A 50-year-old patient with a history of chronic alcohol use presents with jaundice, ascites, and confusion. Blood tests reveal elevated serum bilirubin and an increased prothrombin time. Which of the following is the most likely diagnosis?

A patient with chronic hypertension presents with a new-onset murmur best heard at the left upper sternal border. Echocardiography reveals left ventricular hypertrophy with a thickened, calcified aortic valve. What is the most likely underlying cause of the patient’s murmur?

A patient with type 2 diabetes presents with increased thirst, frequent urination, and fatigue. His blood glucose is 350 mg/dL, and his sodium is 133 mmol/L. The patient's pH is 7.33, bicarbonate is 18 mmol/L, and anion gap is 22. What is the most likely diagnosis?

A 35-year-old woman presents with a butterfly-shaped rash, photosensitivity, and joint pain. Lab results reveal positive antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. Which of the following is the most specific finding for the diagnosis of systemic lupus erythematosus (SLE)?

A patient presents with severe abdominal pain, vomiting, and a history of recent surgery for small bowel obstruction. On physical examination, the abdomen is distended, and there is absent bowel sound. Abdominal X-ray shows dilated loops of small bowel. What is the most likely diagnosis?

A 65-year-old male with a history of smoking and hypertension presents with sudden onset of severe chest pain radiating to the back. His blood pressure is 180/110 mmHg. CT angiography shows a dissection of the aorta. Which of the following is the most likely cause of the aortic dissection in this patient?

A patient with a long history of alcohol abuse develops confusion, ataxia, and nystagmus. MRI of the brain reveals lesions in the mamillary bodies. What is the most likely diagnosis?

A patient with a known history of rheumatoid arthritis presents with progressive shortness of breath and dry cough. Chest X-ray reveals bilateral interstitial infiltrates. What is the most likely cause of the patient’s pulmonary symptoms?

A 25-year-old male with a history of chronic back pain and morning stiffness that improves with activity is found to have bilateral sacroiliitis on X-ray. Which of the following is the most likely diagnosis?

A patient presents with weight loss, night sweats, and fatigue. Physical examination reveals painless cervical lymphadenopathy. Biopsy of the lymph node shows Reed-Sternberg cells. What is the most likely diagnosis?

Which of the following changes in the ECG is most characteristic of hyperkalemia?

A 40-year-old woman presents with a history of fatigue, cold intolerance, constipation, and dry skin. Laboratory tests reveal a low free T4 and elevated TSH. What is the most likely diagnosis?

A 45-year-old male presents with left-sided chest pain that radiates to his left arm. He has a history of hypertension and smoking. His ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is the most likely diagnosis?

A 60-year-old male with chronic obstructive pulmonary disease (COPD) presents with a productive cough and shortness of breath. Chest X-ray reveals hyperinflation and a flattened diaphragm. What is the most likely cause of these findings?

A 70-year-old male with a history of prostate cancer presents with new onset back pain. An MRI of the spine shows vertebral collapse and a "sunburst" pattern of bone destruction. What is the most likely cause of this finding?

A 60-year-old patient presents with difficulty swallowing, regurgitation of food, and weight loss. Barium swallow reveals a "bird's beak" appearance. Which of the following is the most likely diagnosis?

A 55-year-old male with a history of chronic smoking presents with a productive cough and hemoptysis. Chest X-ray shows a mass in the upper lobe of the right lung. Which of the following is the most likely diagnosis?

A 40-year-old woman presents with a painless mass in her neck and a history of weight loss. Ultrasound of the thyroid shows a hypoechoic lesion with microcalcifications. Fine needle aspiration reveals irregular cell borders and crowding of cells. What is the most likely diagnosis?

A 45-year-old female presents with progressive fatigue, muscle weakness, and ptosis. On examination, she has a positive Tensilon test. Which of the following is the most likely diagnosis?

A 70-year-old male with a history of atrial fibrillation presents with a sudden onset of severe leg pain and pallor. Doppler ultrasound reveals a lack of blood flow to the right femoral artery. What is the most likely cause of this patient's symptoms?

A 50-year-old male presents with dysuria, frequency, and lower abdominal pain. Urinalysis shows positive leukocyte esterase, nitrites, and white blood cells. Which of the following is the most likely diagnosis?

A 60-year-old woman presents with generalized fatigue, weight gain, and cold intolerance. Her TSH is elevated, and free T4 is low. What is the most likely diagnosis?

A 60-year-old patient with a history of hypertension and smoking presents with sudden-onset chest pain and diaphoresis. ECG shows ST-segment elevation in leads V1-V4. Which of the following coronary arteries is most likely occluded?

A 72-year-old female with a history of chronic constipation presents with nausea, vomiting, and distended abdomen. Abdominal X-ray reveals a "step ladder" appearance of dilated loops of small bowel. What is the most likely diagnosis?

A 55-year-old diabetic patient presents with recurrent episodes of hypoglycemia. His insulin levels are elevated despite fasting, and a pancreatic mass is detected on imaging. What is the most likely diagnosis?

A 40-year-old patient with no significant medical history presents with hematuria, hypertension, and a family history of kidney disease. His renal ultrasound shows multiple cysts in both kidneys. What is the most likely diagnosis?

A 60-year-old male presents with fatigue, pale conjunctiva, and splenomegaly. Blood work reveals a low hemoglobin, low reticulocyte count, and a peripheral blood smear showing hypochromic microcytic red cells. What is the most likely diagnosis?

A 50-year-old female with a history of obesity presents with irregular periods, hirsutism, and acne. Blood work reveals elevated testosterone levels. What is the most likely diagnosis?

A 40-year-old male presents with chest pain, palpitations, and dizziness. ECG reveals a narrow QRS complex tachycardia with a rate of 160 bpm and a regular rhythm. What is the most likely diagnosis?

A 35-year-old female with a history of systemic lupus erythematosus (SLE) presents with fatigue, weight gain, and cold intolerance. Her TSH is elevated, and free T4 is low. Which of the following is the most likely cause of her hypothyroidism?

A 45-year-old male presents with weight loss, fatigue, and jaundice. His liver function tests show markedly elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT), with a normal bilirubin level. An abdominal ultrasound reveals dilated intrahepatic bile ducts. What is the most likely diagnosis?

A 24-year-old female presents with sudden onset of severe headache, nausea, and vomiting. She reports the worst headache of her life. A non-contrast CT scan of the brain reveals a hyperdense lesion in the subarachnoid space. What is the most likely diagnosis?

A 55-year-old male with a history of smoking presents with hemoptysis, weight loss, and night sweats. Chest X-ray reveals a large central mass. CT scan shows mediastinal lymphadenopathy. What is the most likely diagnosis?

A 34-year-old woman presents with polyuria, polydipsia, and fatigue. Blood tests reveal a random blood glucose of 300 mg/dL, and her HbA1c is 9%. Which of the following is the most appropriate next step in management?

A 45-year-old male with a history of diabetes presents with progressive difficulty swallowing, hoarseness, and a cough when drinking. Barium swallow shows a dilated esophagus with food stasis. What is the most likely cause of this patient's symptoms?

. A 32-year-old male presents with a nonproductive cough, fever, and night sweats. His PPD test is positive, and a chest X-ray shows a cavitary lesion in the upper lobe of the right lung. What is the most likely diagnosis?

A 28-year-old woman with a history of lupus presents with joint pain, pleuritic chest pain, and a butterfly-shaped rash. Her urine analysis shows proteinuria and hematuria. Which of the following is the most likely diagnosis?

A 52-year-old male presents with fatigue, easy bruising, and palpitations. On examination, there is splenomegaly, and blood tests reveal an elevated white blood cell count with a left shift. What is the most likely diagnosis?

A 35-year-old male presents with progressive shortness of breath, a dry cough, and a history of recent travel to the Middle East. Chest X-ray shows bilateral alveolar infiltrates. What is the most likely diagnosis?

A 62-year-old male with a history of hypertension presents with sudden-onset headache, nausea, and vomiting. His blood pressure is 200/110 mmHg. Fundoscopy reveals bilateral retinal hemorrhages and papilledema. What is the most likely diagnosis?

A 30-year-old male presents with a nonproductive cough, fever, and dyspnea. Chest X-ray reveals bilateral infiltrates. His HIV test is positive, and his CD4 count is 50 cells/µL. What is the most likely diagnosis?

A 47-year-old female with a history of hypertension presents with severe epigastric pain radiating to the back. Serum lipase is markedly elevated. CT scan of the abdomen shows inflammation of the pancreas. What is the most likely diagnosis?

A 68-year-old male with a history of chronic alcoholism presents with confusion, tremors, and asterixis. His liver function tests are elevated, and his ammonia level is elevated. What is the most likely diagnosis?

A 34-year-old woman presents with fatigue, palpitations, and weight loss. Her TSH is suppressed, and her free T4 is elevated. What is the most likely diagnosis?

A 58-year-old male with a history of smoking presents with a persistent cough, hemoptysis, and chest pain. His chest X-ray shows a central mass with associated lymphadenopathy. What is the most likely diagnosis?

A 72-year-old female presents with acute onset of severe right lower quadrant abdominal pain, nausea, and vomiting. On examination, she has fever, and her WBC count is 15,000/µL. A CT scan of the abdomen reveals a thickened appendix with surrounding fat stranding. What is the most likely diagnosis?

A 58-year-old male with a history of alcohol use disorder presents with tremors, altered mental status, and fever. His vital signs show a temperature of 38.4°C (101.1°F) and heart rate of 110 bpm. He is disoriented and exhibits agitation. What is the most likely diagnosis?

A 45-year-old female presents with a persistent headache, visual disturbances, and a palpable mass in her neck. She also has a history of excessive thirst and frequent urination. Laboratory tests reveal a high serum calcium level and low serum phosphate level. What is the most likely diagnosis?

A 64-year-old male presents with progressive difficulty swallowing, regurgitation of undigested food, and weight loss. He has a history of GERD. Esophageal manometry shows a lack of peristalsis in the lower esophagus and incomplete relaxation of the lower esophageal sphincter. What is the most likely diagnosis?

A 24-year-old male presents with a painful, swollen knee following a traumatic injury. On examination, there is significant joint effusion, and a rapid aspiration reveals a cloudy synovial fluid with a white blood cell count of 25,000/µL. What is the most likely cause of his joint effusion?