Tüm alıştırma soruları

An $8$-year-old girl with a history of moderate persistent asthma is brought to the emergency department by emergency medical services due to severe respiratory distress. On arrival, she is tachypneic, diaphoretic, and sitting in a tripod position. Her respiratory rate is $48$/min, and oxygen saturation is $84\%$ on room air. Physical examination reveals severe suprasternal and intercostal retractions, with markedly diminished air entry and faint expiratory wheezing bilaterally.

Assuming the patient continues to clinically deteriorate and fails to improve at each stage of treatment, arrange the following interventions in the correct chronological sequence of therapeutic escalation for status asthmaticus.

A 24-year-old primigravida presents to the clinic for her first prenatal visit at 8 weeks gestation. She has an uncomplicated medical history and wishes to understand the schedule for her upcoming evaluations. As part of routine prenatal care, various screening tests and imaging studies are recommended at specific gestational ages. Arrange the following routine prenatal evaluations in the correct chronological sequence from earliest to latest in a normal, uncomplicated pregnancy.

A 32-year-old G2P1 woman at 39 weeks gestation is in the second stage of active labor. Suddenly, she gasps for air, becomes profoundly cyanotic, and loses consciousness. The fetal monitor shows an acute, prolonged deceleration to 60/min. The patient is apneic and has no palpable carotid pulse. Arrange the following management steps in the most appropriate sequential order for this catastrophic obstetric emergency.

A 7-year-old girl is brought to the emergency department with severe respiratory distress. She has a history of moderate persistent asthma and has been using her albuterol inhaler every 2 hours at home without relief. On presentation, she is alert but anxious, speaking in single words. Vital signs show a respiratory rate of 42/min, heart rate of 150/min, and oxygen saturation of 88% on room air. Examination reveals diffuse inspiratory and expiratory wheezes with prominent suprasternal retractions. Arrange the following interventions in the most appropriate sequential order of escalation for managing this patient's acute severe asthma exacerbation, from initial presentation to refractory respiratory failure.

An 8-month-old infant, recently immigrated from a rural region without a universal newborn screening program, is brought to the pediatric clinic for evaluation of developmental delay. The parents report that the infant has not yet started to sit unsupported, roll over, or babble. On physical examination, the infant has noticeably lighter skin and hair pigmentation compared to both biological parents, a diffuse eczematous rash on the flexor surfaces, and a distinct 'musty' body odor. A presumptive diagnosis of a metabolic disorder is made. Arrange the following steps in the most appropriate chronological sequence for the comprehensive evaluation and lifespan management of this patient's condition, from the immediate next diagnostic step to adulthood.

Emergency medical services arrive with a 7-year-old male who has homozygous sickle cell disease (HbSS). His parents report that he abruptly developed right arm paralysis and lost the ability to speak approximately 45 minutes ago. His temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $112/72 \text{ mm Hg}$, pulse is $118\text{/min}$, and respirations are $22\text{/min}$. Oxygen saturation is $98\%$ on room air. Neurological examination reveals a right-sided facial droop, expressive aphasia, and $2/5$ muscle strength in the right upper and lower extremities. Laboratory studies show a hemoglobin of $7.5 \text{ g/dL}$, hematocrit of $22\%$, and a reticulocyte count of $12\%$. Arrange the following steps in the most appropriate chronological sequence for the comprehensive immediate and long-term management of this patient.

A 28-year-old G1P0 woman at 38 weeks gestation is brought to the emergency department after experiencing a generalized tonic-clonic seizure at home. Her blood pressure is 168/112 mm Hg. She is currently postictal and breathing spontaneously. Continuous fetal monitoring shows a baseline heart rate of 135/min with moderate variability and no decelerations. Arrange the following management steps in the most appropriate chronological sequence for this patient.

A 29-year-old G4P3 woman at 39 weeks gestation delivers a 4,200-g (9-lb 4-oz) neonate vaginally following a prolonged labor augmented with oxytocin. Shortly after the spontaneous delivery of an intact placenta, she develops profuse vaginal bleeding. Her blood pressure is 88/50 mm Hg and pulse is 122/min. On examination, the uterus is soft, boggy, and palpated above the umbilicus. A continuous oxytocin infusion is already running through two large-bore intravenous lines.

Assuming each consecutive intervention fails to control the hemorrhage, arrange the following management steps in the correct sequential order from the immediate next step to the definitive final treatment.

A 9-year-old boy is evaluated in the pediatric endocrinology clinic for new-onset severe polyuria, polydipsia, and nocturia over the past month. He is otherwise healthy, and a recent comprehensive metabolic panel and hemoglobin A1c were within normal limits, ruling out diabetes mellitus. The physician suspects diabetes insipidus and admits the patient to the hospital for a water deprivation test. Arrange the following steps in the correct chronological sequence for performing this diagnostic test.

A 6-week-old female infant is brought to the clinic for a well-child visit. Her parents report that she is exclusively breastfed and feeding well, but they have noticed her skin appearing increasingly yellow over the past two weeks. Additionally, her stools have recently become very pale, resembling the color of clay. Physical examination is notable for scleral icterus, generalized jaundice, and a palpable liver edge 2 cm below the right costal margin. Arrange the following steps in the most appropriate chronological sequence for the standard evaluation and definitive management of this patient's suspected condition.

A 2-week-old male infant is evaluated in the pediatric orthopedic clinic for bilateral foot deformities present since birth. Physical examination reveals marked plantar flexion of the ankles, inversion of the heels, and medial deviation of the forefeet. The deformities are rigid and cannot be passively corrected to a neutral, anatomic position. Neurological examination of the lower extremities is unremarkable, and the spine is normal. A diagnosis of idiopathic congenital talipes equinovarus (clubfoot) is made, and the parents agree to proceed with the gold-standard conservative management approach. Arrange the following steps of this treatment protocol (the Ponseti method) in the most appropriate chronological order, from initial intervention to long-term maintenance.

A 26-year-old woman, gravida 1, para 0, presents to the clinic at 6 weeks gestation for her initial prenatal visit. She has a completely uncomplicated medical history. Her blood type is O negative, and her partner is known to be A positive. The patient is a systems engineer and requests a highly detailed, chronological roadmap of her anticipated maternal physiological changes, physical examination milestones, and routine prenatal care interventions. Based on current obstetric guidelines for an uncomplicated normal pregnancy, arrange the following events in the correct chronological order from earliest in gestation to latest.

A 4-year-old boy of East Asian descent is admitted to the pediatric ward with a 6-day history of persistent fever measuring up to $39.8^\circ\text{C}$ ($103.6^\circ\text{F}$). His parents report that he has been highly irritable and refuses to eat. On physical examination, the child is tachycardic but normotensive. He has bilateral nonexudative conjunctival injection, cracked and fissured lips, a prominent 'strawberry tongue,' and tender cervical lymphadenopathy. Erythema and edema of the dorsal hands and feet are noted, along with a polymorphous maculopapular rash over the trunk. A baseline transthoracic echocardiogram obtained upon admission shows structurally normal coronary arteries. He is diagnosed with classic Kawasaki disease.

Arrange the following management and follow-up steps in the correct chronological sequence for this patient, starting with immediate inpatient treatment and concluding with long-term outpatient preventive care.

A 4-year-old girl is brought to the pediatric emergency department with a 2-day history of high fever, severe headache, and vomiting. Over the last 6 hours, she has become increasingly lethargic. Her temperature is 39.5°C (103.1°F), heart rate is 145/min, blood pressure is 112/68 mmHg, and respiratory rate is 26/min. On physical examination, she is difficult to arouse. She exhibits marked nuchal rigidity and a newly appreciated right-sided abducens nerve (cranial nerve VI) palsy. The remainder of the neurologic examination is limited by her somnolence but shows symmetric withdrawal to pain.

Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for managing this patient.

Paramedics bring a 14-day-old infant to the emergency department due to severe lethargy, poor feeding, and mottled skin. On physical examination, the infant has a depressed level of consciousness and is in marked respiratory distress with grunting and severe subcostal retractions. Capillary refill time is 6 seconds. Vital signs show a heart rate of 195/min, respiratory rate of 75/min, and oxygen saturation of 89% on room air. Palpation of the extremities reveals bounding brachial pulses and imperceptible femoral pulses. Arterial blood gas analysis demonstrates severe uncompensated metabolic acidosis. Arrange the following clinical interventions and diagnostic steps in the most appropriate chronological sequence for managing this patient.

A 32-year-old G2P1 at 39 weeks of gestation is in the second stage of labor. Following a 2-hour active pushing phase, the fetal head delivers but immediately retracts firmly against the maternal perineum. The anterior shoulder does not deliver with gentle downward traction. The obstetrician diagnoses shoulder dystocia and instructs the patient to stop pushing while requesting immediate assistance from anesthesia, pediatrics, and additional nursing staff.

Arrange the following obstetric interventions in the most appropriate sequential order of implementation, proceeding from initial first-line management to maneuvers of last resort.

A 2-year-old child is brought to the emergency department after passing a massive volume of painless, dark red stool at home. On examination, the patient appears pale, mottled, and lethargic. Vital signs reveal a heart rate of 165/min, respiratory rate of 28/min, and blood pressure of 70/40 mmHg. Capillary refill time is prolonged at 4 seconds. The abdomen is soft, non-distended, and non-tender to palpation. Arrange the following medical interventions in the most appropriate chronological sequence for the evaluation and management of this patient.

Parents of an infant currently aged 6 months bring him to the urgent care clinic. They report that he recently began having clusters of sudden, symmetric forward bending of his head and torso, along with extension of his arms. These spells primarily happen just as he is waking up. During the physical examination, the physician notes the presence of three distinct, ash-leaf shaped hypopigmented macules on the infant's trunk. Arrange the following interventions in the most appropriate chronological sequence for evaluating and managing this patient's condition.

A 27-year-old woman, gravida 1, para 1, experiences a sudden onset of severe vaginal bleeding immediately following the delivery of the placenta. Her blood pressure drops to 80/40 mmHg and heart rate increases to 125/min. On pelvic examination, a purplish, fleshy mass is seen protruding through the vaginal introitus, and the uterine fundus cannot be palpated through the anterior abdominal wall. Arrange the following management steps for this complication in the correct chronological sequence.

A 9-month-old male infant is brought to the emergency department due to sudden episodes of severe, inconsolable crying during which he draws his legs up to his abdomen. Between episodes, he appears lethargic but calm. The parents report one episode of dark, bloody, mucus-like stool on the way to the hospital. He is tachycardic but normotensive, and the abdomen is soft with a palpable 'sausage-shaped' mass in the right upper quadrant. Arrange the following steps in the correct chronological sequence for the evaluation and management of this patient.