1. A 30-year-old woman presents with infertility, irregular periods, and hirsutism. Ultrasound shows enlarged ovaries with multiple cysts. Which of the following is most consistent with her diagnosis?
A. Primary ovarian insufficiency
B. Hypogonadotropic hypogonadism
C. Polycystic ovary syndrome
D. Premature menopause
E. Clear cell adenocarcinoma
2. A 60-year-old man presents with a history of premature coronary artery disease. His lipid profile shows markedly elevated low-density lipoprotein (LDL) cholesterol. Genetic testing reveals a mutation affecting the LDL receptor. Which type of familial dyslipidemia is most likely in this patient?
A. Type I familial dyslipidemia
B. Type II familial dyslipidemia
C. Type III familial dyslipidemia
D. Type IV familial dyslipidemia
E. Type V familial dyslipidemia
3. A 40-year-old asplenic patient presents with fever and rusty-colored sputum. Chest X-ray reveals a lobar consolidation. Which of the following vaccinations would have best prevented this condition?
A. Hib vaccine
B. Influenza vaccine
C. Meningococcal vaccine
D. Pneumococcal polysaccharide vaccine
E. Varicella vaccine
4. A 35-year-old male presents with loss of visual and auditory reflexes following a severe head injury. The injury most likely affected which part of the brainstem?
A. Superior colliculus
B. Inferior colliculus
C. Pyramidal decussation
D. Pons
E. Superior cerebellar peduncle
5. A 60-year-old female with hypertension has plasma para-aminohippuric acid (PAH) concentration (PPAH) of 0.2 mg/mL, urine PAH concentration (UPAH) of 50 mg/mL, and urine flow rate (V) of 2 mL/min. Which parameter can be estimated using these values?
A. Glomerular filtration rate (GFR)
B. Renal blood flow (RBF)
C. Effective renal plasma flow (eRPF)
D. Plasma volume
E. Cardiac output
6. A 68-year-old male is brought to the emergency department with a 2-hour history of left-sided weakness and slurred speech. He has a history of atrial fibrillation, managed with anticoagulants. A non-contrast CT of the head is performed to assess for hemorrhage, which is negative. What is the next best step in the management of this patient?
A. Start intravenous tPA
B. Administer aspirin and clopidogrel
C. Perform thrombectomy
D. Order a diffusion-weighted MRI
E. Begin heparin infusion
7. A 60-year-old man with a history of chronic kidney disease presents with irritability and stupor. Laboratory tests reveal an elevated serum sodium level. What is the most likely cause of his symptoms?
A. Hyponatremia
B. Hypernatremia
C. Hyperkalemia
D. Hypercalcemia
E. Hypophosphatemia
8. A clinical study reports a 95% confidence interval (CI) for the mean difference in blood pressure between two treatments as (2 mmHg, 10 mmHg). Which statement correctly interprets this finding?
A. The null hypothesis (H0) is not rejected.
B. The results are not statistically significant.
C. The true mean difference is expected to be exactly 6 mmHg.
D. There is a 5% chance that the true mean difference is either less than 2 mmHg or more than 10 mmHg.
E. The null hypothesis (H0) is rejected.
9. A 50-year-old woman presents with progressive symmetric proximal muscle weakness, particularly involving her shoulders. Laboratory tests are positive for anti-Jo-1 antibodies, and muscle biopsy shows endomysial inflammation with CD8+ T cells. What is the most likely diagnosis?
A. Polymyositis
B. Dermatomyositis
C. Polymyalgia rheumatica
D. Fibromyalgia
E. Myositis ossificans
10. A 32-year-old woman is diagnosed with a hydatidiform mole. Histological examination reveals some hydropic villi with focal trophoblastic proliferation and the presence of fetal parts. What is the most likely karyotype in this case?
A. 46,XX
B. 46,XY
C. 69,XXX
D. 46,XXY
E. 46,XY