Tüm alıştırma soruları

A 24-year-old primigravida at 39 weeks gestation is completely dilated and actively pushing in the second stage of labor. The fetal head is descending through the maternal pelvis. To successfully navigate the pelvic structures, the fetus must undergo a series of specific positional changes. Arrange the following cardinal movements of labor in the correct chronological order from first to last.

A 12-month-old boy is brought to the pediatric genetics clinic for evaluation of global developmental delay and recurrent otitis media. His parents report that he sat independently at 9 months but is not yet crawling or pulling to stand. Vital signs are within normal limits. Physical examination reveals macrocephaly, a prominent forehead, thickened facial features, and a flattened nasal bridge. Ophthalmologic examination shows bilateral corneal clouding. Abdominal examination demonstrates a firm liver edge palpable 4 cm below the right costal margin and a palpable spleen tip. Initial skeletal radiography shows anterior beaking of the lumbar vertebrae and thickened, shortened diaphyses (dysostosis multiplex). The physician suspects a severe metabolic disorder.

Arrange the following diagnostic and management steps in the most appropriate chronological sequence for this patient, from initial evaluation to definitive long-term therapy.

A 3-year-old girl is rushed to the emergency department by her parents due to sudden onset of high fever, severe sore throat, and difficulty breathing. The family recently immigrated, and the child has not received any childhood immunizations. On examination, the patient appears toxic, is leaning forward with her neck extended, and is drooling. Her temperature is 39.4°C (102.9°F), heart rate is 150/min, and respiratory rate is 42/min. She has prominent suprasternal retractions and a muffled, "hot potato" voice. Inspiratory stridor is audible without a stethoscope.

Arrange the following steps in the management of this patient in the most appropriate chronological order from first to last.

During a preconception counseling session, a healthy nulliparous patient inquires about the timeline of physiological changes she should expect during a normal pregnancy. Arrange the following maternal physiological and anatomical milestones in the chronological order in which they typically reach their peak, nadir, or maximum extent during a normal, uncomplicated gestation.

Following a spontaneous vaginal delivery of a macrosomic infant, a patient develops profuse vaginal bleeding. The placenta was delivered intact five minutes prior. Abdominal examination reveals a soft, boggy fundus resting at the level of the umbilicus. The care team identifies uterine atony and initiates a management protocol. Assuming the hemorrhage persists despite each successive action, arrange the following interventions in the standard chronological order of escalation.

A 4-day-old term female infant is brought to the emergency department by her parents due to multiple episodes of green-tinged vomiting that began 6 hours ago. She has been exclusively breastfed and previously had normal stooling and wet diapers. Her temperature is 37.1°C (98.8°F), heart rate is 148/min, respiratory rate is 42/min, and blood pressure is 76/42 mm Hg. Physical examination reveals a soft, non-distended, and non-tender abdomen with active bowel sounds. Capillary refill time is 2 seconds. Arrange the following steps in the most appropriate sequence for the evaluation and management of this patient, from the first step to the definitive final step.

A 34-year-old G4P3 woman experiences massive postpartum hemorrhage due to uterine atony immediately following an uncomplicated vaginal delivery of a 4100-g (9 lb) neonate. Despite the administration of continuous intravenous oxytocin and vigorous bimanual uterine massage, profuse vaginal bleeding persists. Her blood pressure decreases to 76/40 mm Hg and her heart rate increases to 132/min. Assuming each successive intervention fails to arrest the hemorrhage, arrange the following management steps in the correct escalating sequence according to standard obstetric protocols.

While waiting in the obstetric triage area, a primigravida at $38$ weeks of gestation abruptly loses consciousness and exhibits generalized tonic-clonic motor activity. Moments prior to this event, she had complained of a severe, unrelenting headache and seeing 'flashing lights'. Her last recorded blood pressure, taken ten minutes earlier, was $185/115\text{ mmHg}$. During the convulsion, the continuous external fetal monitor records a sudden, prolonged drop in the fetal heart rate to $65\text{/min}$.

Arrange the following critical management steps in the correct chronological sequence to appropriately address this acute emergency.

A $4$-day-old male infant born at term is admitted to the neonatal intensive care unit with progressive lethargy, hypothermia, and poor feeding over the past $24$ hours. Physical examination reveals a somnolent neonate with profound hypotonia and tachypnea. Initial laboratory studies show a severe respiratory alkalosis and a serum ammonia level of $1,250 \mu\text{mol/L}$ (normal: $15$-$50 \mu\text{mol/L}$). There is no metabolic acidosis or ketosis. The clinical team suspects a urea cycle disorder and recognizes a severe hyperammonemic crisis. Arrange the following interventions in the most appropriate chronological sequence for the acute management of this patient.

A 27-year-old primigravida presents for her initial prenatal visit at 8 weeks gestation. Her blood type is subsequently confirmed to be O, Rh(D)-negative. She experiences an uncomplicated pregnancy and delivers a healthy, Rh(D)-positive infant at 39 weeks gestation. A routine postpartum screening test indicates the presence of a significant fetomaternal hemorrhage. Arrange the following clinical steps regarding her Rh(D) management in the standard chronological sequence required to evaluate and prevent maternal alloimmunization, from the first trimester through her postpartum care.

A 7-year-old boy with a history of moderate persistent asthma is brought to the emergency department for severe shortness of breath. He is speaking in single words, sitting in a tripod position, and using accessory muscles to breathe. Physical examination reveals diffuse expiratory wheezing and a prolonged expiratory phase. His oxygen saturation is 88% on room air. Arrange the following steps in the most appropriate sequential order for the acute management of this patient.

A nulligravid 24-year-old female is evaluated in the emergency department for a 3-day history of progressively worsening lower pelvic pain, severe nausea, and subjective fevers. She reports having a new sexual partner over the past 2 months and admits to inconsistent barrier protection. Her temperature is 38.9°C (102.0°F), blood pressure is 100/60 mm Hg, and pulse is 112/min. Physical examination demonstrates marked bilateral lower quadrant tenderness with involuntary guarding. Speculum examination reveals a purulent endocervical exudate. Bimanual examination elicits severe cervical motion tenderness and reveals a palpable, exquisitely tender 6-cm right adnexal fullness.

Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient.

A 9-month-old infant with a known, uncorrected congenital cardiac anomaly is evaluated in the pediatric triage area. His father reports that after waking up from a nap and crying vigorously, the infant's skin became notably dusky and he stopped responding to his name. Triage vital signs show a heart rate of 170/min and an oxygen saturation of 65% on room air. A harsh, crescendo-decrescendo systolic ejection murmur is prominent at the left upper sternal border. The child is currently extremely agitated, inconsolable, and tachypneic.

Arrange the following interventions in the correct chronological sequence for managing this patient's acute presentation, starting with the initial non-invasive bedside action and progressing to escalating pharmacologic steps for refractory symptoms.

A term female neonate, born at 39 weeks gestation via uncomplicated vaginal delivery, is evaluated in the nursery at 6 hours of life due to worsening central cyanosis. Her oxygen saturation is $68\%$ on room air. After receiving $100\%$ supplemental oxygen via hood for 15 minutes, her oxygen saturation only increases to $70\%$. Physical examination reveals a respiratory rate of $62/\text{min}$, equal and strong pulses in all four extremities, a prominent right ventricular impulse, and a loud, single second heart sound ($S_2$) without an appreciable murmur. Assuming the patient is ultimately found to have inadequate interatrial mixing upon diagnostic evaluation, arrange the following management steps in the most appropriate chronological sequence from initial emergency intervention to definitive treatment.

A 27-year-old nulligravid woman is admitted to the gynecology service with worsening lower abdominal pain, chills, and purulent vaginal discharge over the past three days. Her temperature is 38.8°C (101.8°F), blood pressure is 115/75 mm Hg, and pulse is 98/min. Pelvic examination reveals significant cervical motion tenderness and a palpable, tender left adnexal mass. A transvaginal ultrasound demonstrates a 7-cm complex, multiloculated left adnexal fluid collection consistent with a tubo-ovarian abscess. There is no free fluid in the cul-de-sac. The patient is hemodynamically stable and has a soft abdomen with normal bowel sounds. Arrange the following steps in the most appropriate chronological order for the standard evidence-based management of this patient's condition.

Parents bring their 24-month-old daughter to the emergency department because she has been refusing to stand or walk for the past 48 hours. They also report that she developed new-onset urinary incontinence this morning. The patient appears irritable but is consolable. Temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $115/70\text{ mmHg}$, and heart rate is $120\text{/min}$. Physical examination reveals a firm, irregular, palpable abdominal mass crossing the midline. Neurologic examination of the lower extremities shows $2/5$ motor strength bilaterally, $3+$ patellar and Achilles deep tendon reflexes, and a positive Babinski sign bilaterally. Anal sphincter tone is decreased.

Based on the most likely diagnosis, arrange the following management steps in the most appropriate chronological order of execution.

A 29-year-old G2P1 at 39 weeks gestation presents to the labor and delivery triage in the second stage of labor with an overwhelming urge to push. Her pregnancy has been uncomplicated, though she missed her final prenatal visits. Bedside ultrasound confirms a frank breech presentation. Pelvic examination reveals complete cervical dilation, complete effacement, and the fetal buttocks distending the perineum at +3 station. Continuous fetal heart rate monitoring demonstrates a reassuring Category I tracing. Given the imminent delivery, the obstetrician prepares for an assisted vaginal breech delivery.

Arrange the following obstetric maneuvers and actions in the correct chronological sequence for an assisted vaginal breech delivery.

An uncomplicated full-term pregnancy brings a 29-year-old expectant mother to the obstetric triage unit experiencing painful, regular uterine contractions. Arrange the following stages and phases of a normal obstetric labor in the correct chronological order, starting from the onset of true labor and concluding with the immediate postpartum recovery period.

A 6-year-old girl is brought to the pediatric emergency department by emergency medical services due to a generalized tonic-clonic seizure that has been ongoing for 10 minutes. She has a known history of generalized epilepsy and recently had a gastrointestinal illness with frequent vomiting. On arrival, her eyes are deviated upward, and she has rhythmic jerking of all four extremities. Intravenous access is successfully established by the nursing staff. Arrange the following steps in the most appropriate chronological sequence for the evaluation and management of this patient, assuming the seizure activity continues unabated despite each successive intervention.

An obstetrician is reviewing the standard prenatal care schedule with a patient who has just established care at 8 weeks gestation. The patient, who is pregnant with her first child, has an unremarkable medical history and is currently asymptomatic. To properly educate the patient on what to expect throughout her uncomplicated singleton pregnancy, the physician outlines the timeline for standard maternal and fetal assessments. Arrange the following routine prenatal interventions in the correct chronological sequence from the earliest gestational age to the latest.