Archives: MSRA

MSRA-0800

A 72-year-old male presents to the emergency department with complaints of new-onset pain in his left groin. Upon examination, a large, warm, non-reducible mass located inferolateral to the pubic tubercle is observed, accompanied by erythema of the overlying skin. The patient reports vomiting twice and passing stools with blood mixed in them once. He appears to be in pain and is sweating profusely. His medical history includes peptic ulcer disease, which is managed with omeprazole. What is the most likely diagnosis?

MSRA-0783

A 45-year-old woman presents to the Emergency Department with symptoms of nausea, upper abdominal discomfort and distension. She has been taking aspirin regularly for the past 8 weeks due to a chronic back pain. She has been tested for Helicobacter pylori and was negative so the aspirin has been discontinued. A gastroscopy is performed which reveals the presence of gastritis and a benign duodenal ulcer that is not actively bleeding.
What is the most appropriate next step in managing this patient?

MSRA-0784

A 42-year-old woman with chronic upper gastrointestinal (GI) symptoms has recently been diagnosed as having a gastric ulcer at endoscopy. No evidence of oesophageal or duodenal pathology was found. Helicobacter pylori testing was positive. She is not allergic to penicillin.
Which of the following treatment regimens would be best suited to her case?

MSRA-0785

A 42-year-old woman presents to her General Practitioner with a diagnosis of primary biliary cholangitis (PBC). She initially complained of abdominal pain and itching, but is now asymptomatic except for significant fatigue. What medication should be prescribed for this patient? Choose the most likely option.

MSRA-0786

A 32-year-old man with a known diagnosis of ulcerative colitis visits his General Practitioner (GP) complaining of a 4-day history of a feeling of rectal fullness, tenesmus, diarrhoea with small, frequent stools and mucus, and rectal bleeding. He denies systemic symptoms. He is not sexually active. Physical examination is unremarkable. The GP thinks a diagnosis of inflammatory exacerbation of proctitis is likely and contacts the local Inflammatory Bowel Disease (IBM) specialist nurse for advice.
Which of the following is the most appropriate treatment?
Select the SINGLE most appropriate treatment from the list below.
Select ONE option only.

MSRA-0787

A 25-year-old man presents to the Emergency Department complaining of acute rectal pain. He has a 2-month history of perianal pain and bright red rectal bleeding at the time of defaecation. He has been taking regular codeine for the past six months for low back pain.
On examination, there is a thrombosed haemorrhoid visible externally. It is impossible to proceed with digital rectal examination because the patient is in too much pain.
What is the most appropriate immediate treatment for this patient?
Select the SINGLE most likely option.
Select ONE option only.

MSRA-0788

A 32-year-old teacher presents with bloody diarrhoea; he says that he has been passing up to 10 motions a day for the past 3–4 weeks. He now presents to the Emergency Department, complaining of abdominal pain and bloating. On examination, he is dehydrated with a clearly distended, tender abdomen. There is anaemia with raised plasma viscosity; potassium level is mildly decreased at 3.3 mmol/l (reference range 3.5–5.1 mmol/l), and urea level is raised, in keeping with dehydration. Liver function testing reveals a decreased albumin level. Autoantibody screen is positive for c-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibody). Colonoscopy shows friable mucosa with a uniform pattern of inflammation and loss of normal mucosa. Stool culture is negative.
Which one of these diagnoses fits best with this clinical picture?

MSRA-0789

A 45-year-old man visits his GP with a 7-month history of abdominal bloating, pain and urgency to defecate in the morning. He has no history of nausea/vomiting, per rectum bleeding, mucus on stools or weight loss. He says that his symptoms become much worse, with worsening constipation, when he is stressed. Physical examination is unremarkable.
Which of the following is the best initial treatment for his symptoms?

MSRA-0790

A 42-year-old woman with diagnosed irritable bowel syndrome (IBS) is currently taking loperamide, movicol and hyoscine butylbromide (Buscopan) for management. However, she is still experiencing bloating and abdominal pain.
What would be the next treatment option from the list below?

MSRA-0791

A 6-year-old girl is brought to see her GP by her mother. She is noted to be on the 4th centile for weight. Her mother notes that for the past few months her daughter has been tired and passes greasy foul-smelling stools three times a day. Blood tests reveal mild anaemia, positive serum IgA anti-endomysial antibody (EMA-IgA) and very elevated tissue transglutaminase (tTG) levels.
Which of the following is the most likely cause of her symptoms?
Select the SINGLE most likely cause from the list below. Select ONE option only.