MSRA Clinical Problem Solving

Question 1

A 45-year-old woman presents with sudden onset severe headache she describes as 'the worst headache of her life.' A CT head is normal. What is the most appropriate next investigation?

Accepted Answer

Lumbar puncture for xanthochromia

Answer

MRI brain with gadolinium

Answer

CT angiography of the brain

Answer

Blood cultures and CRP

Question 2

A 68-year-old man with COPD has an ABG showing pH 7.32, PaCO2 58 mmHg, PaO2 52 mmHg, and HCO3 28 mEq/L. What is the correct interpretation?

Accepted Answer

Type II respiratory failure with compensatory metabolic alkalosis

Answer

Acute metabolic acidosis

Answer

Type I respiratory failure

Answer

Respiratory alkalosis with renal compensation

Question 3

A 25-year-old woman reports 3 months of fatigue, unintentional weight loss, heat intolerance, and palpitations. Lab results show an undetectable TSH and elevated free T4. What is the most likely diagnosis?

Accepted Answer

Hyperthyroidism (Graves' disease)

Answer

Primary hypothyroidism

Answer

Thyroid carcinoma

Answer

Subacute (De Quervain's) thyroiditis

Question 4

A 55-year-old man reports chest pain radiating to the jaw on exertion that resolves with rest. His resting ECG is normal. What is the most appropriate next investigation?

Accepted Answer

Exercise tolerance test (ETT)

Answer

Transthoracic echocardiogram

Answer

24-hour Holter monitor

Answer

Chest X-ray

Question 5

A 30-year-old woman at 32 weeks gestation presents with a blood pressure of 158/104 mmHg, 2+ proteinuria on dipstick, and a severe headache. What is the most likely diagnosis?

Accepted Answer

Pre-eclampsia

Answer

Gestational hypertension

Answer

Chronic essential hypertension

Answer

HELLP syndrome

Question 6

A 70-year-old man develops sudden painless loss of vision in his right eye, describing it as a 'curtain coming down.' Fundoscopy reveals a pale retina with a cherry-red spot at the macula. What is the diagnosis?

Accepted Answer

Central retinal artery occlusion

Answer

Vitreous hemorrhage

Answer

Rhegmatogenous retinal detachment

Answer

Central retinal vein occlusion

Question 7

A 40-year-old woman has recurrent episodes of palpitations. ECG during an episode shows a regular narrow complex tachycardia at 180 bpm with P waves visible just after the QRS complexes. What is the most likely diagnosis?

Accepted Answer

AV nodal re-entrant tachycardia (AVNRT)

Answer

Atrial fibrillation

Answer

Atrial flutter with 2:1 block

Answer

Ventricular tachycardia