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MSRA Clinical Reasoning Flashcards

6 cards from real MSRA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 6 MSRA Clinical Reasoning flashcards as text

  1. A 45-year-old woman presents with sudden-onset severe headache described as 'the worst headache of her life.' What is the most important diagnosis to exclude?

    Answer: Subarachnoid hemorrhage

    A sudden severe 'thunderclap' headache is the classic presentation of subarachnoid hemorrhage and must be excluded urgently with CT head and, if negative, lumbar puncture.

  2. A 62-year-old man with type 2 diabetes presents with a painless foot ulcer over the metatarsal head. Pulses are present. What is the most likely underlying mechanism?

    Answer: Peripheral neuropathy

    Painless neuropathic ulcers at pressure points with preserved pulses are characteristic of peripheral diabetic neuropathy rather than ischemia.

  3. A 28-year-old woman in her third trimester presents with right upper quadrant pain, elevated liver enzymes, and thrombocytopenia. What syndrome should be considered?

    Answer: HELLP syndrome

    HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe complication of pre-eclampsia presenting with this triad in late pregnancy.

  4. 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.

  5. A 55-year-old male smoker presents with progressive dyspnea, barrel chest, and reduced breath sounds bilaterally. Spirometry shows FEV1/FVC of 0.55. What is the diagnosis?

    Answer: COPD

    An obstructive spirometry pattern (FEV1/FVC < 0.7) combined with a smoking history, barrel chest, and reduced breath sounds is diagnostic of COPD.

  6. A 35-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. TSH is markedly elevated with low free T4. What is the first-line treatment?

    Answer: Levothyroxine

    Primary hypothyroidism confirmed by elevated TSH and low free T4 is treated with oral levothyroxine replacement therapy.

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Sources & references

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  1. medical.hee.nhs.uk — Exam format, registration deadline, score release, test dates, eligibility, passing score, retake policy, time limit, test delivery, exam information · verified Oct 2026