MSRA Clinical Reasoning Flashcards

A 30-year-old woman presents with butterfly rash, joint pain, fatigue, and a positive ANA. Complement levels are low. What is the most likely diagnosis?

Answer: Systemic lupus erythematosus

The malar butterfly rash, polyarthritis, positive ANA, and low complement (consumed by immune complex deposition) are classic features of SLE.

A 55-year-old man presents with progressive exertional dyspnea and a slow-rising carotid pulse. On auscultation there is an ejection systolic murmur at the right second intercostal space radiating to the carotids. What is the diagnosis?

Answer: Aortic stenosis

An ejection systolic murmur at the right upper sternal border radiating to the carotids with a slow-rising pulse and exertional symptoms is the classic presentation of aortic stenosis.

A 65-year-old woman presents with macrocytic anaemia, peripheral neuropathy, and a sore tongue. She had a total gastrectomy 5 years ago. What is the most likely cause?

Answer: Vitamin B12 deficiency

Total gastrectomy removes the source of intrinsic factor, leading to vitamin B12 malabsorption and resulting in megaloblastic anaemia with subacute combined degeneration of the cord.

A 40-year-old male with a history of alcohol excess presents with epigastric pain radiating to the back, vomiting, and elevated serum amylase. What is the first-line management?

Answer: IV fluids, analgesia, and nil by mouth

Acute pancreatitis is managed initially with aggressive IV fluid resuscitation, adequate analgesia, and nutritional support — surgery is reserved for complications.

A 19-year-old female presents with recurrent episodes of palpitations, sweating, and anxiety relieved by eating. Fasting glucose is 2.1 mmol/L with elevated insulin levels. What is the diagnosis?

Answer: Insulinoma

Whipple's triad (symptoms of hypoglycaemia, low blood glucose, and relief with glucose) with elevated fasting insulin strongly suggests an insulin-secreting insulinoma.

A 78-year-old man presents with acute urinary retention, a palpable bladder, and a PSA of 18 ng/mL. DRE reveals a hard irregular prostate. What is the immediate management?

Answer: Urethral catheterisation to relieve retention

Acute urinary retention requires immediate urethral catheterisation to relieve bladder distension; further investigation of the underlying prostate pathology follows after stabilisation.