Correct Answer: Alpha Blocker
Most candidates should feel comfortable and confident in their ability to respond to this relatively simple question.
Correct Answer: Stop Smoking
The patient is exhibiting sporadic claudication. While many of the options are helpful, quitting smoking is the most crucial first step in managing your health.
Correct Answer: Pulmonary Fibrosis
The question's seemingly contradictory details can point to several different diagnoses, but the important detail is that the crackles in the 'fine' range correspond to a typical JVP. The goal of the AF is to lead physicians astray. Thus, pulmonary fibrosis is the most likely diagnosis.
Correct Answer: Oral Haloperidol
Because delirium is caused by multiple factors, this is a difficult question with no obvious right answer. PO Haloperidol is the only and most suitable drug among those offered, coming from the approved NICE CKS list of medications for short-term use in delirium (Haloperidol, Lorazepam, Levomepromazine). PO Haloperidol continues to be the most acceptable option among those offered, even though treating the underlying cause of delirium is the most appropriate management approach and is not listed as an option.
Correct Answer: Multinodular Goitre
Compared to Graves' Disease, which typically manifests as a smooth goitre, multinodular goitre is the more likely diagnosis due to the multiple nodules and thyrotoxic symptoms. The symptoms and observations at this time do not point to a thyroid storm, although this could worsen into one if treatment is delayed.
Correct Answer: Myocarditis
This case illustrates the difficulty with the MSRA. Many of these possibilities are realistic, and in order to rule out some of the causes, more testing (such as ECG, Troponin, and CXR) would be necessary. However, myocarditis is the most likely diagnosis given the three-day history and recent flu-like symptoms.
Correct Answer: Antimuscarinics
If symptoms don't go away after bladder training, antimuscarinic drugs like tolterodine and oxybutynin can be used.
