MSRA MSRA Clinical Reasoning 1

Question 1

A 45-year-old woman presents with sudden-onset severe headache described as 'the worst headache of her life.' What is the most important diagnosis to exclude?

Accepted Answer

Subarachnoid hemorrhage

Answer

A sudden severe 'thunderclap' headache is the classic presentation of subarachnoid hemorrhage and must be excluded urgently with CT head and, if negative, lumbar puncture.

Question 2

A 62-year-old man with type 2 diabetes presents with a painless foot ulcer over the metatarsal head. Pulses are present. What is the most likely underlying mechanism?

Accepted Answer

Peripheral neuropathy

Answer

Painless neuropathic ulcers at pressure points with preserved pulses are characteristic of peripheral diabetic neuropathy rather than ischemia.

Question 3

A 28-year-old woman in her third trimester presents with right upper quadrant pain, elevated liver enzymes, and thrombocytopenia. What syndrome should be considered?

Accepted Answer

HELLP syndrome

Answer

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe complication of pre-eclampsia presenting with this triad in late pregnancy.

Question 4

A 70-year-old man on warfarin presents with an INR of 8.5 and minor bleeding from the gums. He is otherwise hemodynamically stable. What is the most appropriate management?

Accepted Answer

Hold warfarin and give oral vitamin K 1–2 mg

Answer

For minor bleeding with a markedly elevated INR, withholding warfarin and administering low-dose oral vitamin K is sufficient to bring the INR into a safe range.

Question 5

A 55-year-old male smoker presents with progressive dyspnea, barrel chest, and reduced breath sounds bilaterally. Spirometry shows FEV1/FVC of 0.55. What is the diagnosis?

Accepted Answer

COPD

Answer

An obstructive spirometry pattern (FEV1/FVC < 0.7) combined with a smoking history, barrel chest, and reduced breath sounds is diagnostic of COPD.

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA Exam (Multi-Specialty Recruitment Assessment) Practice Test

MSRA MSRA Clinical Reasoning 1