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

Metformin should be used at reduced doses and with caution in CKD stage 3b (eGFR <45) due to risk of lactic acidosis; it is contraindicated below eGFR 30.

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

Patients have a right to information; clinicians should explore the family's concerns while upholding the patient's autonomy and right to know.

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

Sudden onset dyspnea with pleuritic pain and tachycardia in a post-operative patient is pulmonary embolism until proven otherwise.

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

Doctors must not work when fatigued to the point of impairing patient safety; escalating to the rota coordinator is the appropriate professional response.

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

The combination of fatigue, weight gain, constipation, cold intolerance, dry skin, and bradycardia is classic for hypothyroidism.

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

MSRA Practice and Application 4