*Gandreti Srinivas
*Postgraduate Resident, Department of Medicine, Lady Hardinge Medical College, New Delhi
- A 58-year-old male presents with complaints of progressive weakness of his hands and legs over the past few months. He reports difficulty gripping objects and ascending stairs. On examination, he has weakness of finger flexion. His knee extension in medical research council (MRC) 4/5 whereas knee flexion is within normal limits. His CK is 920 IU/L. Which of the following is the most likely diagnosis in this patient?
A) Polymyositis
B) Nonaka myopathy
C) Inclusion Body myositis
D) dermatomyositis
- A 40-year-old male got stuck in the heavy rain in a slum area in Mumbai. He developed on and off fever for which he took acetaminophen. After two weeks, he presented with jaundice, fever and purple-blue spots on his skin. He developed hematuria and neck stiffness soon after that. The microscopic agglutination test is positive.
Vitals and lab reports:
BP: 118/70 mm of Hg
HR: 52 bpm
Temp: 1010F
Hb: 9gm/dl
TLC: 1500
BUN: elevated
A) Meningococcemia
B) Typhoid
C) Leptospirosis
D) Cerebral malaria
- A woman presents with recurrent episodes of blurry vision, tingling and numbness in the legs, and falls. She says that during hot weather, she finds it difficult to walk and often falls.
Recently she had flu, due to which symptoms aggravated. MRI brain was done which showed Dawson’s fingers. CSF studies report with presence of the oligoclonal bands. What is the criteria used for the clinical diagnosis of her condition?
A) Kurtzke expanded disability status scale
B) Revised McDonald criteria
C) Functional status score
D) Hess and Hunts scale
- A 19 year old male presents to the hospital emergency with episodes of sudden weakness on the right side of the body and difficulty speaking. His parents reports that these episodes last for a few minutes and resolve spontaneously. His medical history is unremarkable, but the family has a history of stroke. Neurological examination reveals mild right-sided weakness. His speech and language functions appear to be intact. Based on the provided information, what is the most likely diagnosis?
A) Transient Ischemic Attack (TIA)
B) Migraine with Aura
C) Moyamoya Disease
D) Hemiplegic Migraine
5 .A 35-year-old patient with a history of epilepsy has been recently started on a new antiepileptic medication, lamotrigine. Three weeks after starting the medication, the patient develops fever, rash, and swollen lymph nodes. Blood tests reveal elevated eosinophil count and liver enzymes. The patient denies any other recent changes in medications or exposure to new substances.
What is the most likely diagnosis for this patient’s condition?
A) Allergic contact dermatitis
B) Stevens-Johnson Syndrome
C) Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome
D) Serum sickness
- A 54-year-old male presents to the emergency department with complaints of facial and upper body swelling, difficulty breathing, and dilated veins on the chest and neck. He reports a history of lung cancer and has been undergoing chemotherapy for the past few months. Physical examination reveals distended neck veins, prominent collateral veins on the chest, and edema of the face and upper extremities. A contrast-enhanced CT scan of the chest is performed, revealing a mediastinal mass compressing the superior vena cava.
What is the most likely diagnosis in this case?
A) Aortic Aneurysm
B) Pulmonary Embolism
C)Superior Vena Cava Syndrome
D) Pericardial Effusion
- A 30-year-old individual from a rural area presents to the clinic with a sudden onset of fever, headache, muscle aches, and a rash. The rash started as a small red spot at the site of a tick bite on their abdomen and has since spread to other parts of the body. The patient reports spending a lot of time in outdoor activities, including farming and hiking. On physical examination, the patient appears febrile, and there are multiple rashes at the tick bite sites. Laboratory tests show elevated liver enzymes and thrombocytopenia.
What is the most likely diagnosis in this case?
A) Lyme Disease
B) Dengue Fever
C) Typhoid Fever
D) Scrub Typhus
- A 40-year-old shepherd presents to the clinic with a history of fever, fatigue, joint pain, and sweats for the past few weeks. He reports having close contact with his flock of sheep and drinking unpasteurized milk. On physical examination, the patient appears pale, has a low-grade fever, and has tenderness in multiple joints. Laboratory tests reveal mild anemia, elevated liver enzymes, and a positive blood culture for Gram-negative cocci.
What is the most likely diagnosis in this case?
A) Tuberculosis
B) Lyme Disease
C) Typhoid Fever
D) Malta Fever
- A 38-year-old patient with a history of untreated tuberculosis presents to the rheumatology clinic with complaints of symmetric polyarthritis involving the large joints. The patient denies any respiratory symptoms or cough. Physical examination reveals swollen and tender joints, with no evidence of joint deformities. Laboratory tests show an elevated erythrocyte sedimentation rate (ESR) and a negative rheumatoid factor. Imaging studies demonstrate no erosive changes in the affected joints.
What is the most likely diagnosis in this case?
A) Rheumatoid Arthritis
B) Ankylosing Spondylitis
C) Psoriatic Arthritis
D) Poncet’s Disease
- A 50-year-old individual presents with painless swelling in the lacrimal glands and salivary glands. They also have a history of autoimmune pancreatitis. Laboratory tests reveal elevated serum IgG4 levels. Imaging studies show enlargement of affected glands, with characteristic diffuse glandular and retroperitoneal fibrosis. Biopsy of a salivary gland demonstrates dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis.
What is the most likely diagnosis in this case?
A) Sjögren’s Syndrome
B) Rheumatoid Arthritis
C) IgG4-Related Disease
D) Systemic Lupus Erythematosus
ANSWERS
1C, 2C, 3B, 4C, 5C, 6C, 7D, 8D, 9D, 10C