MSRA Clinical Problem Solving 4 — Questions and Answers
Question 1: A 68-year-old man presents with painless macroscopic haematuria. What is the most important diagnosis to exclude?
- Bladder cancer (Correct answer)
- Urinary tract infection
- Renal stones
- Benign prostatic hyperplasia
Correct answer: Bladder cancer
Painless visible haematuria in an older adult requires urgent investigation to exclude bladder malignancy.
Question 2: A 40-year-old woman has recurrent episodes of unilateral throbbing headache with nausea, photophobia and visual aura. What is the most likely diagnosis?
- Migraine (Correct answer)
- Tension headache
- Cluster headache
- Temporal arteritis
Correct answer: Migraine
Unilateral throbbing headache with aura, nausea and photophobia is typical of migraine.
Question 3: A 58-year-old smoker has a chronic cough, haemoptysis and unintentional weight loss. What is the most appropriate initial imaging?
- Chest X-ray (Correct answer)
- Abdominal CT
- MRI brain
- Echocardiogram
Correct answer: Chest X-ray
A chest X-ray is the appropriate first-line investigation for suspected lung cancer.
Question 4: A 32-year-old woman presents with palpitations, weight loss, heat intolerance and a fine tremor. Which result would confirm hyperthyroidism?
- Low TSH with high free T4 (Correct answer)
- High TSH with low free T4
- Normal TSH and T4
- Low TSH with low free T4
Correct answer: Low TSH with high free T4
Primary hyperthyroidism is confirmed by a suppressed TSH alongside an elevated free T4.
Question 5: An 80-year-old falls and presents with a shortened, externally rotated right leg. What is the most likely injury?
- Fractured neck of femur (Correct answer)
- Ankle sprain
- Patellar dislocation
- Pubic ramus fracture
Correct answer: Fractured neck of femur
A shortened, externally rotated leg after a fall in the elderly is the classic sign of a hip (neck of femur) fracture.
Question 6: A 6-month-old infant has a fever, drawing up of the legs and episodes of inconsolable crying with 'redcurrant jelly' stools. What is the likely diagnosis?
- Intussusception (Correct answer)
- Gastroenteritis
- Pyloric stenosis
- Constipation
Correct answer: Intussusception
Colicky pain with redcurrant jelly stools in an infant is characteristic of intussusception.
Question 7: A 50-year-old man with hypertension presents with a tearing chest pain radiating to the back and a blood pressure difference between both arms. What is the most likely diagnosis?
- Aortic dissection (Correct answer)
- Myocardial infarction
- Pericarditis
- Pulmonary embolism
Correct answer: Aortic dissection
Tearing interscapular pain with an inter-arm BP difference strongly suggests aortic dissection.
MSRA Clinical Problem Solving 4
A 68-year-old man presents with painless macroscopic haematuria.
What is the most important diagnosis to exclude?