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?

A 3-month-old infant with Down syndrome presents with poor feeding, tachypnea, and failure to thrive. Cardiac exam reveals a systolic ejection murmur at the left upper sternal border and a fixed split S2. What is the most likely diagnosis?

newborn presents with jaundice, an enlarged tongue, and lethargy. Labs show high TSH and low free T4. What is the most likely diagnosis?