20 qs

A 28-year-old female presents with pain and swelling in her right big toe. On examination, the joint is red, warm, and tender to touch. She mentions that she had a similar episode in the same joint a few months ago. Laboratory findings show an elevated serum uric acid level. What is the most likely diagnosis?

A 32-year-old male presents with fever, headache, and photophobia. On neurological examination, he has nuchal rigidity and positive Brudzinski’s sign. Lumbar puncture shows an elevated opening pressure and an increased white blood cell count with predominantly neutrophils. The Gram stain of the cerebrospinal fluid (CSF) is negative. What is the most likely diagnosis?

A 50-year-old male with a history of hypertension presents with sudden-onset severe headache, vomiting, and altered mental status. On neurological examination, he has a decreased level of consciousness and right-sided hemiparesis. Non-contrast CT scan of the head shows a hyperdense area in the left basal ganglia. What is the most likely diagnosis?

A 35-year-old female presents with a several-week history of progressive fatigue, low-grade fever, and night sweats. Physical examination reveals splenomegaly, and laboratory findings show anemia and thrombocytopenia. Peripheral blood smear shows atypical lymphocytes with “smudge cells.” Flow cytometry shows the expression of CD5, CD20, CD23, and low levels of surface immunoglobulin (sIg). What is the most likely diagnosis?

A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, cough, and increased sputum production. On examination, he has decreased breath sounds, scattered wheezes, and crackles on auscultation. Chest X-ray shows hyperinflation and flattened diaphragms. Arterial blood gas analysis reveals a low partial pressure of oxygen (PaO2) and an increased partial pressure of carbon dioxide (PaCO2). What is the most appropriate initial management for this patient?