Archives: MSRA

MSRA-0792

A 35-year-old woman is admitted for an endoscopic retrograde cholangiopancreatography (ERCP) due to biliary colic. She has an uneventful procedure but is re-admitted the same night with severe abdominal pain.
On examination, she is tachycardic, short of breath, and has a pleural effusion on her chest X-ray (CXR).
Investigations reveal the following:
Investigation Result Normal value
C-reactive protein (CRP) 180 mg/l < 10 mg/l
White cell count (WCC) 15.0 × 109/l 4.0–11.0 × 109/l
Creatine (Cr) 140 µmol/l 50–120µmol/l
Urea 7.5mmol/l 2.5–6.5mmol/l
Phosphate (PO4-) 1.0mmol/l 0.8–1.5 mmol/l
Corrected Calcium (Ca2+) 0.8 mmol/l 2.20–2.60 mmol/l
What is her most likely diagnosis?

MSRA-0793

A 67-year-old woman presents to the Surgical Assessment Unit with mild abdominal pain that has been occurring on and off for several weeks. However, the pain has now intensified, causing her to feel nauseated and lose her appetite. She has not had a bowel movement in three days and has not noticed any blood in her stool. Upon examination, her temperature is 38.2 °C, her heart rate is 110 beats per minute, and her blood pressure is 124/82 mmHg. Her abdomen is soft, but she experiences tenderness in the left lower quadrant. Bowel sounds are present but reduced, and rectal examination reveals tenderness only. She has no history of gastrointestinal problems and only sees her General Practitioner for osteoarthritis. She has not had a sexual partner since her husband passed away two years ago. Based on this information, what is the most likely diagnosis?

MSRA-0794

A 25-year-old man presents with worries about the appearance of his tongue. He reports that it has been like this for a few months but is not causing any discomfort or issues. On examination, the tongue appears mildly erythematous with a few patches surrounded by a white-ish border, and there is no exudate that can be scraped off. What is the MOST probable diagnosis?

MSRA-0795

A 32-year-old man presents with a burning sensation and unusual appearance to his tongue. Upon examination, small bumps are observed on the surface of the tongue, along with red patches and white lines that resemble a map.
What is the most probable cause?

MSRA-0796

What is the most accurate description of a characteristic of irritable bowel syndrome (IBS)?

MSRA-0797

Helicobacter pylori infection is most commonly associated with which disorder?

MSRA-0798

A 49-year-old woman comes to see her doctor complaining of increasing fatigue, itchy skin, and pain in the upper right side of her abdomen. She has a medical history of autoimmune disorders such as hypothyroidism and coeliac disease. The doctor suspects that she may have primary biliary cholangitis (PBC). What is the first test that should be ordered for this patient?

MSRA-0799

A 55-year-old man visits the clinic with concerns about his worsening haemorrhoids. He reports having to manually push them back in after bowel movements.
Which class of haemorrhoids is most likely present?

MSRA-0767

A 35-year-old woman presents with epigastric pain which radiates to the back. She feels nauseous and has been vomiting since arriving at the Emergency Department. On questioning, the woman tells you that she takes no regular medication. She was last in hospital three years ago after she slipped and fell in the shower. She was not admitted. She travelled to Thailand to visit relatives two months ago.
On examination, the woman’s abdomen is tender in the epigastrium. She is jaundiced. She is also tachycardia and pyrexia.
Investigations reveal the following:
Investigation Result Normal
Alkaline phosphatase (ALP) 280 IU 30–130 IU
Alanine aminotransferase (ALT) 50 IU 5–30 IU
Bilirubin 40 µmol/l 2–17 µmol/l
Amylase 900 u/l 30-100 u/l
What is the best initial treatment for this woman?

MSRA-0768

A 32-year-old woman presents to her General Practitioner complaining of occasional abdominal distension and bloating, which varies with her menstrual cycle and is accompanied by episodes of constipation. She works as a teacher and finds work stressful; she has previously taken a course of sertraline for depression/anxiety. On examination, bloods and colonoscopy are normal.
Which of the following is the most probable diagnosis?