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

A 68-year-old man known to have ischemic heart disease came with a history of diffuse abdominal pain for one day. Abdominal X-ray showed a dilated small bowel and a thinned wall. Amylase was 600, serum pH was 7.23. What is the most likely diagnosis?

A) Pancreatitis
B) Intestinal obstruction
C) Perforated peptic ulcer
D) Mesenteric ischemia

A woman is diagnosed with a molar pregnancy and asks about contraception options. Which is the most appropriate method to use after evacuation?

A) Intrauterine device (IUD)
B) Oral contraceptive pills (OCP)
C) Vaginal ring
D) Barrier method only

A child with cystic fibrosis (CF) is brought to the clinic. The mother asks if it is safe for her child to play with another child who also has cystic fibrosis. What is the best advice?

A) Yes, it is safe; they can play together freely
B) Avoid close contact to prevent cross-infection
C) Only if both children are on antibiotics
D) Only if they wear masks

A diabetic mother gave birth to a baby who developed respiratory distress after 6 hours. On examination the baby has mild tachypnea only. What is the diagnosis?

A) Transient tachypnea of the newborn
B) Respiratory distress syndrome
C) Meconium aspiration syndrome
D) Congenital pneumonia

A 69-year-old man with a 40-pack-year smoking history presents with shortness of breath, weight loss, and a large left-sided pleural effusion. Thoracentesis reveals 1,500 mL of bloody, exudative fluid by Light's criteria. What is the most appropriate next step?

A) Empirical broad-spectrum antibiotics
B) CT with contrast
C) Echo
D) Pleural biopsy

A physician is counseling a mother about how to manage her young child's acute illness. After explaining the management steps, the physician is concerned that she may not have fully understood the instructions. He repeats the explanation and then asks the mother to repeat back what he has explained to her. Which communication technique is being used?

A) Call-out
B) Teach-back
C) Specific model
D) Shared decision-making

A 65-year-old man presents with sudden chest pain, tachycardia, and dyspnea. He describes the pain as severe, sharp, and tearing, radiating to his back. He has a history of hypertension. X-ray reveals a widened mediastinum. What is the likely diagnosis?

A) Aortic dissection
B) Pericarditis
C) Myocardial infarction
D) Cardiomyopathy

A 32-year-old woman has stage III choriocarcinoma with lung metastases and a WHO prognostic score of 10. What is the most appropriate treatment?

A) Total hysterectomy alone
B) Observation with serial hCG measurements
C) Methotrexate monotherapy
D) Multiagent chemotherapy

A patient has lower-GI bleeding. Upper GI endoscopy is normal. What is the most likely cause?

A) Diverticulosis
B) Angiodysplasia
C) Cancer
D) Haemorrhoids