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

A barking cough with stridor that worsens at night in a young child is the hallmark presentation of croup, typically caused by parainfluenza virus.

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

The triad of arthritis, urethritis, and conjunctivitis following an enteric or urogenital infection is diagnostic of reactive arthritis (formerly Reiter's syndrome).

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

A TIA in a patient with AF carries high early stroke risk; same-day neurovascular assessment and urgent investigation are mandatory under the fast-track TIA pathway.

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

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

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

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.

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA MSRA Clinical Reasoning 2