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

The malar butterfly rash, polyarthritis, positive ANA, and low complement (consumed by immune complex deposition) are classic features of SLE.

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

An ejection systolic murmur at the right upper sternal border radiating to the carotids with a slow-rising pulse and exertional symptoms is the classic presentation of aortic stenosis.

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

Total gastrectomy removes the source of intrinsic factor, leading to vitamin B12 malabsorption and resulting in megaloblastic anaemia with subacute combined degeneration of the cord.

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

Acute pancreatitis is managed initially with aggressive IV fluid resuscitation, adequate analgesia, and nutritional support — surgery is reserved for complications.

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

Whipple's triad (symptoms of hypoglycaemia, low blood glucose, and relief with glucose) with elevated fasting insulin strongly suggests an insulin-secreting insulinoma.

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA MSRA Clinical Reasoning 3