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

ST elevation in leads II, III, and aVF indicates an inferior STEMI, typically caused by right coronary artery occlusion, requiring urgent reperfusion therapy.

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

DKA management priorities are fluid resuscitation (0.9% saline), IV insulin infusion, potassium monitoring and replacement, and identifying the precipitating cause. Bicarbonate is reserved for severe acidosis (pH <6.9).

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

Thunderclap headache requires urgent CT head to rule out subarachnoid hemorrhage. If CT is negative but clinical suspicion remains, lumbar puncture should be performed to look for xanthochromia.

Question 4

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

Accepted Answer

NIH Stroke Scale (NIHSS)

Answer

The NIHSS quantifies stroke severity by assessing consciousness, gaze, visual fields, facial palsy, motor function, ataxia, sensory function, language, dysarthria, and extinction/inattention.

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

For INR >5.0 with minor bleeding, warfarin should be stopped and oral vitamin K (1-5mg) administered. IV vitamin K and FFP are reserved for major or life-threatening bleeding.

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA Clinical Problem Solving