Essential MSRA MCQ 1 — Questions and Answers
Question 1: The 54-year-old Ramesh is requesting a PSA test at your next appointment because he is concerned after learning that a colleague has been diagnosed with prostate cancer. After discussing the fact that a PSA test is not diagnostic, you schedule one. <br> Of the following, which one wouldn't have an impact on a PSA reading?
- Had a biopsy on the prostate six weeks prior.
- An active urinary infection
- Ejaculation 72 hours ago (Correct answer)
- Vigorously worked out the previous 48 hours
Correct answer: Ejaculation 72 hours ago
PSA levels can be temporarily elevated by various factors that irritate or inflame the prostate, including recent prostate biopsy, active urinary tract infections, and vigorous exercise. While ejaculation can also cause a transient rise in PSA, this effect is typically short-lived and usually resolves within 24-48 hours. Therefore, ejaculation 72 hours prior would generally not have a significant impact on a PSA reading, unlike the other options which can cause more prolonged or significant elevations.
Question 2: Jenny arrives to discuss her baby's potential for hip developmental dysplasia—she is twelve weeks along and her friend's child just underwent surgery for the condition. <br> Which of the following is not a risk factor for a person's developmentally dysplastic hip dysplasia (DDH)?
- Female sex
- Polyhydramnios (Correct answer)
- First born
- Breech presentation
Correct answer: Polyhydramnios
Developmental Dysplasia of the Hip (DDH) has several known risk factors, including female sex, first-born status, and breech presentation, all of which can influence fetal positioning and hip development. Polyhydramnios, which is an excessive amount of amniotic fluid, typically provides more space for fetal movement, making it less likely to restrict hip development. In contrast, oligohydramnios (too little amniotic fluid) would be a risk factor due to restricted movement.
Question 3: Seven-year-old Tom started going to school with his mother when he noticed a lump on his right leg. Tom is typically in good health, and neither of them can recall any past trauma. With the exception of slight exhaustion, he denies experiencing any pain or changed sensations. <br> Upon examination, there is no skin alterations overlying the bony swelling at the distal end of his right femur. Firm and anchored to the underlying structures is the swelling. There isn't any discernible localized lymphadenopathy. <br> What would be the best course of action to take next?
- Urgent X-Ray within 7 days
- Urgent orthopaedic review
- Same day paediatric review
- Extremely urgent 48-hour direct access X-ray (Correct answer)
Correct answer: Extremely urgent 48-hour direct access X-ray
A new, firm, bony swelling in a child, especially without a clear history of trauma and with associated mild systemic symptoms like exhaustion, raises significant concern for a possible bone tumour, such as osteosarcoma. Current guidelines recommend extremely urgent imaging, specifically an X-ray within 48 hours, for unexplained bone pain or swelling in children. This prompt action is crucial for early diagnosis and management of potential malignancies.
Question 4: Jane, a sixteen-year-old competitive cyclist and gymnast, trains multiple times a week. Her mother, who is worried about her right knee, accompanies her to the GP office. For the past six months, they have experienced intermittent pain, but despite the mild discomfort, they are worried about how long the symptoms will last. Subsequent investigation revealed that there is no knee swelling or other affected joints, but that kneeling and jumping exacerbate the pain. Jane is in good health overall and has no additional medical history. <br> Examining the area revealed tibial tuberosity tenderness, which grew worse when the knee was extended against resistance. She has a normal gait, no swelling in her knee joints, and complete range of motion in both knees.
- Osgood-Schlatter disease (Correct answer)
- Osteochondritis dissecans
- Patellofemoral pain syndrome
- Pseudogout
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is a common cause of knee pain in active adolescents, particularly those involved in sports like cycling and gymnastics that involve repetitive quadriceps contractions. The classic presentation includes pain and tenderness at the tibial tuberosity (just below the kneecap), which is exacerbated by activities such as kneeling, jumping, and resisted knee extension. It is an overuse injury involving inflammation of the patellar tendon insertion.
Question 5: Terry, 52, was recently diagnosed with hypertension, but despite taking his medication as directed, his condition is regrettably still out of control. Upon closer inspection, his potassium level is consistently low, and his sodium level is on the verge of being high. He is otherwise fine; neither his weight nor appearance have changed. <br> Of the following conditions, which one is most likely to be present in him?
- Essential hypertension
- Cushing’s disease
- Phaechromocytoma
- Conn’s syndrome (Correct answer)
Correct answer: Conn’s syndrome
Conn's syndrome, or primary hyperaldosteronism, is characterized by resistant hypertension, consistently low potassium (hypokalemia), and often mild elevation of sodium (hypernatremia). The excess aldosterone production leads to increased sodium reabsorption and potassium excretion in the kidneys, causing these specific electrolyte imbalances and contributing to difficult-to-control high blood pressure. This clinical picture makes Conn's syndrome the most likely diagnosis for secondary hypertension.
Question 6: The 34-year-old female secretary reports having bloated for seven months, changed bowel habits, and abdominal pain that worsens with food and goes away with feces. What would be the best course of action to take next?
- FODMAP Dietary Advice
- Flexible Sigmoidoscopy
- FBC, ESR, CRP and Coeliac Screen (Correct answer)
- No further investigation necessary
Correct answer: FBC, ESR, CRP and Coeliac Screen
While the patient's symptoms (bloating, changed bowel habits, abdominal pain relieved by defecation) are suggestive of Irritable Bowel Syndrome (IBS), it is crucial to rule out other potentially serious gastrointestinal conditions, especially given the duration of symptoms (seven months) and the patient's age. Blood tests such as a Full Blood Count (FBC), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and a Coeliac Screen are essential to exclude inflammatory bowel disease, anaemia, infection, or coeliac disease before a definitive diagnosis of IBS can be made. This constitutes a standard 'red flag' screening for new-onset bowel symptoms.
Question 7: A 6-week period of nasal discharge, eye itching, and sneezing is exhibited by an 8-year-old boy who has a family history of atopy in July. With the diagnosis confirmed, which of the following would be the best course of action?
- Patch test
- No further investigation required (Correct answer)
- ELISA test
- Skin prick test
Correct answer: No further investigation required
The boy's symptoms of nasal discharge, eye itching, and sneezing, occurring seasonally (in July for six weeks) with a family history of atopy, are highly characteristic of seasonal allergic rhinitis, commonly known as hay fever. Given this clear clinical picture and a confirmed diagnosis based on history, further diagnostic tests like patch tests, ELISA, or skin prick tests are generally not required. The focus should be on symptom management and avoidance strategies.
Essential MSRA MCQ 1
The 54-year-old Ramesh is requesting a PSA test at your next appointment because he is concerned after learning that a colleague has been diagnosed with prostate cancer.
After discussing the fact that a PSA test is not diagnostic, you schedule one.
Of the following, which one wouldn't have an impact on a PSA reading?