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

Inferior ST elevation (II, III, aVF) most commonly reflects right coronary artery occlusion.

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

A silent chest, exhaustion and hypoxia are features of life-threatening asthma requiring urgent escalation.

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

Epigastric pain radiating to the back with raised amylase in an alcohol user indicates acute pancreatitis.

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

Fever with rigors and thrombocytopenia after travel to an endemic area mandates excluding malaria with blood films.

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

Acute confusion (delirium) with fever and abnormal urine in the elderly is commonly due to a UTI.

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

MSRA Clinical Problem Solving 3