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👉 A 19-year-old male is evaluated for fatigue and scleral icterus, worsening during viral illnesses. He reports a family history of hemolytic anemia requiring prior splenectomy. Physical exam shows icterus and splenomegaly. CBC shows Hb 10.2 g/dL, reticulocytes 8%, and an increased MCHC. The direct Coombs test is negative. Peripheral smear reveals spherocytes. Which of the following tests is considered the most highly sensitive and specific for confirming this patient’s diagnosis?

A. Eosin-5’-maleimide (EMA) binding test
B. Hemoglobin electrophoresis
C. Bone marrow aspiration and biopsy
D. Glucose-6-phosphate dehydrogenase (G6PD) fluorescent spot test

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👉 A 54-year-old male presents with painless jaundice, unintended weight loss, and bilateral submandibular gland swelling over 3 months. Labs show direct hyperbilirubinemia, normal amylase/lipase, and a serum IgG4 level of 520 mg/dL. CT shows the finding in image with distal common bile duct strictures. Biopsy of a submandibular gland reveals a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells and storiform fibrosis. Which of the following is the most appropriate initial therapy for this patient’s underlying condition?

A. Long-term oral cyclophosphamide
B. High-dose oral glucocorticoids
C. Pancreaticoduodenectomy (Whipple procedure)
D. Endoscopic retrograde cholangiopancreatography (ERCP) with prophylactic stenting alone

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👉 A 45-year-old male presents with persistent epigastric burning and chronic, voluminous diarrhea for the past year. He has a history of three perforated peptic ulcers, requiring multiple interventions. Current EGD reveals thickened gastric folds and multiple ulcerations extending into the second and third portions of the duodenum and the proximal jejunum. A fasting serum gastrin level is markedly elevated at 1,500 pg/mL, and the gastric pH is 1.5. If a genetic syndrome is responsible for this patient’s condition, which of the following additional findings is most likely to be present?

A. Medullary thyroid carcinoma
B. Primary hyperparathyroidism
C. Hemangioblastomas of the cerebellum
D. Mucocutaneous neuromas

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👉 A 52-year-old female with obesity (BMI 36 kg/m ²), type 2 diabetes mellitus, and dyslipidemia is referred to hepatology after routine blood work shows an asymptomatic elevation of liver enzymes (AST 45 U/L, ALT 68 U/L). She consumes alcohol rarely (less than one drink a month) and viral hepatitis serologies are negative. A right upper quadrant ultrasound shows a hyperechoic liver. What is the gold standard modality to distinguish simple steatosis from steatohepatitis and evaluate for fibrosis in this patient?

A. Non-contrast CT scan of the abdomen
B. Magnetic Resonance Elastography (MRE)
C. Percutaneous Liver Biopsy
D. FibroScan (Transient Elastography)

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👉 A 68-year-old male with a history of small cell lung cancer presents with confusion, lethargy, and a generalized tonic-clonic seizure. Labs show serum sodium of 114 mEq/L, serum osmolality of 240 mOsm/kg, and inappropriately concentrated urine. A rare, congenital, X-linked mimicker of this acquired condition is caused by a constitutive activating mutation in which of the following genes?

A. AVPR2
B. AQP2
C. SLC12A1
D. TRPV4

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👉 A 4-year-old child is evaluated for failure to thrive, severe polyuria, and profound muscle weakness. Blood pressure is normal. Labs show serum K⁺ of 2.2 mEq/L HCO3− of 32 mEq/L and hypercalciuria. This phenotype results from loss-of-function mutations affecting which of the following molecular targets?

A. Thiazide-sensitive Na+−Cl− cotransporter in the distal convoluted tubule
B. Epithelial sodium channel in the cortical collecting duct
C. Apical Na+−K+−2Cl− cotransporter in the thick ascending limb
D. Basolateral chloride-bicarbonate exchanger in type A intercalated cells

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