Tüm alıştırma soruları

Match each patient's clinical presentation with its corresponding primary structural or hemodynamic finding.

A 68-year-old man is brought to the emergency department by his family due to confusion, a severe headache, and high fever that began 24 hours ago. He has a history of type 2 diabetes mellitus and hypertension. His temperature is 39.2°C (102.6°F), blood pressure is 112/74 mm Hg, heart rate is 115/min, and respiratory rate is 22/min. Physical examination shows marked nuchal rigidity. Neurologic examination reveals lethargy and a mild left-sided hemiparesis. The physician suspects bacterial meningitis. Arrange the following management steps in the most appropriate chronological order for this patient.

During physical examination of the cardiovascular system, palpation of the arterial pulse can provide critical clues regarding underlying hemodynamics. Match the following characteristic arterial pulse abnormalities with the cardiovascular condition they most classically represent.

A 68-year-old man with a history of severe chronic obstructive pulmonary disease (COPD) is brought to the emergency department by his wife due to worsening shortness of breath, profound fatigue, and confusion. According to the wife, the patient has had severe, large-volume, watery diarrhea for the past four days. His temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure is $100/60$ mm Hg, pulse is $112$/min, and respiratory rate is $24$/min. Physical examination reveals dry mucous membranes, decreased skin turgor, and diminished breath sounds bilaterally with a prolonged expiratory phase.

Laboratory results are as follows:

Arterial blood gas analysis on room air:

Which of the following best describes this patient's primary acid-base disturbance?

Match each classic clinical presentation to the most likely acute gastrointestinal diagnosis.

Paramedics bring a distressed gentleman in his late sixties to the emergency department. He reports severe, unremitting abdominal pain that began $48$ hours ago as intermittent cramps but has now become constant and sharply localized. His last bowel movement was three days ago, and he has vomited dark, foul-smelling fluid multiple times since yesterday. His surgical history is notable for a ruptured appendix requiring an open appendectomy in his twenties.

On evaluation, his temperature is $38.8^\circ\text{C}$ ($101.8^\circ\text{F}$), heart rate is $122/\text{min}$, blood pressure is $88/54\text{ mmHg}$, and respiratory rate is $22/\text{min}$. The abdomen is tense, visibly distended, and exquisitely tender to light palpation across all quadrants, with involuntary guarding. Auscultation reveals a silent abdomen. Laboratory analysis demonstrates a leukocyte count of $19,500/\text{mm}^3$ and a serum lactate of $4.5\text{ mmol/L}$. Upright abdominal radiography displays multiple dilated loops of small bowel with air-fluid levels and a complete absence of gas in the rectum.

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

A 59-year-old woman suddenly collapses while walking in the hospital corridor. A rapid response team arrives immediately. The patient is completely unresponsive, apneic, and has no palpable carotid pulse. The team brings a crash cart with a manual defibrillator, and cardiac monitoring reveals coarse ventricular fibrillation. Arrange the following resuscitative interventions in the correct chronological sequence according to current Advanced Cardiac Life Support (ACLS) guidelines for this rhythm.

Match each clinical presentation of chronic liver disease to the most appropriate next step in management or definitive therapy.

A 62-year-old man with a history of ischemic cardiomyopathy suddenly collapses while walking in the hospital corridor. A rapid response team arrives immediately. The patient is unresponsive, apneic, and has no palpable carotid pulse. High-quality chest compressions are initiated, and a defibrillator is attached. The monitor displays coarse ventricular fibrillation.

Assuming the patient remains in refractory ventricular fibrillation throughout the resuscitation, arrange the following advanced cardiac life support (ACLS) interventions in the correct chronological sequence.

Match each clinical presentation or hemodynamic profile in a patient with advanced liver cirrhosis to the most appropriate systemic complication.

Match each characteristic arterial pulse finding on physical examination with its most likely underlying cardiovascular pathology.

Match each of the following serum laboratory profiles with the most likely underlying clinical diagnosis. (Reference ranges: Calcium $8.4-10.2\text{ mg/dL}$, Phosphorus $2.7-4.5\text{ mg/dL}$, Intact PTH $15-65\text{ pg/mL}$)

Match the following cardiac arrhythmias and conduction disorders with their characteristic electrocardiogram (ECG) findings.

A 65-year-old man is brought to the emergency department due to severe, sudden-onset shortness of breath that awakened him from sleep. The patient has a history of essential hypertension, hyperlipidemia, type 2 diabetes mellitus, and a 35-pack-year history of smoking. Current medications include amlodipine, metformin, and atorvastatin.

Temperature is 37.1°C (98.8°F), blood pressure is 210/115 mmHg, heart rate is 115/min, and respiratory rate is 28/min. Pulse oximetry is 88% on room air.

Physical examination reveals an anxious, diaphoretic man in severe respiratory distress, utilizing accessory muscles of respiration. Lung auscultation reveals a prolonged expiratory phase with diffuse bilateral wheezing and scattered crackles in the lower lung fields. Cardiac examination shows a tachycardic, regular rhythm with a prominent S4 gallop and no murmurs. There is 1+ bilateral pitting edema of the lower extremities.

Chest radiograph demonstrates bilateral perihilar alveolar opacities, indistinct pulmonary vascular margins, and cephalization of the pulmonary veins. There is no focal lobar consolidation.

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

A $71$-year-old woman is evaluated in the surgical step-down unit for a sudden onset of shortness of breath and a nonproductive cough. She is currently on postoperative day $3$ following an uncomplicated right total knee arthroplasty. Her medical history is significant for coronary artery disease, heart failure with preserved ejection fraction, and a $40$-pack-year smoking history with known chronic obstructive pulmonary disease. Her temperature is $37.4^\circ\text{C}$ ($99.3^\circ\text{F}$), blood pressure is $168/96\text{ mmHg}$, pulse is $108/\text{min}$, and respirations are $26/\text{min}$. Oxygen saturation is $89\%$ on room air. Physical examination reveals distended neck veins with a jugular venous pressure of $11\text{ cm H}_2\text{O}$. Chest auscultation demonstrates a prolonged expiratory phase with diffuse bilateral wheezes and scattered bibasilar crackles. Cardiac examination reveals a regular tachycardia with a distinct S4 gallop and no murmurs. Her lower extremities show bilateral $2+$ pitting edema, which is unchanged from her preoperative baseline. Which of the following is the most appropriate next step in management?

Following a transurethral resection of the prostate four weeks ago, a 65-year-old man presents to the emergency department reporting two weeks of worsening fatigue, night sweats, and shortness of breath with mild exertion. He has no other significant past medical history and takes no daily medications. Vital signs show a temperature of 38.4°C (101.1°F), heart rate of 98/min, and blood pressure of 118/72 mm Hg. Cardiac auscultation reveals a new grade 3/6 holosystolic murmur at the apex radiating to the left axilla. Dermatologic examination shows dark red, linear lesions in the nail beds of both hands. Laboratory evaluation reveals a leukocyte count of 14,500/mm³. A transesophageal echocardiogram demonstrates a 1.4-cm mobile vegetation on the mitral valve with moderate regurgitation. Gram stain of blood cultures drawn at admission shows gram-positive cocci in pairs and short chains. Subsequent speciation confirms *Enterococcus faecalis*. The susceptibility report indicates the organism is susceptible to ampicillin, vancomycin, and daptomycin, but testing demonstrates high-level resistance to gentamicin. Which of the following is the most appropriate definitive intravenous pharmacotherapy for this patient?

A gastroenterology team is evaluating several adult patients presenting with elevated liver function tests and suspected chronic liver disease. Match each clinical diagnosis with its most specific characteristic serologic marker or initial diagnostic laboratory finding.

An 11-year-old boy is brought to the pediatric emergency department due to severe, worsening shortness of breath over the past 24 hours. He has a known history of moderate persistent asthma and has been using his albuterol inhaler every 2 hours at home without relief. On arrival, the patient appears lethargic and diaphoretic. He is only able to speak in single syllables. His temperature is $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), pulse is $155/\text{min}$, respirations are $14/\text{min}$, and blood pressure is $112/68\text{ mm Hg}$. Pulse oximetry is $87\%$ on room air. Lung auscultation reveals a "silent chest" with profoundly diminished air entry bilaterally and minimal wheezing.

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

Emergency medical services transport a 64-year-old male to the trauma bay following multiple episodes of massive, bright red rectal bleeding at his residence. He is somnolent and profoundly diaphoretic. Initial vital signs reveal a temperature of 36.8°C (98.2°F), heart rate of 134/min, respiratory rate of 24/min, and blood pressure of 76/42 mm Hg. Collateral history from his partner indicates he takes daily high-dose naproxen for lumbar osteoarthritis. The abdomen is soft and non-tender without organomegaly. Digital rectal examination demonstrates a vault full of fresh blood and clots. Two large-bore peripheral intravenous catheters have just been inserted. Arrange the following subsequent management steps in the most appropriate chronological order for evaluating and treating this hemodynamically unstable patient.

A $65$-year-old man is evaluated in the intensive care unit on day $3$ of admission for septic shock secondary to severe community-acquired pneumonia. He has a past medical history of severe chronic obstructive pulmonary disease and heart failure with preserved ejection fraction. He was intubated on the day of admission and remains mechanically ventilated.

Current vital signs include a temperature of $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure of $105/65\text{ mm Hg}$ on vasopressors, and heart rate of $98\text{/min}$.

Physical examination reveals diminished breath sounds bilaterally with prolonged expiration and scattered expiratory wheezing. Jugular venous pressure is normal, and there are no pulmonary crackles or peripheral edema.

Blood and sputum cultures obtained on admission have finalized, growing *Streptococcus pneumoniae* susceptible to penicillin and ceftriaxone. He is currently receiving continuous intravenous norepinephrine, vancomycin, and piperacillin-tazobactam.

An arterial blood gas analysis is obtained on the current ventilator settings:
pH: $7.22$
$\text{PaCO}_2$: $35\text{ mm Hg}$
$\text{PaO}_2$: $82\text{ mm Hg}$
$\text{HCO}_3^-$: $14\text{ mEq/L}$

Based on the current clinical data, which of the following actions are appropriate in the ongoing management of this patient? (Select all that apply)