Q1433. 27-year-old woman presents with photosensitivity and well-defined erythematous discoid rash on the face. She also complains of arthralgia and oral ulcers. Laboratory evaluation confirms a diagnosis of systemic lupus erythematosus. Which of the following autoantibodies is associated with the worst prognosis in SLE?

Q1434. Patient presents with progressive weakness of both upper and lower limbs for 8 months. He has muscle wasting of the hands, fasciculations, and brisk deep tendon reflexes. Plantar response is extensor. Sensory examination is normal. There is no bladder or bowel involvement. What is the most likely diagnosis?

Q1435. A 42-year-old man presents with 3 days of fever, headache, confusion, and altered behavior. CSF analysis shows WBC 150/µL (lymphocytic), protein 80 mg/dL, glucose normal. MRI brain: hyperintensities in the temporal lobes. What is the most likely diagnosis?

Q1436. A patient is brought to the emergency department in a state of shock. A laboratory evaluation is performed, revealing the following biochemical profile: pH = 4.5, HCO3- = 20 mEq/L, and pCO2 = 25 mmHg. Which of the following best describes this patient's acid-base status?

Q1437. retrosternal chest pain associated with diaphoresis and nausea. Electrocardiogram shows ST-segment elevation in leads II, III, and aVF. On examination, his blood pressure is 80/60 mmHg with cool extremities, but lung fields are clear on auscultation. What is the next best step in management?

Q1438. examination, there is a visibly strong, bounding pulsation in the neck with a prominent carotid upstroke. Careful inspection of the nail beds reveals rhythmic pulsatile blanching synchronous with the cardiac cycle. Which of the following auscultatory findings best corresponds to this clinical presentation?

Q1439. You are asked to assess the pulse tracing of the patient. Demonstrates two ystolic peaks per cardiac cycle. The following pulse corresponds to involvement of which of the following heart valves?

Q1440. A patient presents with complaints of shortness of breath and effort intolerance. On auscultation, a loud opening snap with a mid-diastolic murmur is heard. Echocardiography shows an EF of 38%. What is the likely diagnosis?

Q1441. level of the umbilicus and urinary and bowel incontinence. On neurological examination: Power in both lower limbs is reduced Knee and ankle reflexes are absent What is the most likely diagnosis?

Q1442. lifestyle measures. Laboratory evaluation reveals hypokalemia associated with metabolic alkalosis. There is no history of diuretic intake, and renal function tests are within normal limits. Which of the following is the most likely diagnosis?

Q1443. history of endocrine tumors, and genetic counseling is advised on labs, calcium is raised. The clinician plans further evaluation to identify associated inherited syndromes and guide family screening. Which of the following statements regarding this condition is correct?

Q1444. A patient is admitted with a head injury in the ER. On examination, he is having bradycardia with hypertension and posturing. You notice the following breathing pattern. Diagnosis is?

Q1445. mouth, requiring frequent use of artificial tears and water while swallowing food. There is no history of skin tightening, Raynaud phenomenon, oral ulcers, or photosensitive rash. Based on this clinical presentation, what is the most likely diagnosis?

Q1446. alcohol intake or gallstone disease. MRI abdomen reveals a diffusely enlarged pancreas with a characteristic “sausage-shaped” appearance. Laboratory evaluation shows markedly elevated serum IgG4 levels. Which of the following is the best treatment for this patient?

Q1447. 30 pack-years. There is no history of atopy. Pulmonary function testing shows a post-bronchodilator FEV1/FVC ratio of < 0.7 with an 18% improvement in FEV1 after bronchodilator administration Increased to >220 Fev1. CXR is shown below? What is your diagnosis ?

Q1448. involving the proximal muscles of the lower limbs. He has difficulty climbing stairs and getting up from a squatting position. There is a significant family history, and his elder brother had similar complaints and died around the age of 40 years. What is the most likely diagnosis?

Q1449. of the left upper and lower limbs, slurred speech that started 2 hours ago while he was watching TV. There is no history of headache or loss of consciousness. He has a history of hypertension and type 2 diabetes for 10 years. Non-contrast CT brain is shown. Which of the following is the most appropriate initial management?

Q1451. What is the suspected acid-base disorder based on the ABG analysis? pH 7.45 PaCO2 28 mmHg HCO3 20 mEq/L

Q1452. calf pain), and redness of the eyes for the last 4 days. He gives a history of wading through flood water one week ago. On examination, conjunctival suffusion is noted. There is no jaundice or renal impairment at present. This clinical presentation most likely corresponds to which phase of leptospirosis?