MSRA-0943
A 47-year-old woman from Nigeria complains of fatigue, back pain and excessive thirst. Her ESR is elevated and she has normocytic/normochromic anemia.
What is the most probable diagnosis?
Archives: MSRA
MSRA-0944
A 7-year-old boy who has haemophilia A presents to the Emergency Department after falling off a skateboard and hitting his head. He is drowsy and confused with a Glasgow Coma Score of 9.
What would be the next most appropriate step in this patient’s management?
MSRA-0945
A 28-year-old pregnant woman is brought into the Emergency Department with acute confusion and abnormal behaviour. Her husband says she has been well till today. There is no past medical history of note and she takes no regular medication.
On examination, she is febrile with a temperature of 38.7 °C. Her heart rate is 125 bpm with a blood pressure of 115/95 mmHg. Chest sounds are clear and heart sounds are normal. She has a soft abdomen with a palpable uterus in keeping with 16 weeks’ gestation.
Investigations:
Investigation Result Normal value
Haemoglobin (Hb) 92 g/l 115–155 g/l
White cell count (WCC) 10.3 × 109/l 4.0–11.0 × 109/l
Neutrophils 7.1 × 109/l 2.5–7.5 × 109/l
Lymphocytes 0.9 × 109/l 0.8–5.0 × 109/l
Platelets (PLT) 57 × 109/l 150–400 × 109/l
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Urea 17.3 mmol/l 1.8–7.1 mmol/l
Creatinine (Cr) 225µmol/l 50–120 µmol/l
Estimated glomerular filtration rate (eGFR) 34 60+
Bilirubin 20µmol/l 1–22 µmol/l
Alanine aminotransferase (ALT) 35 U/l 7–55 U/l
Alkaline phosphatase (ALP) 85 U/l 30–150 U/l
Albumin 40 g/l 35–55 g/l
C-reactive protein (CRP) 9 mg/l < 10 mg/l
Which of the following is the best investigation to confirm the likely diagnosis?
Select ONE option only
MSRA-0946
A 12-month-old African-Caribbean boy is brought to see his General Practitioner by his mother with a 6-day history of fever, reduced feeding and increased irritability. His mother has also noticed this morning that his fingers and toes are swollen and tense and some of the skin is peeling. He is reluctant to play with toys or walk. On examination, he is pale, his lips are cracked and there are no rashes present. Ear, nose and throat (ENT) examinations reveal the presence of a red, swollen tongue he also has swollen, tender digits of his hands and feet.
He is admitted to hospital and his full blood count (FBC) result is shown below:
Investigation Result Normal value
Haemoglobin (Hb) 88 g/l 100–135 g/l
White cell count (WCC) 6.2 × 109/l 3.8–11 × 109/l
Platelets 150 × 109/l 150–400 × 1109/l
Mean corpuscular volume 93 fl 85–105 fl
Reticulocytes 6% 0.2–2%
Which of the following is the most likely diagnosis?
MSRA-0947
A 45-year-old woman is referred by her general practitioner due to complaints of headache, fatigue and weakness. Recently, she had a prolonged menstrual bleeding that only stopped after the application of compression for a long time. She also suffered from a urinary tract infection the previous month. She has no family history of a bleeding disorder.
On examination, she has pallor, hepatosplenomegaly and lymphadenopathy. Investigations reveal that she has a low haemoglobin level, a low white blood cell count and a low platelet count; numerous blast cells are visible on peripheral blood film. Bone marrow biopsy reveals 30% of blast cells. The blood film is shown below.
Which one of the following is the most likely diagnosis?
MSRA-0948
A 55-year-old man comes to the Genetic Counselling Clinic after being diagnosed with colon cancer through the national bowel cancer screening programme. He was adopted as a child and has no knowledge of his biological family’s medical history.
What is the most suitable genetic disorder to test for in this individual?
MSRA-0949
A 5-year-old boy has been diagnosed with sickle cell disease following his routine heel-prick screening test. His mother contacts the General Practitioner to discuss the implications of this diagnosis and would like more information about treatment.
Which of the following is the best choice of management?
MSRA-0950
A 55-year-old man is reviewed on the Oncology Ward. He has metastatic lung cancer and a potassium (K+) level of 6.1 mmol/l (normal range: 3.5–5.0 mmol/l). The lab report indicates that there was a delay in processing this sample. His last K+ level recorded two days ago was 4.2 mmol/l. An electrocardiogram (ECG), urine output and observations all provide normal results.
What is the most appropriate initial step in this patient’s management?
MSRA-0951
An 87-year-old woman presents to the Haematology Clinic to review her latest blood test results. These show that her international normalised ratio (INR) is 8.9 (normal range: 2–3). She usually takes warfarin for atrial fibrillation. The patient’s General Practitioner has telephoned her to advise that she stop taking the warfarin. The patient says that she feels well and is asymptomatic.
What is the most appropriate next step in this patient’s management?
MSRA-0952
A 35-year-old woman comes to her General Practitioner complaining of fatigue, weight loss, and palpable lymph nodes in the left supraclavicular fossa.
What is the most suitable location to investigate for a primary tumor in this patient?