MSRA MSRA Clinical Reasoning 2

Question 1

A 4-year-old child presents with fever, stridor, and a 'barking cough' that is worse at night. What is the most likely diagnosis?

Accepted Answer

Croup (laryngotracheobronchitis)

Answer

Epiglottitis

Answer

Foreign body aspiration

Answer

Bacterial tracheitis

Question 2

A 25-year-old male presents with acute onset monoarthritis of the right knee, urethral discharge, and conjunctivitis following a gastrointestinal infection. What is the likely diagnosis?

Accepted Answer

Reactive arthritis

Answer

Septic arthritis

Answer

Gonococcal arthritis

Answer

Gout

Question 3

A 68-year-old woman with known atrial fibrillation presents with sudden left-sided weakness and facial droop lasting 45 minutes before fully resolving. What is the most appropriate next step?

Accepted Answer

Admit urgently using the ABCD2 score and fast-track TIA pathway

Answer

Reassure and discharge

Answer

Start aspirin and review in 2 weeks

Answer

Order an MRI in outpatient clinic

Question 4

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?

Accepted Answer

Primary PCI within 90–120 minutes

Answer

Oral nitrates and observation

Answer

IV heparin and thrombolytics if PCI unavailable within 120 min

Answer

CABG

Question 5

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

Accepted Answer

Haemolytic disease of the newborn

Answer

Breast milk jaundice

Answer

Physiological jaundice

Answer

Gilbert's syndrome

Question 6

A 72-year-old woman presents with confusion, polyuria, and severe hypercalcaemia (Ca²⁺ 3.8 mmol/L). She has a history of non-small cell lung cancer. What is the mechanism?

Accepted Answer

PTHrP secretion by tumor

Answer

Primary hyperparathyroidism

Answer

Vitamin D toxicity

Answer

Sarcoidosis