Q40. A 48-year-old woman presents with complaints of tightening of the skin over her fingers, difficulty swallowing, and episodes of color change in her fingers upon cold exposure. Serologic testing reveals positive anti-Scl-70 antibodies. Which of the following complications is most strongly associated with anti-Scl-70 positivity in the given condition?

Q41. A 45-year-old woman presents with complaints of fatigue, pruritus, and mild right upper quadrant discomfort. Laboratory investigations show elevated ALP. Further testing reveals positive anti-mitochondrial antibodies. A liver biopsy shows non-suppurative, granulomatous destruction of intrahepatic bile ducts. What is the most likely diagnosis?

Q42. A 32-year-old non-smoker presents with a 2-month history of dry cough and progressive dyspnea. Chest X-ray reveals bilateral hilar lymphadenopathy. Biopsy shows non-caseating granulomas composed of epithelioid histiocytes and multinucleated giant cells, with stellate inclusions. Which of the following is the most likely diagnosis?

Q51. A 16-year-old adolescent presents with bone pain and muscle weakness. Lab investigations reveal serum calcium mildly low, decreased serum phosphate, elevated PTH, elevated ALP. A wrist X-ray shows splaying of metaphyses. Which of the following is the best next step in management?

Q57. 68 year old female with history of breast cancer presents with breathlessness, deteriorating health condition and is found to have multiple metastases. She is awake, alert and visibly anxious. The medical team assesses that aggressive chemotherapy, radiotherapy, ICU care and mechanical ventilation would not improve her condition. Despite this, the patients daughter insists on 'doing anything and everything' for her mother. What is the most appropriate next step in managing this case?

Q66. A neonate is diagnosed with congenital hypothyroidism. Investigations reveal decreased T3 and T4 levels with elevated TSH. Neck ultrasound shows a normally located thyroid gland. A radioactive iodine uptake scan shows decreased uptake. What is the most likely underlying cause?

Q115. A 40-year-old woman who underwent ileal resection presents with features of anemia despite a good diet. Her RBC count is 2.8 million/mm³, and serum iron is 164 mcg/dL. Which of the following is most likely to be found in her?

Q117. An 8-year-old boy presents to the OPD for evaluation of a subcutaneous xanthoma on his right elbow. His father recently died of a myocardial infarction. Laboratory investigations reveal total cholesterol of 480 mg/dL, triglycerides of 146 mg/dL, and LDL cholesterol of 300 mg/dL. Which of the following types of familial hypercholesterolemia is the most likely underlying condition?

Q140. A male presents with chronic back pain and anterior uveitis for several months. O/E there is tenderness in SIJ. What is the investigation of choice to make the diagnosis at the earliest?

Q144. 60 year old man presents with generalized body ache and increasing hat size. O/E the bones are warm to touch. Biochemical Investigations Show Normal Serum Calcium, Phosphate, And Parathyroid Hormone (PTH) Levels, But Markedly Elevated Alkaline Phosphatase (ALP). X ray shows lytic areas in long bones. What is the diagnosis?

Q147. An elderly patient presents with knee pain x ray show change of arthritis. Synovial fluid analysis shows rhomboid crystals which were positively birefringent. What is the diagnosis?

Q168. 15 year old male with recent sudden growth. Current height 6'4'' with widening of jaw, large hand and foot. Frequent visual disturbances and headache. On ophthalmic examination he has bitemporal hemianopia. What test is used in the diagnosis?

Q172. A 32-year-old female presents with weakness in the right arm in the form of difficult in kneading dough. On examination, there is hypotonia and sluggish deep tendon reflexes in the affected limb. Which of the following structures is most likely involved?

Q173. A patient with asthma is currently being treated with salbutamol and ipratropium bromide. He now reports frequent nocturnal symptoms. What is the most appropriate next step in management?

Q174. A 35-year-old woman with a history of migraine was initially on over the counter NSAIDs. But since there was not adequate relief, she is currently using sumatriptan for acute attacks. Her father has a history of coronary artery disease. What is the most appropriate agent to add for migraine prophylaxis?

Q175. A 70-year-old patient with a history of hypertension and atrial fibrillation presents with acute-onset right-sided weakness and aphasia, which began 2 hours ago. A non-contrast CT scan of the brain shows no evidence of hemorrhage. What is the next best step in management?

Q176. A 55-year-old patient presents with episodes of shortness of breath and palpitations. An ECG confirms paroxysmal supraventricular tachycardia. What is the most appropriate option for long-term prophylactic treatment?

Q177. Which of the following intravenous fluids when given in large volume is most likely to cause hyperchloremic metabolic acidosis?