Tüm alıştırma soruları

An obstetric patient at $16$ weeks gestation presents to her physician's office for evaluation of increased vaginal discharge that she first noticed a week ago. The $26$-year-old gravida $2$, para $1$, states that the discharge has an unpleasant, "fishy" odor, which becomes more pronounced following intercourse. She has not experienced any vulvar itching, burning with urination, or pelvic pain. Her medical history is unremarkable, and her current pregnancy has been progressing normally. Her temperature is $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $110/70 \text{ mm Hg}$, and pulse is $78/\text{min}$. On speculum examination, a thin, homogenous, gray-white fluid is seen coating the vaginal walls. The cervix appears normal, and there is no surrounding erythema. Vaginal pH testing yields a value of $5.5$. The addition of $10\%$ potassium hydroxide to a sample of the vaginal discharge produces a strong amine odor. A wet mount preparation of the discharge shows squamous epithelial cells that are stippled and have indistinct borders due to numerous adherent bacteria. Which of the following is the most appropriate next step in management for this patient?

An outpatient evaluation is requested for a 41-year-old woman experiencing abnormal uterine bleeding. Over the last 10 months, her menstrual cycles have become highly irregular, occurring at intervals ranging from 20 to 60 days. The periods are characterized by a heavy flow that frequently requires changing a superabsorbent pad every hour during the first two days of menstruation. Her past medical history includes essential hypertension and type 2 diabetes mellitus. Her body mass index is 39 kg/m2. She has never been pregnant. Vital signs are normal. Speculum examination shows a normal-appearing cervix with a moderate amount of dark blood in the vaginal vault. Bimanual examination reveals a mobile, normal-sized uterus and no adnexal masses. Urine human chorionic gonadotropin testing is negative. Transvaginal ultrasonography shows a homogeneously thickened endometrium measuring 14 mm without focal lesions. Which of the following is the most appropriate next step in the management of this patient?

Accompanied by her husband, a $62$-year-old woman arrives at the emergency department experiencing acute-onset breathlessness and a persistent cough. Her symptoms began rapidly over the past $4$ hours. She has a medical history notable for type $2$ diabetes mellitus and refractory major depressive disorder. Her daily medications include metformin and phenelzine. Three days ago, she developed a mild upper respiratory tract infection and began taking an over-the-counter oral decongestant containing pseudoephedrine.

On arrival, the patient is visibly distressed, diaphoretic, and speaking in short phrases. Her temperature is $37.0^{\circ}\mathrm{C}$ ($98.6^{\circ}\mathrm{F}$), blood pressure is $218/116$ mmHg, pulse is $114$/min, and respiratory rate is $26$/min. Pulse oximetry demonstrates an oxygen saturation of $89\%$ on room air. Physical examination reveals prominent jugular venous distention. Cardiac auscultation shows a regular tachycardia with a loud $S_4$ gallop and no discernible murmurs. Pulmonary auscultation reveals diffuse, fine inspiratory crackles bilaterally, extending up to the mid-lung fields. Bilateral trace pedal edema is present.

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

A physician is called to the bedside to evaluate a 68-year-old male who developed acute shortness of breath. The patient underwent an uncomplicated partial bowel resection three days ago. His past medical history includes essential hypertension, hyperlipidemia, and a myocardial infarction four years ago. During the first two postoperative days, he received a total of 5 liters of isotonic crystalloid due to transient episodes of hypotension. Current vital signs show a temperature of 37.4°C (99.3°F), blood pressure of 162/95 mmHg, heart rate of 108/min, and a respiratory rate of 26/min. Pulse oximetry is 89% on room air. On physical examination, the jugular venous pressure is elevated. Lung auscultation reveals bilateral basilar crackles, and cardiac auscultation demonstrates a third heart sound (S3). The surgical incision is intact without erythema or drainage. Which of the following is the most appropriate next step in management?

A 6-month-old male infant, born prematurely at $32$ weeks gestation, is evaluated in the emergency department in mid-January. For the past four days, he has had profuse rhinorrhea and a low-grade fever. Today, he developed significant breathing difficulty and has been unable to breastfeed. Vital signs show a temperature of $37.8^\circ\text{C}$ ($100.0^\circ\text{F}$), heart rate of $165/\text{min}$, respiratory rate of $68/\text{min}$, and oxygen saturation of $88\%$ on room air. Physical examination reveals marked intercostal and subcostal retractions, nasal flaring, and head bobbing. Lung auscultation demonstrates diffuse coarse crackles and prolonged expiratory wheezing bilaterally. Which of the following are appropriate interventions for this patient's acute management? (Select all that apply)

A 62-year-old male patient with a body mass index of 32 kg/m² is evaluated in the outpatient setting for an 8-month history of progressive bilateral knee discomfort. He reports that the pain exacerbates at the end of the day and after prolonged ambulation. Radiographs of the knees demonstrate asymmetric joint space narrowing, subchondral sclerosis, and marginal osteophytes. Arrange the following therapeutic interventions in the standard chronological order of escalation for the management of this patient's condition, assuming inadequate symptomatic relief is achieved at each preceding step.

A 26-year-old male graduate student presents to the university health center complaining of severe sadness, lack of motivation, and poor concentration over the past 5 weeks. He states he has completely lost interest in his coursework and hobbies, which is highly unusual for him. He struggles to get out of bed, sleeping up to 14 hours a day, and reports a 5 kg (11 lb) weight gain during this time. Medical history is unremarkable, and he takes no medications. Physical examination reveals psychomotor retardation and a blunted affect, but vital signs and the remainder of the examination are within normal limits. He denies any suicidal ideation. The patient requests an antidepressant medication to help him "get back on track." Which of the following is the most appropriate next step in the clinical evaluation or management of this patient?

Match each specific substance of abuse with its most characteristic clinical presentation and associated findings.

Match each patient's clinical presentation with the most likely personality disorder diagnosis.

Match each clinical presentation to its most appropriate definitive procedural or surgical management.

Carefully review the following laboratory and clinical profiles of pregnant patients presenting with hepatic or hematologic abnormalities. Match each clinical vignette with its most accurate diagnosis.

Match each of the following clinical presentations of urologic pathology with the most appropriate definitive surgical intervention.

Match each patient's clinical presentation with the most appropriate next step in psychopharmacologic or procedural management.

Match each patient's clinical presentation to the most appropriate DSM-5 diagnosis based on their specific symptom profile and duration.

Match each clinical presentation of an antipsychotic-induced adverse effect to the primary pharmacological mechanism of its most appropriate targeted medical treatment.

Match each presentation of genitourinary trauma or iatrogenic injury with its most appropriate definitive surgical or clinical management step.

Match each patient's clinical presentation and diagnostic findings with the correct underlying pathophysiology and appropriate first-line management.

Match each pediatric patient's clinical vignette (left) with the underlying pathophysiological or embryological mechanism responsible for the condition (right).

A 15-month-old girl is brought to the pediatrician for a routine well-child visit. She was born at 28 weeks gestation via emergency cesarean delivery due to a placental abruption, and her neonatal course was complicated by respiratory distress syndrome requiring mechanical ventilation. Her parents are concerned about her development, noting that she cannot walk independently and her vocabulary consists only of the words "mama" and "dada." However, the parents proudly mention that she is "advanced in her motor skills on the right side," as she has consistently used her right hand to feed herself and reach for toys since she was 8 months old. On physical examination, the patient's growth parameters are at the 50th percentile for her corrected age. She can pull to a stand and cruise along furniture. She makes good eye contact, points to a desired toy across the room, and plays peek-a-boo. When a small block is placed on the examination table, she picks it up using a precise right-sided thumb and index finger grasp. Her left hand remains mostly fisted during the encounter, and there is noticeable resistance to passive extension of the left elbow. Which of the following is the most appropriate next step in management?

A 68-year-old man with a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease (COPD) is brought to the emergency department by his daughter due to lethargy and confusion. The daughter reports that he has had severe nausea and vomiting for the past 3 days and has been unable to eat or take his usual medications, including insulin. On physical examination, the patient is lethargic and oriented to person only. His temperature is 37.2°C (99.0°F), blood pressure is 90/60 mm Hg, pulse is 115/min, and respiratory rate is 24/min with shallow breaths. Mucous membranes are extremely dry, and skin turgor is decreased. Pulmonary examination reveals prolonged expiration with bilateral wheezes and decreased breath sounds.

Laboratory results are as follows:

Arterial blood gas (room air):
$pH$: 7.25
$PaCO_2$: 50 mm Hg
$PaO_2$: 55 mm Hg
$HCO_3^-$: 21 mEq/L

Serum chemistry:
$Na^+$: 140 mEq/L
$K^+$: 4.8 mEq/L
$Cl^-$: 90 mEq/L
$HCO_3^-$: 21 mEq/L
Blood urea nitrogen: 45 mg/dL
Creatinine: 2.2 mg/dL
Glucose: 450 mg/dL
Albumin: 4.0 g/dL

Urinalysis is strongly positive for ketones.

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