Mixed Deck — All MSRA Topics Flashcards

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. Of the following conditions, which one is most likely to be present in him?

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.

A 24-hour urine collection shows protein 5.8 g/day. Serum albumin is 22 g/L. Cholesterol is 8.2 mmol/L. What syndrome is present?

Answer: Nephrotic syndrome

The triad of heavy proteinuria (>3.5 g/day), hypoalbuminaemia, and hypercholesterolaemia defines nephrotic syndrome regardless of the underlying glomerulopathy.

Troponin I at 3 hours is 0.06 µg/L (reference <0.04) and at 6 hours is 0.22 µg/L. ECG shows no ST changes. How should this rise be interpreted?

Answer: Non-ST elevation myocardial infarction (NSTEMI) requiring ACS management

A rising troponin pattern (delta change >20% over 3–6 hours) with symptoms consistent with ACS confirms NSTEMI requiring antiplatelet therapy and cardiology input.

A neonate at 24 hours of life develops jaundice. Total bilirubin is markedly elevated. What is the most important cause to exclude first?

Answer: Haemolytic disease of the newborn

Jaundice in the first 24 hours is always pathological; haemolytic disease of the newborn due to Rh or ABO incompatibility must be excluded urgently to prevent kernicterus.

During a busy night shift, a colleague asks you to co-sign a drug chart for a medication you did not administer or check. What should you do?

Answer: Decline to sign and explain that co-signing implies you verified the medication was given correctly

Co-signing a drug chart implies verification of administration; signing for something you did not witness is dishonest and constitutes a serious documentation and patient safety breach.

Which of the following best defines the legal standard of capacity under the Mental Capacity Act 2005?

Answer: The ability to understand, retain, weigh, and communicate a decision

The MCA 2005 defines capacity as the ability to understand relevant information, retain it, weigh it in the decision, and communicate a decision — irrespective of the wisdom of the choice.

LFTs show: ALP 480 U/L, GGT 510 U/L, ALT 65 U/L, bilirubin 55 µmol/L, albumin 38 g/L. What pattern do these results suggest?

Answer: Cholestatic liver disease

Disproportionate elevation of ALP and GGT relative to aminotransferases, with raised bilirubin, is the hallmark of a cholestatic (obstructive) pattern of liver disease.

Which best describes the mechanism of action of furosemide?

Answer: Inhibits Na-K-2Cl cotransporter in the loop of Henle

Furosemide inhibits the NKCC2 (Na-K-2Cl) cotransporter in the thick ascending limb of the loop of Henle, producing powerful diuresis.

A study reports a relative risk reduction of 30% for a new drug compared to placebo. The control event rate is 6%. What is the absolute risk reduction?

Answer: 1.8%

Absolute risk reduction = relative risk reduction × control event rate = 0.30 × 6% = 1.8%; the NNT would be 1/0.018 ≈ 56 patients.

A 50-year-old male presents with central crushing chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST elevation in V1–V4. What is the immediate priority?

Answer: Primary PCI within 90–120 minutes

Anterior STEMI requires primary percutaneous coronary intervention (PCI) as the first-line reperfusion strategy, targeting a door-to-balloon time within 90–120 minutes.

Why is time management considered critical in the MSRA?

Answer: Both papers have a large number of questions within tight time constraints

Both the CPS and PD papers contain many questions to be completed in limited time, making pacing essential.

A GP receives a Subject Access Request (SAR) from a patient requesting their full medical records. Under GDPR/UK GDPR, what is the maximum response time?

Answer: 30 days (one month)

Under UK GDPR, organisations must respond to a Subject Access Request within one calendar month (approximately 30 days) of receiving the request.

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

Answer: IV fluid resuscitation, IV insulin infusion, and potassium replacement

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).

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?

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.

Which of the following is a contraindication to metformin use?

Answer: eGFR < 30 mL/min/1.73m²

Metformin is contraindicated in severe renal impairment (eGFR < 30) because impaired excretion leads to accumulation and risk of potentially fatal lactic acidosis.

You have been working for 14 consecutive hours due to short-staffing and feel your concentration is significantly impaired. What is the most appropriate action?

Answer: Inform the registrar or on-call consultant that you are no longer safe to work, document this, and hand over outstanding tasks

A doctor who is too fatigued to function safely must escalate this to a senior and formally hand over care — continuing to work unsafely puts patients at risk and is a professional duty breach.

A doctor discovers their colleague is performing procedures while impaired by alcohol. What is the appropriate first action under GMC duty of candour?

Answer: Report immediately to the Clinical Director or nominated responsible officer

GMC Good Medical Practice requires doctors to act promptly when patient safety is at risk from a colleague's health, conduct, or performance — escalation to the responsible officer is mandatory.

A colleague asks you to see their private patients during NHS working hours for a small financial arrangement. What should you do?

Answer: Decline, as seeing private patients during NHS time is a conflict of interest and breach of employment contract

Using NHS time to provide private clinical care constitutes a breach of employment contract, a conflict of interest, and a failure of professional duties to NHS patients.

How is the MSRA structured and what does it assess?

Answer: Two papers: Clinical Problem Solving (1hr 15min) and Professional Dilemmas (1hr 30min), both computer-based

The MSRA consists of two papers: Clinical Problem Solving (CPS) with extended matching and single best answer questions, and Professional Dilemmas (PD) with situational judgment test questions ranking responses.

A 70-year-old man on warfarin presents with an INR of 8.5 and minor bleeding from the gums. He is otherwise hemodynamically stable. What is the most appropriate management?

Answer: Hold warfarin and give oral vitamin K 1–2 mg

For minor bleeding with a markedly elevated INR, withholding warfarin and administering low-dose oral vitamin K is sufficient to bring the INR into a safe range.