Q183. A 45-year-old female presented with a 6-month history of paroxysmal nocturnal dyspnea, palpitations, and breathlessness. JVP elevated, pulse irregularly irregular, tender hepatomegaly. A heaving apex was noted, and a mid-diastolic murmur (MDM) was heard at the apex. The patient also has a history of acute rheumatic fever. Which statement is TRUE?

Q184. A 45-year-old male presents with headache, palpitations, and sweating. Laboratory tests reveal elevated vanillylmandelic acid (VMA) and metanephrine levels. What is the drug of choice for preoperative and intraoperative management?

Q185. Which drug is used for prophylaxis of meningococcal meningitis in close contacts?

Q186. A patient came with complaints of palpitations and dyspnoea since 4 hours. He was hemodynamically stable. On doing ECG it was suggestive of Atrial fibrillation. What is the next best step in management?

Q187. A 24 old male abattoir worker came with complaints of fever and headache since 1 week and also red eyes and reduced urine output. His serum bilirubin levels were raised. What is the most probable diagnosis?

Q188. Which of the following causes of Factor IX deficiency can be improved after Vitamin K injection?

Q189. A 55-year-old woman presents with acute respiratory distress and hemoptysis on day 7 after knee replacement surgery. Her respiratory rate is 28/min, and pulse is 120/min. What is the most appropriate investigation to confirm the diagnosis?

Q190. An HIV-positive patient presents with a 2-week history of fever, cough, and weight loss. He is diagnosed with tuberculosis. What is the most appropriate approach to management?

Q191. A patient with type 2 diabetes mellitus, currently on insulin and metformin, has an HbA1c of 8.3%. He also has features of chronic heart failure (left ventricular ejection fraction < 35%). What is the next best add-on therapy?

Q192. Benralizumab acts on which receptor?

Q193. A 58-year-old male with a 10-year history of poorly controlled type 2 diabetes presents with numbness and tingling in both feet for several months. On examination, ankle jerks are absent, and there is reduced vibration and pinprick sensation in glove and stocking distribution. What is the most likely explanation for his symptoms?

Q194. A 45-year-old woman presents with joint pain and morning stiffness lasting over an hour for the past several months. On examination, there is swelling and tenderness in the small joints of the hands. Laboratory tests show a positive anti-CCP antibody and elevated ESR. Joint aspiration of the wrist is most likely to reveal which of the following findings?

Q195. A 60-year-old male with a history of ischemic heart disease and reduced left ventricular ejection fraction is scheduled for elective abdominal surgery under general anesthesia. He is hemodynamically stable. Which of the following agents is most appropriate in this patient to minimize cardiovascular effects?

Q196. A patient presents with salt craving, hyperkalemia, metabolic acidosis, and skin pigmentation. What is the most likely diagnosis?

Q197. A 22-year-old male is brought to the emergency department following a high-speed road traffic accident. On initial assessment, he is unconscious but hemodynamically stable. A non-contrast CT scan of the head is reported as normal. However, within 3 hours of admission, the patient deteriorates rapidly and succumbs to his injuries. Autopsy reveals petechial hemorrhages in the corpus callosum, brainstem, and gray-white matter junction, along with evidence of brainstem retraction balls. What is the most likely diagnosis?