<prompt> A 30-year-old female presents with a 3-month history of 10kg weight loss despite an increased appetite. She also complains of anxiety, diarrhea and amenorrhea. Examination reveals a fine tremor, brisk reflexes and a systolic murmur heard throughout the precordium. A urine pregnancy screen was negative. What is the most likely finding on examining the pulse?Pulsus paradoxusCollapsing pulseIrregularly irregular pulsePulsus alternans  <response>: Female, weight loss in spite of appetite, amenorrhea, tremors, brisk reflexes are features of Thyrotoxicosis Option A- Pulses Paradoxus is feature of C. Tamponade it is ruled out Option B- Collapsing pulse- Rapidly rising pulse, which collapses suddenly as aerial pressure falls rapidly, during late systole and diastole Corrigans pulse. -Feature of aoic regurgitation AR have Diastolic murmur. Option C- Thyrotoxicosis can be Associated with A. fibrillation. So, irregularly irregular pulse can be presentation of Thyrotoxicosis. Option D- Pulsus Alternans is feature of LVF. 