Q1454. A 48-year-old woman with a 10-year history of rheumatoid arthritis (anti-CCP positive) presents with a rapidly progressive, extremely painful ulcer over the anterior aspect of the shin. What is the most likely diagnosis?

Q1455. Match the specific thyroid autoantibodies (Column A) with their associated pathophysiology or clinical condition (Column B):

Q1456. revealed bronchial breath sounds. He is hemodynamically stable and not confused. On examination, his respiratory rate is 20/min and BP 110/70 mmHg. Lab reports show urea levels of 44 mg/dL. What is the next best step in the management of this patient?

Q1457. A patient undergoes liver surgery. Postoperatively, bilirubin levels remain elevated, despite treatment. Laboratory investigations show elevated direct bilirubin, but unconjugated bilirubin is normal, and there is no increase in urobilinogen in urine. Which of the following is primarily responsible for the elevated bilirubin?

Q1458. A male child is brought to the surgery OPD with groin/inguinoscrotal swelling. Examination shows swelling increases when crying or during micturition and descends medially. What is the most likely diagnosis?

Q1459. A road traffic accident patient presents with sudden respiratory distress, tracheal deviation to the opposite side, hypotension, and absent breath sounds on the left. Chest X-ray shows large left-sided pneumothorax with mediastinal shift. What is the initial emergency management? Image based

Q1461. involving the neck and upper chest from a house fire. On examination, he is alert but tachypneic, with singed nasal hairs and soot in the oral cavity. His oxygen saturation is 80% on room air, and carboxyhemoglobin levels are elevated. Which of the following interventions would most immediately improve his outcome?

Q1462. Histopathology revealed DCIS with a positive surgical margin of 2.5 mm. She subsequently underwent a re-excision, but the margin remains close/positive. There is no evidence of invasive carcinoma or lymph node involvement. What is the next best step in management?

Q1463. and not fixed to the chest wall. There are palpable ipsilateral axillary lymph nodes. There is no evidence of skin involvement, chest wall fixation, or distant metastasis on clinical examination and imaging. What is the most appropriate stage of carcinoma breast?

Q1464. gradually progressive swelling at the base of the tongue for the past 6 months. On oral examination, a smooth, bluish, cystic swelling is seen arising from the floor of the mouth and extending posteriorly toward the base of the tongue. What is the most likely diagnosis?

Q1466. circular mass through the anus, especially during defecation and crying. The child has chronic diarrhea and poor weight gain since infancy. On examination, the prolapsed mass is moist, concentric, and reducible.What is the most appropriate initial management? Prolapse imagw child

Q1467. According to the CEAP classification of chronic venous disease, this condition is classified as.

Q1468. A patient presents to the emergency department with a stab injury to the neck, extending from the angle of the mandible. On examination, there is active air bubbling from the wound. What is the most appropriate management?

Q1469. Intra-operatively, the gallbladder is grossly distended with dense adhesions in Calot’s triangle. There is a stone in the common bile duct, and during dissection the CBD is inadvertently torn, resulting in bile leakage. The surgeon is not experienced in advanced laparoscopic biliary surgery. What is the most appropriate next step in management?

Q1471. epigastric pain radiating to the back, significant weight loss, and steatorrhea for the past 1 year. Investigations show elevated pancreatic enzymes, pancreatic calcifications on CT. There is no pancreatic head mass, no biliary obstruction, and no suspicion of malignancy. What is the most appropriate initial management for this patient?

Q1473. spinal anesthesia. During the procedure, glycine is used as the irrigating fluid. After 50 minutes of resection, the patient develops restlessness, headache, nausea, vomiting, bradycardia, hypotension, and confusion. ECG shows prolonged QT interval, and serum sodium is 118 mEq/L. What is the most appropriate immediate management?

Q1474. A patient involved in a road traffic accident presents with a crush injury to the limb. Based on disaster triage principles, what is the appropriate triage category?

Q1475. A 24-year-old patient presents with recurrent abdominal pain, weight loss, and diarrhea. An image from a small bowel contrast study is given. What is the most likely diagnosis?

Q1476. A patient presents with recurrent episodes of pain and swelling in the submandibular region, especially during meals. Imaging reveals a 1.4 cm stone in the submandibular gland duct, with features of chronic sialadenitis. What is the most appropriate treatment?