MSRA Clinical Problem Solving 3

Question 1

A 65-year-old man presents with central crushing chest pain and ECG shows ST elevation in leads II, III and aVF. Which artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

Left anterior descending

Answer

Left circumflex

Answer

Left main stem

Question 2

A 28-year-old woman with known asthma has a silent chest, exhaustion and falling oxygen saturations despite nebulisers. How is this best classified?

Accepted Answer

Life-threatening asthma

Answer

Moderate asthma

Answer

Mild exacerbation

Answer

Well-controlled asthma

Question 3

A 45-year-old man with a history of alcohol excess presents with epigastric pain radiating to the back and raised serum amylase. What is the diagnosis?

Accepted Answer

Acute pancreatitis

Answer

Peptic ulcer

Answer

Cholecystitis

Answer

Myocardial infarction

Question 4

A 30-year-old returning traveller from sub-Saharan Africa has cyclical fevers, rigors and thrombocytopenia. What is the most important diagnosis to exclude?

Accepted Answer

Malaria

Answer

Influenza

Answer

Dengue

Answer

Typhoid

Question 5

A 75-year-old woman presents acutely confused with a temperature of 38.5°C and offensive cloudy urine. What is the most likely cause of her confusion?

Accepted Answer

Urinary tract infection

Answer

Alzheimer's disease

Answer

Subdural haematoma

Answer

Hypothyroidism

Question 6

A 55-year-old man has progressive dysphagia to solids then liquids with weight loss. What is the most appropriate first investigation?

Accepted Answer

Upper GI endoscopy

Answer

Barium swallow only

Answer

Abdominal ultrasound

Answer

Colonoscopy

Question 7

A 19-year-old presents with a non-blanching purpuric rash, neck stiffness, photophobia and fever. What is the immediate management priority?

Accepted Answer

Urgent IV/IM antibiotics

Answer

Oral paracetamol only

Answer

Outpatient referral

Answer

Lumbar puncture before any treatment