MSRA Core Knowledge and Fundamentals 2 — Questions and Answers
Question 1: A 58-year-old man presents with sudden-onset tearing chest pain radiating to the back. His BP is 160/90 mmHg in the right arm and 130/80 mmHg in the left arm. What is the most likely diagnosis?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Pericarditis
Correct answer: Aortic dissection
Inter-arm BP difference >20 mmHg combined with tearing back pain strongly suggests aortic dissection.
Question 2: Which electrolyte abnormality is most commonly associated with prolonged QT interval on ECG?
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperkalemia
- Hypermagnesemia
Correct answer: Hypocalcemia
Hypocalcemia prolongs the ST segment and QT interval, increasing the risk of torsades de pointes.
Question 3: A patient on warfarin presents with an INR of 8.2 but has no active bleeding. What is the most appropriate management?
- Give IV vitamin K 10 mg
- Give fresh frozen plasma immediately
- Hold warfarin and give oral vitamin K 1-2 mg (Correct answer)
- Continue warfarin and recheck INR in 24 hours
Correct answer: Hold warfarin and give oral vitamin K 1-2 mg
For supratherapeutic INR without bleeding, withholding warfarin and giving low-dose oral vitamin K is the recommended approach.
Question 4: Which of the following is the most sensitive test for diagnosing pulmonary embolism in a haemodynamically stable patient?
- D-dimer
- CT pulmonary angiography (Correct answer)
- V/Q scan
- Echocardiography
Correct answer: CT pulmonary angiography
CT pulmonary angiography (CTPA) is the gold standard and most sensitive test for diagnosing PE in stable patients.
Question 5: A 35-year-old woman at 32 weeks gestation presents with BP 158/104 mmHg and 3+ proteinuria. She has severe headache. What is the most appropriate initial management?
- Administer magnesium sulfate and antihypertensives (Correct answer)
- Immediate caesarean section
- Oral labetalol and outpatient monitoring
- IV furosemide for fluid reduction
Correct answer: Administer magnesium sulfate and antihypertensives
Severe pre-eclampsia with neurological symptoms requires magnesium sulfate for seizure prophylaxis and urgent antihypertensive therapy.
Question 6: What is the primary mechanism of action of metformin in type 2 diabetes?
- Stimulates pancreatic beta cells to secrete insulin
- Inhibits hepatic gluconeogenesis via AMPK activation (Correct answer)
- Blocks intestinal glucose absorption
- Increases renal glucose excretion
Correct answer: Inhibits hepatic gluconeogenesis via AMPK activation
Metformin activates AMPK, primarily reducing hepatic glucose production (gluconeogenesis) without causing hypoglycaemia.
Question 7: A 70-year-old man presents with confusion, asterixis, and jaundice. His ammonia level is markedly elevated. Which condition best explains these findings?
- Uraemic encephalopathy
- Hepatic encephalopathy (Correct answer)
- Wernicke's encephalopathy
- Hypertensive encephalopathy
Correct answer: Hepatic encephalopathy
Elevated ammonia, asterixis, and jaundice together indicate hepatic encephalopathy from impaired liver detoxification.
MSRA Core Knowledge and Fundamentals 2
A 58-year-old man presents with sudden-onset tearing chest pain radiating to the back.
His BP is 160/90 mmHg in the right arm and 130/80 mmHg in the left arm.
What is the most likely diagnosis?