Archives: MSRA

MSRA-0690

A 50-year-old man visits his doctor with concerns about his recent private medical screening test results. His liver function tests have shown abnormalities, but he has no symptoms and is generally healthy. He admits to consuming approximately 40 units of alcohol per week. The following are his blood test results:
– Bilirubin: 21 µmol/l
– ALP: 100 u/l
– ALT: 67 u/l
– γGT: 110 u/l
– Albumin: 40 g/l
Other blood tests, including FBC, U&Es, and fasting glucose, were normal. An ultrasound of his liver revealed fatty changes. His liver screen showed:
– Hepatitis B: Negative
– Hepatitis C: Negative
– Serum ferritin: 550 microg/L (normal range: 25-300 microg/L)
– Immunoglobulins: Normal
– Transferrin saturation: 41% (normal range: <50%) What is the most likely underlying cause of the elevated ferritin levels?

MSRA-0691

A 28-year-old woman comes in for a check-up. She reports having ‘IBS’ and experiencing occasional episodes of abdominal pain, bloating, and loose stools for the past two years. However, her symptoms have worsened significantly over the past two weeks. She is now having 3-4 watery, grey, ‘frothy’ stools per day, along with increased abdominal bloating, cramps, and flatulence. She also feels that she has lost weight based on the fit of her clothes. The following blood tests are ordered:
Hb 10.9 g/dl
Platelets 199 * 109/l
WBC 7.2 * 109/l
Ferritin 15 ng/ml
Vitamin B12 225 ng/l
Folate 2.1 nmol/l
What is the most likely diagnosis?

MSRA-0692

Primary biliary cholangitis is most commonly associated with middle-aged women and which specific antibodies?

MSRA-0693

A 40-year-old woman with amyotrophic lateral sclerosis is in a meeting with her clinical team to discuss her ongoing care. The team notes that she has been experiencing weight loss and increased fatigue. The patient reports struggling with chewing and swallowing food, even when it has been mashed or pureed. What is the most suitable long-term management plan for this patient?

MSRA-0694

A 30-year-old woman presents with a complaint of epigastric pain after meals for the past 2 months. She has no significant medical history and is not currently taking any medications. Despite trying gaviscon, her symptoms have not improved. What is the most suitable course of action for management?

MSRA-0695

A previously healthy 26-year-old female complains of profuse diarrhoea and is worried after observing bright red blood in her stool. She has been feeling unwell for the past four days and denies consuming any unusual food, although she did attend a barbecue five days ago. What is the most probable organism responsible for her symptoms?

MSRA-0696

A 56-year-old woman complains of dysphagia for the past 3 months, affecting both solids and liquids, accompanied by heartburn symptoms. What could be the probable underlying diagnosis?

MSRA-0697

A 72-year-old woman with a history of atrial fibrillation presents with abdominal pain and bloody diarrhoea. During examination, her temperature is 37.8ºC, pulse 102 / min, and respiratory rate 30 / min. She has generalised guarding and tenderness in her abdomen. Blood tests reveal the following results: Hb 10.9 g/dl, MCV 76 fl, Plt 348 * 109/l, WBC 23.4 * 109/l, Na+ 141 mmol/l, K+ 5.0 mmol/l, Bicarbonate 14 mmol/l, Urea 8.0 mmol/l, and Creatinine 118 µmol/l. What is the most probable diagnosis?

MSRA-0698

A 64-year-old man comes to his GP complaining of pain when swallowing for the past 2 months. He works as a construction worker and has had two colds in the past 2 months since the new building project started – despite his cold symptoms resolving, he reports an ongoing painful swallow. He has noticed some hoarseness in his voice, but attributes this to drinking less water than usual due to his painful swallow. He has no past medical history. He has a 25 pack-year smoking history and does not drink alcohol.
What should be the GP’s next course of action?

MSRA-0699

A 54-year-old man presents to your clinic after a routine blood test showed abnormal liver function tests. He denies any alcohol consumption and his hepatitis screen is negative. His cholesterol level is 4.2 and his HBA1c is 38ml/mol. He has a body mass index of 31 kg/m² and an ultrasound reveals non-alcoholic fatty liver disease. What is the most suitable approach to manage this condition?