MSRA Data Interpretation Flashcards

A 55-year-old woman has TSH 0.08 mU/L (low), free T4 28 pmol/L (high), and free T3 9.2 pmol/L (high). She is symptomatic with palpitations and weight loss. What is the diagnosis?

Answer: Overt hyperthyroidism

Suppressed TSH with elevated free T4 and free T3 in a symptomatic patient confirms overt primary hyperthyroidism requiring treatment.

An ECG shows a rate of 150 bpm, regular, narrow QRS complexes, no visible P waves, and a sawtooth baseline at 300/min. What is the rhythm?

Answer: Atrial flutter with 2:1 block

Atrial flutter typically produces a sawtooth atrial rate of ~300/min; with 2:1 AV block, the ventricular rate is ~150 bpm with regular narrow complexes.

Blood film shows target cells, Howell-Jolly bodies, and a platelet count of 650 × 10⁹/L. What is the most likely explanation?

Answer: Post-splenectomy state or functional hyposplenism

Howell-Jolly bodies (nuclear remnants normally removed by the spleen), target cells, and reactive thrombocytosis are characteristic of asplenia or hyposplenism.

A bone profile shows: Ca²⁺ 2.85 mmol/L, phosphate 0.65 mmol/L, ALP 320 U/L, and PTH 12.8 pmol/L (elevated). What is the diagnosis?

Answer: Primary hyperparathyroidism

Elevated PTH driving hypercalcaemia with hypophosphataemia (PTH promotes phosphate excretion) and raised ALP confirms primary hyperparathyroidism.

A clotting screen shows: PT 18 s (normal 11–13), APTT 55 s (normal 26–36), fibrinogen 0.9 g/L, platelets 58 × 10⁹/L, d-dimers markedly elevated. What condition is present?

Answer: Disseminated intravascular coagulation (DIC)

Prolonged PT and APTT with low fibrinogen, thrombocytopaenia, and elevated d-dimers reflects consumption of clotting factors and platelets in disseminated intravascular coagulation.

An OGTT shows fasting glucose 5.9 mmol/L and 2-hour glucose 9.5 mmol/L. How should this be classified?

Answer: Impaired glucose tolerance

A 2-hour OGTT glucose of 7.8–11.0 mmol/L with a fasting value below 7.0 mmol/L meets WHO criteria for impaired glucose tolerance (pre-diabetes).