$, a respiratory rate of $44/\text{min}$, and an oxygen saturation of $89\%$ on $4\text{ L/min}$ supplemental oxygen via nasal cannula. On physical examination, she is diaphoretic, visibly fatigued, and sitting forward. There are prominent supraclavicular and intercostal retractions. Lung auscultation reveals markedly diminished air entry bilaterally without audible wheezing. Which of the following interventions are indicated as part of the immediate management bundle for this patient? (Select all that apply)

Match each clinical vignette describing a neonate with a congenital infection to the most likely causative pathogen.