Basic MSRA Practice 1 — Questions and Answers
Question 1: A 40 year-old woman exhibits symptoms of heat intolerance, weight loss, sweating, and loose stools. Upon examination, three thyroid nodules were found, and the following measurements were made: T = 36.8, HR = 92, and BP = 129/83. Provide the most plausible diagnosis.
- Thyroid storm
- Graves’ Disease
- Multinodular Goitre (Correct answer)
- Sick Euthyroid
Correct answer: Multinodular Goitre
The patient presents with classic symptoms of hyperthyroidism, including heat intolerance, weight loss, sweating, and an elevated heart rate. The key finding is the presence of three thyroid nodules. While Graves' disease also causes hyperthyroidism, the specific finding of multiple nodules strongly suggests a toxic multinodular goitre, where autonomous nodules produce excess thyroid hormone, leading to the hyperthyroid state.
Question 2: A 50-year-old man with chest pain experienced flu-like symptoms for three days after finishing a half-marathon a week prior. He is currently speaking in complete sentences and has a 110 pulse. From the list of diagnoses below, select the most likely one.
- Pleural Effusion
- Costochondritis
- Costochondritis
- Myocarditis (Correct answer)
Correct answer: Myocarditis
Myocarditis is an inflammation of the heart muscle, often triggered by a viral infection, which aligns with the patient's recent flu-like symptoms. Strenuous physical activity, such as a half-marathon, can exacerbate or unmask myocarditis. The combination of chest pain, recent viral illness, and an elevated pulse (tachycardia) makes myocarditis the most plausible diagnosis in this context.
Question 3: Which class of medications is used to treat female urge incontinence?
- Tricyclic Antidepressants
- SNRI
- Antimuscarinics (Correct answer)
- Alpha blocker
Correct answer: Antimuscarinics
Urge incontinence is characterized by involuntary contractions of the bladder muscle (detrusor), leading to a sudden and strong need to urinate. Antimuscarinic medications work by blocking muscarinic receptors in the bladder, which helps to relax the detrusor muscle and reduce these involuntary contractions. This mechanism directly addresses the underlying physiological cause of urge incontinence, making them a primary treatment option.
Question 4: Which class of medications is used to treat male patients primarily for voiding symptoms in the first line of care?
- Alpha Blocker (Correct answer)
- Antimuscarinics
- 5-alpha reductase inhibitor
- SNRI
Correct answer: Alpha Blocker
Voiding symptoms in male patients, often associated with benign prostatic hyperplasia (BPH), are caused by the enlargement of the prostate gland obstructing the urethra. Alpha-blockers work by relaxing the smooth muscles in the prostate and bladder neck, which reduces the resistance to urine flow. This action improves urinary symptoms like hesitancy, weak stream, and incomplete emptying, making them a first-line treatment.
Question 5: A 75-year-old man who has been diagnosed with AF appears with bilateral fine crepitations and a cough. He has not raised his JVP. HR: 72 Regular, Temperature: 36.8 C, Oxygen Saturations: 95%, and Respiratory Rate: 18. Which diagnosis seems most likely?
- Consolidation
- Aspergilloma
- Pulmonary Fibrosis (Correct answer)
- Pulmonary Oedema
Correct answer: Pulmonary Fibrosis
The patient's presentation of bilateral fine crepitations and a cough in an elderly man with a history of AF, but without a raised JVP or signs of acute heart failure (normal HR, O2 sats, RR), is highly suggestive of pulmonary fibrosis. Pulmonary fibrosis is a chronic interstitial lung disease characterized by progressive scarring of the lungs, typically presenting with persistent cough and characteristic 'Velcro' crackles on auscultation. Pulmonary oedema would typically involve a raised JVP and more acute respiratory distress.
Question 6: In the case of an 80-year-old delirious inpatient who has removed his third cannula today, which medicine would be the most appropriate?
- Oral Quatiepine
- Rectal Diazepam
- Oral Haloperidol (Correct answer)
- IM Chlorpromazine
Correct answer: Oral Haloperidol
Haloperidol is a first-generation antipsychotic commonly used for the acute management of severe agitation and psychotic symptoms in delirium, especially when non-pharmacological interventions have been unsuccessful. In an elderly, delirious inpatient who is actively interfering with medical care (removing cannulas), oral haloperidol is an appropriate choice to help manage agitation and reduce the risk of further self-harm or disruption. It is generally preferred over benzodiazepines for delirium due to a lower risk of paradoxical agitation or respiratory depression.
Question 7: An 80-year-old overweight man complains of leg cramps that get worse when he exercises. He smokes fifteen cigarettes a day and consumes thirty units of alcohol daily. Which of the following suggestions would be the best place to start?
- Increase Exercise
- Reduce Alcohol Intake
- Stop Smoking (Correct answer)
- Lose Weight
Correct answer: Stop Smoking
The patient's leg cramps worsening with exercise (intermittent claudication) are highly indicative of peripheral arterial disease (PAD). Smoking is the single most significant modifiable risk factor for the development and progression of PAD, as it directly contributes to atherosclerosis. While other lifestyle changes like reducing alcohol intake, losing weight, and increasing exercise are beneficial, stopping smoking offers the most immediate and impactful benefit in slowing disease progression and improving symptoms.
Basic MSRA Practice 1
A 40 year-old woman exhibits symptoms of heat intolerance, weight loss, sweating, and loose stools.
Upon examination, three thyroid nodules were found, and the following measurements were made: T = 36.8, HR = 92, and BP = 129/83.
Provide the most plausible diagnosis.