MSRA Practice and Application 4

Question 1

A 67-year-old man with type 2 diabetes and CKD stage 3 has an eGFR of 42. His HbA1c is 86 mmol/mol. Which glucose-lowering agent should be used with most caution?

Accepted Answer

Metformin at full dose

Answer

DPP-4 inhibitor (sitagliptin)

Answer

SGLT-2 inhibitor (empagliflozin)

Answer

GLP-1 receptor agonist (liraglutide)

Question 2

A patient's family asks you not to tell their relative that he has been diagnosed with terminal cancer. What is the most appropriate response?

Accepted Answer

Explain that you cannot withhold information the patient wants, but explore why the family has this concern

Answer

Agree, as family wishes must be respected

Answer

Ask the patient directly if they want to know their diagnosis without mentioning the family's request

Answer

Document that information was withheld at family request

Question 3

A 50-year-old post-operative patient develops sudden dyspnea, pleuritic chest pain, and tachycardia on day 3. SpO2 is 91%. What is the most likely diagnosis?

Accepted Answer

Pulmonary embolism

Answer

Hospital-acquired pneumonia

Answer

Pleural effusion

Answer

Atelectasis

Question 4

A junior colleague asks you to cover their on-call shift at the last minute. You are already working a full day shift. What is the most appropriate response?

Accepted Answer

Decline if covering would compromise patient safety due to fatigue, and escalate to the rota coordinator

Answer

Agree to cover to support your colleague

Answer

Agree but report it as a concern after completing both shifts

Answer

Tell the colleague to find cover themselves

Question 5

A 40-year-old woman presents with a 3-month history of fatigue, weight gain, constipation, and cold intolerance. Examination reveals dry skin and bradycardia. What is the most likely diagnosis?

Accepted Answer

Hypothyroidism

Answer

Depression

Answer

Addison's disease

Answer

Chronic fatigue syndrome

Question 6

A patient with chronic back pain asks for opioid analgesics. You feel they are already on an adequate regimen. What is the most appropriate approach?

Accepted Answer

Explore the patient's concerns, review current analgesia, and discuss alternative pain management strategies

Answer

Prescribe the requested opioids to maintain the therapeutic relationship

Answer

Refuse to discuss opioids as they are addictive

Answer

Refer the patient to another doctor

Question 7

A 76-year-old man with COPD is admitted with an acute exacerbation. ABG shows pH 7.29, PaCO2 8.1 kPa, PaO2 7.0 kPa on 28% oxygen. What is the most appropriate next step?

Accepted Answer

Initiate non-invasive ventilation (NIV)

Answer

Increase oxygen to 60% via non-rebreather mask

Answer

Administer IV aminophylline as first-line treatment

Answer

Arrange urgent intubation and mechanical ventilation