A 60-year-old man presents with progressive abdominal distension. Paracentesis reveals: Ascitic albumin: 1.0 g/dL, Serum albumin: 3.5 g/dL, Total protein (ascites): 3.8 g/dL, WBC: 180/mm³ (lymphocyte predominant). Most likely cause of this ascites is?

A 72-year-old man with a history of recurrent diverticulitis presents with pneumaturia and recurrent UTIs. He denies abdominal pain. Which of the following statements is most accurate regarding colovesical fistula?

A 65-year-old man has a right groin bulge lateral to the inferior epigastric vessels, reducible and worse with coughing. Which of the following is the most accurate?

A 45-year-old man presents with painless bright red rectal bleeding on defecation. On anoscopy, you see a hemorrhoid that prolapses with straining and spontaneously reduces. Which of the following statements is most accurate?

A 52-year-old man has painless rectal bleeding but no prolapse. He is found to have internal hemorrhoids visible only on anoscopy. Which is the most accurate description and initial management?

A 68-year-old woman with prior abdominal surgeries has vomiting, distension, constipation, and high-pitched bowel sounds. X-ray shows dilated small bowel with air-fluid levels; colon is collapsed. Which is most accurate?

A 65-year-old man presents with progressive epigastric pain, early satiety, & unintentional weight loss. On endoscopy, a ulcerated lesion with raised edges is noted in the antrum, and biopsy confirms adenocarcinoma. The most accurate statement is?

A 72-year-old man presents with sudden-onset abdominal distension, constipation & vomiting. On examination, his abdomen is tympanic and diffusely tender, with high-pitched bowel sounds. AXR shows a “coffee bean” sign pointing to the RUQ. Most accurate?

Congenital atresia of the foramina of Luschka and Magendie leads to:

A term neonate with severe unconjugated hyperbilirubinemia later develops choreoathetoid movements, vertical gaze palsy, and sensorineural deafness. Most likely site of injury?

A newborn with cyanosis shortly after birth is found to have a large VSD and an overriding aorta. The mechanism responsible for systemic desaturation is:

A 19-year-old athlete presents with exertional syncope. Cardiac exam reveals a harsh systolic murmur that increases with Valsalva. Where is this murmur typically loudest?

A cyanotic newborn is found to have truncus arteriosus. Chest X-ray shows an absent thymic shadow. What is the most likely underlying diagnosis?

A 10-year-old child has a soft systolic murmur with no symptoms and a normal echocardiogram. The murmur becomes softer when the child stands or performs a Valsalva maneuver. What is the most likely explanation?

A newborn presents with cyanosis and signs of heart failure. Cardiac exam reveals a widely split S1 and S2 with a loud S3, creating a “triple gallop,” along with a holosystolic murmur at the left lower sternal border. What is the most likely diagnosis?

A 6-year-old child is asymptomatic but noted to have a systolic ejection murmur at the left upper sternal border and a wide, fixed split S2 that does not vary with respiration. Oxygen saturation is normal. What is the most likely diagnosis?

A 3-year-old child presents with 5 days of fever, conjunctival injection, strawberry tongue, and cervical lymphadenopathy. Kawasaki disease is suspected. Which of the following is the most appropriate next step regarding cardiac evaluation?

A 2-year-old child with known Tetralogy of Fallot develops sudden cyanosis and irritability while playing. The child instinctively squats. Which mechanism best explains the improvement in oxygenation?