MSRA Clinical Problem Solving

Question 1

A 65-year-old patient presents with acute chest pain, sweating, and shortness of breath. The ECG shows ST elevation in leads II, III, and aVF. What is the most likely diagnosis?

Accepted Answer

Inferior ST-elevation myocardial infarction

Answer

Pulmonary embolism

Answer

Pericarditis

Answer

Aortic dissection

Question 2

What is the most appropriate initial management of a patient presenting with diabetic ketoacidosis?

Accepted Answer

IV fluid resuscitation, IV insulin infusion, and potassium replacement

Answer

Oral hypoglycemic agents

Answer

Subcutaneous insulin only

Answer

Bicarbonate infusion as first-line treatment

Question 3

A 30-year-old woman presents with sudden-onset severe headache described as the worst headache of her life. What investigation should be performed urgently?

Accepted Answer

CT head without contrast, followed by lumbar puncture if CT is negative

Answer

MRI brain with contrast

Answer

Skull X-ray

Answer

Blood tests only

Question 4

What scoring system is used to assess stroke severity in MSRA clinical scenarios?

Accepted Answer

NIH Stroke Scale (NIHSS)

Answer

Glasgow Coma Scale

Answer

ABCD2 score

Answer

CHA2DS2-VASc score

Question 5

A patient on warfarin presents with an INR of 8.0 and minor bleeding. What is the most appropriate management?

Accepted Answer

Stop warfarin and give oral vitamin K

Answer

Continue warfarin at a reduced dose

Answer

Give IV vitamin K and fresh frozen plasma immediately

Answer

Administer protamine sulfate

Question 6

What is the Wells score used to assess?

Accepted Answer

Clinical probability of pulmonary embolism or deep vein thrombosis

Answer

Severity of heart failure

Answer

Risk of stroke in atrial fibrillation

Answer

Likelihood of appendicitis