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?

Q178. A 45-year-old woman presents with a 6-month history of dry mouth, dry eyes, and dry cough. Laboratory investigations reveal that she is ANA positive, anti-Ro positive, and anti-La positive. Which of the following findings is most commonly associated with this condition?

Q179. A teenage girl with known type 1 diabetes mellitus, currently on insulin therapy, presents to the outpatient department with severe dehydration after skipping her last insulin dose. Her random blood glucose is markedly elevated at 720 mg/dL, and her serum sodium is 126 mEq/L and serum potassium is 4.3 mEq/l. Which of the following is NOT appropriate as part of her management?

Q180. A patient with tuberculosis and HIV (CD4 count <150) is found to be rifampicin-resistant on CBNAAT. What is the appropriate management, and what is the most likely associated complication?

Q181. A patient diagnosed with hyponatremic encephalopathy presents with a serum sodium level of 95 mEq/L. She was treated with 3% hypertonic saline, and after 24 hours, her sodium level increased to 111 mEq/L. After sodium correction, her neurological status has deteriorated. What is the next best step in management?

Q182. A critically ill patient with covid 19 is admitted into ICU and is currently on mechanical ventilation. The PaO2/FiO2 ratio is 100, indicative of ARDS. Which of the following is the Most appropriate ventilation strategy to manage the patient?

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?

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?