Which valvular lesion is considered high risk in pregnancy?

A) Mitral stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Tricuspid regurgitation

A 4-year-old boy presents with convulsion and altered consciousness following a recent viral infection and fever. Examination shows no focal neurological deficits.
CSF results: leukocytes mainly lymphocytes, normal protein, slightly decreased glucose. What is the most appropriate management?

A) Azithromycin
B) Vancomycin and ceftriaxone
C) Antifungal therapy
D) Acyclovir

A 6-year-old girl is brought in after her mother witnessed a brief myoclonic tonic seizure during sleep with full recovery afterward. Recently, similar brief jerks were noted during hair brushing. EEG shows centro-temporal spikes. What is the most likely diagnosis?

A) Childhood absence epilepsy
B) Rolandic epilepsy
C) Lennox-Gastaut syndrome
D) Juvenile myoclonic epilepsy

A 36-year-old patient presents with a neck mass that has been present for 3 years. Physical examination confirmed a palpable left thyroid gland with no palpable cervical lymph nodes. The neck ultrasound shows a left thyroid nodule occupying most of the left lobe, measuring 3.4 x 3.8 cm, with mixed cystic and solid components. The right lobe is normal. Fine needle aspiration findings are coded as Bethesda IV (suspicious for follicular neoplasm). Which of the following is the most appropriate management?

A) Thyroid scan
B) Total thyroidectomy
C) Left hemithyroidectomy
D) Repeat fine needle aspiration

A 22-year-old man presents with a 2-day history of dysuria and urethral discharge. He reports recent sexual activity with a new female partner. He is afebrile, and physical examination is unremarkable. What is the most appropriate treatment?

A) Gentamicin
B) Azithromycin
C) Ceftriaxone
D) Nitrofurantoin

A 30-year-old male, a chronic smoker, accidentally finds a lung nodule on an X-ray. Which risk factor increases the likelihood of the nodule being cancerous?

A) Age
B) Diameter of the nodule more than 2.5 cm
C) Upper lobe site
D) Hypercalcemia

A pregnant woman at 15 weeks gestation has a known seizure disorder and is currently taking phenytoin. Her last seizure attack occurred 6 years ago. What should be done regarding her medication?

A) Switch the medication
B) Continue the medication
C) Decrease the dose
D) Increase the dose

A patient had colorectal cancer and had talked to the doctor about wishing not to do the surgery. His wife and son do not agree with him. The patient went on to have a decreased level of consciousness and his family requested to do the surgery. What is the most appropriate management?

A) Do the surgery if there is written consent
B) Refuse the surgery as the patient wishes
C) Do the surgery if there is benefit for life
D) Consult the ethics committee

A patient with a history of depression now presents with talkativeness, decreased sleep and overspending. On examination he has tachycardia and dilated pupils. What is the diagnosis?

A) Bipolar I disorder
B) Substance-induced mood disorder
C) Schizoaffective disorder
D) Generalized anxiety disorder

A patient has normal coagulation labs and normal platelet count. He presents with umbilical stump bleeding, and his clot undergoes lysis after 5 minutes. His brother has the same issue. What is the most likely diagnosis?

A) Factor XIII deficiency
B) Bernard–Soulier syndrome
C) von Willebrand disease
D) Platelet function defect

A young patient with hypertension is on two antihypertensive medications (ACE inhibitor and calcium channel blocker) with no improvement. Laboratory results show low potassium and high bicarbonate levels. What is the most appropriate next diagnostic test?

A) Serum metanephrines
B) Urine metanephrines
C) Renin-aldosterone ratio
D) 24-hour urine cortisol

A man with diabetes and hypertension is admitted with an extensive anterior ST-elevation myocardial infarction (STEMI). He underwent successful angioplasty and stenting of the left anterior descending artery and was started on aspirin, clopidogrel, bisoprolol, and enalapril. Which additional treatment is recommended?

A) No additional medication is indicated
B) Atorvastatin
C) Fenofibrate
D) Niacin

A 26-year-old pregnant woman in her 30th week of pregnancy visits the clinic for a regular follow-up. She is asymptomatic. Physical examination reveals a mid-systolic ejection murmur at the right upper sternal border that radiates to the carotids, with no diastolic murmur heard. Which of the following is the most likely diagnosis?

A) Aortic Stenosis
B) Mitral Stenosis
C) Tricuspid Stenosis
D) Physiologic Murmur of Pregnancy

A primigravida presents to the antenatal clinic with a positive home pregnancy test and vaginal spotting. Her last menstrual period was 6 weeks ago. Serum β-hCG level is 700 mIU/mL. Transvaginal ultrasound shows no intrauterine or extrauterine gestational sac. What is the most appropriate management?

A) Give methotrexate immediately
B) Reassess serum β-hCG levels in 48 hours
C) Repeat transvaginal ultrasound in 48 hours
D) Reassure and discharge home

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A 35-year-old woman with a normal breast examination has a family history of breast cancer and tested positive for the BRCA1 gene. What is the most appropriate screening?

A) Follow up with ultrasound every 6 months
B) Breast MRI now
C) Mammogram at 35 years annually
D) No screening until age 40

A fetus was diagnosed with hydronephrosis, and postnatally it was confirmed along with thickening of the bladder wall. What is the most appropriate test to make the diagnosis?

A) Voiding cystourethrogram
B) DMSA scan
C) Intravenous pyelogram
D) MAG3 renogram

A woman is admitted to the hospital following a motor vehicle accident and is managed with an NGT (nasogastric tube) and catheter. Her chest X-ray is normal. A few days later, she wakes up and is oriented and talking to doctors, but she develops a high fever. What is the next best step in management?

A) Head MRI
B) Chest CT
C) Check catheter
D) Repeat chest X-ray

A pediatric patient presents with a 6-hour history of testicular pain and swelling. Examination shows absence of the cremasteric reflex and negative transillumination. What is the most likely diagnosis?

A) Testicular torsion
B) Hydrocele
C) Epididymitis
D) Orchitis

A 44-year-old female is complaining of dysmenorrhea and menorrhagia. Pelvic exam revealed symmetrical enlargement of the uterus and tenderness. Endometrial biopsy was normal. What is the most likely diagnosis?

A) Adenomyosis
B) Endometriosis
C) Sarcoma
D) Leiomyoma