Tüm alıştırma soruları

A 26-year-old primigravida at 39 weeks gestation is in the active phase of the second stage of labor. The fetus is in a cephalic presentation and the fetal head is descending through the maternal pelvis. Arrange the following cardinal movements of labor in the correct chronological sequence as the fetus navigates the maternal birth canal.

A 3-month-old infant is admitted to the pediatric intensive care unit with severe respiratory syncytial virus (RSV) bronchiolitis. Over the next 24 hours, the infant's condition progressively deteriorates, demonstrating worsening tachypnea, severe intercostal retractions, and increasing oxygen requirements. The clinical team must escalate respiratory support as the infant progresses toward impending respiratory failure. Arrange the following respiratory interventions in the standard step-wise escalation sequence, starting with the least invasive initial measure and ending with the most advanced rescue therapy.

A $9$-year-old boy is diagnosed with Burkitt lymphoma after presenting with a rapidly enlarging abdominal mass and abdominal pain. Laboratory studies reveal a white blood cell count of $14,000/\text{mm}^3$, a uric acid level of $11.2 \text{ mg/dL}$, potassium of $5.1 \text{ mEq/L}$, phosphorus of $6.5 \text{ mg/dL}$, and calcium of $7.2 \text{ mg/dL}$. His serum creatinine is $0.8 \text{ mg/dL}$. He is admitted to the pediatric intensive care unit for management. Arrange the following steps in the most appropriate chronological order for the prevention and management of tumor lysis syndrome (TLS) and its potential complications in this patient, starting from the initial intervention upon admission.

A 25-year-old primigravida presents to the obstetric clinic at 8 weeks gestation for her initial prenatal visit. She has no significant past medical history, takes no medications other than a daily prenatal vitamin, and her physical examination is unremarkable. She wishes to undergo standard comprehensive prenatal care. Arrange the following routine prenatal screening tests and evaluations in the correct chronological sequence in which they are indicated during a normal pregnancy (from earliest to latest gestational age).

A $36$-year-old nulligravid woman with a history of polycystic ovary syndrome (PCOS) and obesity (body mass index $41$) presents with frequent, heavy menstrual bleeding occurring every $14$ to $60$ days. She has not responded to an initial trial of combined oral contraceptives. The patient explicitly states a strong desire to have children in the near future.

Arrange the following steps in the most appropriate chronological sequence for the diagnosis, definitive management, and long-term follow-up of this patient.

A 48-hour-old full-term neonate is evaluated in the neonatal intensive care unit for failure to pass meconium since birth. Over the past six hours, the infant has developed progressive abdominal distension and just had an episode of dark green vomiting. Vital signs show a heart rate of 158/min, respiratory rate of 48/min, temperature of 37.1°C (98.8°F), and blood pressure of 65/42 mmHg. Physical examination reveals a tensely distended, tympanitic abdomen with hypoactive bowel sounds, but no abdominal wall erythema or rigidity. Digital rectal examination reveals normal anal tone and an empty rectal vault with no stool expulsion upon withdrawal of the finger. Arrange the following steps in the most appropriate sequence for the evaluation and management of this patient.

A $28$-year-old woman, G1P1, presents to the gynecology clinic reporting an absence of menstrual periods for the past $8$ months. She delivered a healthy infant vaginally $10$ months ago. Her immediate postpartum course was complicated by severe hemorrhage that required emergent dilation and curettage. She formula-feeds her infant and has not experienced any galactorrhea, weight changes, hot flashes, or temperature intolerance. Vital signs are within normal limits. Pelvic examination shows a normal-appearing vagina and cervix with no adnexal masses. Arrange the following diagnostic steps in the most appropriate sequential order for evaluating this patient's secondary amenorrhea.

A 4-week-old male infant is brought to the pediatric clinic by his parents for persistent jaundice. He was born at 39 weeks gestation via an uncomplicated vaginal delivery and has been exclusively breastfed. His parents note that over the past two weeks, his stools have become pale and clay-colored, and his urine stains the diaper dark yellow. He is feeding well and gaining weight appropriately. Vital signs are within normal limits for age. Physical examination reveals scleral icterus, jaundice, and a soft, non-distended abdomen with a liver edge palpable 3 cm below the right costal margin. Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for the evaluation and management of this patient's most likely condition.

A 7-year-old girl with a known history of moderate persistent asthma is brought to the emergency department by her parents due to rapidly worsening shortness of breath over the past 4 hours. At home, she received three doses of her albuterol inhaler with no improvement. On examination, the patient is agitated, speaking in single words, and leaning forward. Vital signs reveal a temperature of 37.1°C (98.8°F), heart rate of 145/min, respiratory rate of 42/min, and oxygen saturation of 87% on room air. Physical examination demonstrates marked suprasternal and intercostal retractions, diminished breath sounds bilaterally, and faint expiratory wheezes. Arrange the following therapeutic interventions in the most appropriate sequential order for managing this patient's acute severe status asthmaticus, from the most immediate initial step to the most advanced rescue therapy.

A 26-year-old primigravida presents to the clinic for her initial prenatal visit at 6 weeks gestation. She is currently asymptomatic and has no significant past medical history. As part of her prenatal education, the physician discusses the expected anatomical and physiological changes she will experience. Arrange the following physiological adaptations and clinical findings in the chronological order they typically occur or reach their peak or nadir during a normal, uncomplicated pregnancy.

A 31-year-old G2P2 patient is evaluated in the emergency department for sudden, severe left lower quadrant abdominal pain and profound chills that started 24 hours ago. Her most recent menstrual period ended three weeks ago, and she had a copper intrauterine device inserted four weeks ago. Vitals include a temperature of 38.9°C (102.0°F), a heart rate of 112/min, and a blood pressure of 110/70 mmHg. She is in visible distress. Arrange the following diagnostic and therapeutic steps in the most appropriate chronological sequence for managing this patient's condition.

A 16-year-old girl is brought to the outpatient clinic due to the absence of menarche. She reports no cyclical pelvic or lower abdominal pain. Her medical history is unremarkable, and she takes no medications. On physical examination, her height is at the 60th percentile and weight is at the 55th percentile. Breast development and pubic hair are both at Tanner stage 4. Pelvic examination reveals normal external female genitalia, but there is a shortened, blind-ending vaginal pouch and the cervix cannot be visualized. Arrange the following steps in the most appropriate sequential order for the diagnostic evaluation and management of this patient.

A clinical pathway coordinator is updating the standard operating procedures for a community obstetrics practice. They are mapping out the anticipated schedule of evaluations for healthy patients presenting with an uncomplicated singleton pregnancy in the first trimester. Arrange the following routine prenatal screening evaluations in the correct chronological order from earliest gestational age to latest gestational age.

A 59-year-old nulliparous female presents to her gynecologist with new-onset vaginal bleeding. She has a history of type 2 diabetes mellitus and a body mass index of 42. Arrange the following steps in the standard chronological sequence for the evaluation and definitive management of her most likely condition, from initial diagnostic testing to post-surgical care.

A 5-year-old boy with a known history of severe hemophilia A is brought to the pediatric emergency department after falling from a playground structure and striking his head. His parents report that he has vomited twice since the fall and appears unusually lethargic. On primary survey, his airway is patent, breathing is unlabored, and perfusion is adequate. His Glasgow Coma Scale score is 13. Arrange the following management steps in the most appropriate chronological order.

During a busy night shift on the labor and delivery unit, a $32$-year-old multiparous woman (G3P2) at $40$ weeks of gestation successfully delivers a $4100$ g neonate vaginally. Shortly after the third stage of labor concludes with the delivery of an intact placenta, the patient experiences a sudden, massive gush of vaginal blood. Abdominal palpation reveals a soft, poorly contracted uterus extending above the umbilicus. Assuming each intervention fails to arrest the hemorrhage, arrange the following clinical management steps in their standard procedural sequence from least invasive to most definitive.

A 3-week-old full-term male is evaluated in the emergency department for sudden onset of bilious (green) vomiting. He has had two episodes in the past four hours. His prenatal course and birth history were unremarkable. On physical examination, the infant is awake and alert. Vital signs are within normal limits for age, and he is hemodynamically stable. The abdomen is soft, non-distended, and non-tender, with normal bowel sounds. Arrange the following steps in the most appropriate chronological order for the evaluation and management of this patient.

A $3$-year-old girl is brought to the pediatric emergency department at 4:00 AM by her parents. For the past $48$ hours, she has had rhinorrhea and a low-grade fever. Tonight, she awoke with a loud, brassy cough and difficulty breathing. Vital signs include a temperature of $38.1^\circ\text{C}$ ($100.6^\circ\text{F}$), a heart rate of $135\text{/min}$, a respiratory rate of $40\text{/min}$, and an oxygen saturation of $94\%$ on room air. Physical examination reveals an anxious but alert child with prominent inspiratory stridor at rest and visible intercostal retractions. Arrange the following clinical steps in the most appropriate chronological sequence for managing this patient's condition.

During a routine health maintenance visit, a thirty-four-year-old patient reports that she has not menstruated for the past nine months. Her menarche occurred at age $12$, and previously she experienced predictable $28$-day cycles. Over the last several months, she has been struggling with unexpected mood fluctuations, poor sleep, and sudden, intense episodes of upper body warmth accompanied by sweating. She is nulligravid, has no history of chronic medical conditions, and does not take any medications. Vital signs are within normal limits, with a BMI of $24 \text{ kg/m}^2$. On physical examination, her secondary sexual characteristics are appropriately developed. Pelvic examination reveals a pale vaginal mucosa with diminished rugae, but no adnexal masses are palpated. The thyroid gland is normal to palpation, and there is no evidence of galactorrhea or hirsutism. Arrange the following clinical interventions in the correct chronological sequence to appropriately evaluate and manage this patient's condition.

A 24-year-old primigravida presents to the clinic at 10 weeks gestation reporting severe nausea, vomiting, and dark red vaginal spotting for the past two days. Her blood pressure is 142/90 mmHg, and her heart rate is 105/min. Physical examination reveals a uterus that is palpably enlarged to the level of the umbilicus, which is consistent with a 20-week gestation. A bedside urine pregnancy test is positive. She has no significant past medical history.

Arrange the following steps in the most appropriate chronological sequence for the diagnosis, definitive management, and standard follow-up of this patient's condition.