MSRA Clinical Problem Solving 1

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

A normal CT does not exclude subarachnoid hemorrhage; lumbar puncture looking for xanthochromia is required when clinical suspicion remains high.

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

Elevated PaCO2 with low PaO2 defines Type II respiratory failure, and the raised bicarbonate reflects chronic renal compensation for the respiratory acidosis.

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

Suppressed TSH with elevated free T4 is consistent with primary hyperthyroidism, and Graves' disease is the most common cause in young women.

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

Classic exertional angina with a normal resting ECG warrants an exercise tolerance test to provoke ischemic changes under stress.

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

New hypertension after 20 weeks with significant proteinuria and symptoms such as headache defines pre-eclampsia.

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

MSRA Clinical Problem Solving 1