MSRA MSRA Clinical Reasoning 3

Question 1

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?

Accepted Answer

Systemic lupus erythematosus

Answer

Rheumatoid arthritis

Answer

Dermatomyositis

Answer

Scleroderma

Question 2

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?

Accepted Answer

Aortic stenosis

Answer

Aortic regurgitation

Answer

Mitral stenosis

Answer

Hypertrophic obstructive cardiomyopathy

Question 3

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?

Accepted Answer

Vitamin B12 deficiency

Answer

Folate deficiency

Answer

Iron deficiency

Answer

Hypothyroidism

Question 4

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?

Accepted Answer

IV fluids, analgesia, and nil by mouth

Answer

Emergency laparotomy

Answer

Urgent ERCP

Answer

High-dose corticosteroids

Question 5

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?

Accepted Answer

Insulinoma

Answer

Type 1 diabetes mellitus

Answer

Reactive hypoglycaemia

Answer

Addison's disease

Question 6

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?

Accepted Answer

Urethral catheterisation to relieve retention

Answer

Prescribe alpha-blocker and reassess in 1 week

Answer

Start finasteride

Answer

Emergency prostatectomy