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?

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?

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?

Q1453. A 35-year-old man presents with headache and neck stiffness for 5 days. Lumbar puncture reveals the following CSF findings: 90% lymphocytes and 10% neutrophils, with CSF glucose: 40 mg/dL (plasma glucose: 100 mg/dL); protein is 1 gm/dL. What is the most likely diagnosis?

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?

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?

Q1479. A 2-year-old intravenous drug user presents with a large, pulsatile, painful mass in the groin. There is local erythema, warmth, and tenderness, and systemic features suggest infection. What is the best next investigation to confirm the diagnosis?

Q1485. A 52 years old postmenopausal woman presents with hot flushes and a dry vagina. What are the expected levels of FSH, LH, estrogen, and progesterone?

Q1486. A 50-year-old postmenopausal woman presents with bleeding. Ultrasound shows a “feeding vessel” sign. What is the most appropriate management?

Q1499. A woman undergoes a routine Pap smear, which reports atypical glandular cells. She is otherwise asymptomatic. What is the next appropriate investigation?

Q1505. A diabetic woman on insulin is planning to get pregnant and visits for a pre-conceptional check. Her HbA1c is 8.5. What is the next best advice for her?

Q1506. A 35-year-old patient presents with dysmenorrhea and bleeding per rectum, which occurs whenever she has her periods. On examination, a nodule is felt anteriorly on per-rectal examination. What is the diagnosis?

Q1508. A 52-year-old postmenopausal woman presents with bleeding and is found to have a 3 cm fibroid in the uterine wall with an endometrial thickness of 8 mm. What is the next best step?

Q1533. A 35-year-old man presents with chronic knee pain, swelling, and intermittent locking of the joint. There is no history of trauma. An X-ray of the knee joint shows multiple, well-defined loose bodies within the joint space. Synovial fluid aspiration reveals chondrocytes. What is the most likely diagnosis?