Archives: MSRA

MSRA-0739

A 47-year-old man with ulcerative colitis visits the GP clinic due to a flare-up. He reports having diarrhoea 5 times a day with small amounts of blood, which has not improved with oral mesalazine. He feels fatigued but is otherwise in good health. The patient’s vital signs are as follows:
– Heart rate: 94 beats/minute
– Blood pressure: 121/88 mmHg
– Respiratory rate: 12 breaths/minute
– Temperature: 37.4ºC
– Oxygen saturation: 99% on room air

What is the appropriate management plan for this patient?

MSRA-0740

A 32-year-old woman with a past medical history of kidney stones awaiting elective lithotripsy attends the general practice surgery complaining of fever, fatigue and acute abdominal pain. On examination, she has a temperature of 38.5 °C, a heart rate 118 bpm, yellow sclera and her abdomen is soft but tender on palpation of the right upper quadrant.
Which of the following is the most likely diagnosis?

MSRA-0741

A 62-year-old man with a history of hypertension presents to the emergency department with sudden onset of abdominal pain, vomiting and diarrhoea. On examination, his abdomen is distended and tender, with generalised guarding. Vital signs show heart rate 110 beats/min, BP 120/80 mmHg. Bloods show lactate 3.5 mmol/l, urea 10 mmol/l, creatinine 150 µmol/l and bicarbonate 14 mmol/l.
Blood test
Reference range
Lactate
<2 mmol/l
Urea
2.5–7.1 mmol/l
Creatinine
44–97 µmol/l
Bicarbonate
22–29 mmol/l.
Based on the history, what is the most likely diagnosis?
Choose the SINGLE most likely diagnosis from the options below.

MSRA-0742

What is an accurate statement about alcoholic liver disease (ALD)?

MSRA-0743

A 42-year-old woman presents with a persistent history of acid reflux. She has visited her primary care physician multiple times. A trial of low-dose proton pump inhibitor (PPI) and lifestyle changes has not improved her symptoms. She has been tested for Helicobacter pylori, and the results were negative. Her screening blood tests are normal.
What is the best course of action for management?

MSRA-0744

A 26-year-old woman has been asked to come in for a consultation at her local medical practice after her blood test results showed an elevated level of anti-tissue transglutaminase antibody (anti-TGA). What condition is linked to anti-TGA?

MSRA-0745

A 38-year-old, overweight woman presents to the clinic with complaints of occasional abdominal pain for the past few months. She experienced a constant pain episode two days ago that started in the epigastric region and then moved to the right upper quadrant, accompanied by vomiting.
What is the most probable diagnosis?

MSRA-0746

A 35-year-old overweight man visits the clinic with concerns about abdominal discomfort he experienced over the weekend. He reports that the discomfort began in his upper abdomen shortly after eating a large pizza on Friday night. The discomfort then shifted to the left side of his abdomen. He also vomited a few times. Most of the symptoms subsided within 24 hours. During the examination, he is still slightly tender in the left upper quadrant and has no fever or jaundice.
What is the most probable diagnosis?

MSRA-0747

A 42-year-old construction worker is referred by his family doctor with chronic upper abdominal pain on the right side. He admits to drinking a six-pack of beer every night after work. Over the past year, he has lost about 9 kg (1.5 stone) in weight, and his wife says that he often skips meals in favor of alcohol. He has occasional diarrhea, which he describes as greasy and difficult to flush away. Physical examination reveals a lean man with tenderness upon deep palpation in the right upper quadrant. Blood testing reveals mild normochromic/normocytic anaemia and alanine aminotransferase (ALT) level raised to twice the upper limit of normal. Amylase and anti-gliadin antibodies are normal. Upper abdominal ultrasound is performed and there is diffuse pancreatic calcification, but nothing else of note.
Which diagnosis best fits this clinical picture?

MSRA-0748

A 45-year-old man presents to the Emergency Department with worsening epigastric pain and water brash for the past few weeks. He has been taking ibandronic acid tablets for osteoporosis. There is no history of food sticking or significant weight loss.
What is the most probable diagnosis?