MSRA Clinical Problem Solving 2

Question 1

A 24-year-old woman presents with sudden pleuritic chest pain and breathlessness 2 weeks after starting the combined oral contraceptive pill. What is the most likely diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Recent oestrogen-containing contraception plus pleuritic chest pain and dyspnoea strongly suggests pulmonary embolism.

Question 2

A 60-year-old man with type 2 diabetes has a foot ulcer with surrounding erythema, warmth and purulent discharge. What is the most appropriate initial management?

Accepted Answer

Oral antibiotics and wound review

Answer

An infected diabetic foot ulcer requires antibiotics and close wound review to prevent progression.

Question 3

A 35-year-old presents with a sudden severe occipital headache described as 'the worst of my life'. CT head is normal at 12 hours. What is the next best investigation?

Accepted Answer

Lumbar puncture

Answer

If CT is negative beyond 6 hours, lumbar puncture for xanthochromia is needed to exclude subarachnoid haemorrhage.

Question 4

A 70-year-old man on warfarin presents with melaena and an INR of 8.0 but no major bleeding. What is the most appropriate action?

Accepted Answer

Stop warfarin and give oral vitamin K

Answer

For high INR with minor bleeding, withhold warfarin and give vitamin K to reverse anticoagulation.

Question 5

A 4-year-old child has a barking cough, stridor and hoarseness that is worse at night. What is the most likely diagnosis?

Accepted Answer

Croup

Answer

Barking cough with stridor and hoarse voice is the classic picture of croup (laryngotracheobronchitis).

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

MSRA Clinical Problem Solving 2