Archives: MSRA

MSRA-0675

Samantha, 74, visits her doctor complaining of jaundice. She is also a heavy drinker, consuming around 30-35 units per week. During the examination, a palpable gallbladder is detected, but there is no history of abdominal pain. The doctor orders blood tests, and the results are as follows:
– Albumin: 28 g/L
– Alk Phos: 320 U/L
– ALT: 90 U/L
– Bilirubin: 100 umol/L
– INR: 1.5
– GGT: 120 U/L

What is the most likely diagnosis for Samantha?

MSRA-0676

A 14-year-old boy has arrived at the emergency department after overdosing on paracetamol. He has come in 3 days after taking the overdose due to feeling extremely ill. What liver disease patterns are most probable to be observed?

MSRA-0677

A 50-year-old man presents to the emergency department with an acutely swollen and tender abdomen. He reports that it has been happening over the past few days. The patient appears unkempt and denies any significant medical history, medications, or drug use. He admits to drinking but is unsure of the amount. Upon examination, his abdomen is distended with shifting dullness, he has approximately 10 blanching red spots on his upper chest, and has tortuous dilated veins on his abdomen. The following are his vital signs:

Temperature: 36.4ºC
Blood pressure: 134/87 mmHg
Heart rate: 94 beats/min
Respiratory rate: 12 breaths/min
Oxygen saturation: 98% on room air

What is the most appropriate medication to initiate in this scenario, given the probable diagnosis?

MSRA-0678

You are assessing an 80-year-old man who has a medical history of hypothyroidism, Parkinson’s disease, and depression. His conditions are well-managed with levothyroxine, co-careldopa, and citalopram. He reports experiencing symptoms indicative of gastroesophageal reflux disease. What medication should be avoided to manage his symptoms effectively?

MSRA-0679

What advice would you give a young man about his alcohol consumption?

MSRA-0680

A 50-year-old female with a history of Sjogren’s syndrome presents to the gastroenterology clinic with elevated liver function tests. She reports experiencing fatigue and itching that has worsened over the past 3 months. On physical examination, her abdomen is soft, nontender, and without any organ enlargement. Laboratory results show a low hemoglobin level, normal platelet count and white blood cell count, elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transferase levels, and positive anti-mitochondrial antibodies. What is the initial treatment recommended to halt the progression of her liver disease?

MSRA-0647

A 68-year-old man comes to the clinic complaining of intermittent swallowing difficulties for the past two years. His wife has noticed that he has bad breath and coughs at night. He has a history of type 2 diabetes mellitus but reports that he is generally healthy. Despite having a good appetite, his weight has remained stable. Upon clinical examination, no abnormalities are found. What is the probable diagnosis?

MSRA-0648

A 29-year-old woman presents to the Emergency Department with a history of chlamydia, low-grade fever, and worsening abdominal pain over the past 6 hours. She reports that the pain is most severe on the right side and radiates into her shoulder. The patient is a smoker with no known medical conditions and is currently taking Microgynon for contraception. Her vital signs are within normal limits, and on palpation of the abdomen, she experiences tenderness in the right upper quadrant. An abdominal ultrasound scan, urine dip, and beta-hCG test all come back normal. What is the most likely cause of this patient’s symptoms?

MSRA-0649

A 32-year-old man presents with a recent change in bowel habit and is scheduled for outpatient sigmoidoscopy. He reports passing 3 stools daily with some mucus but no blood. The patient is in good overall health, with stable vital signs and normal blood test results. He has no known allergies and is not taking any medications at present.

During the sigmoidoscopy, the patient is found to have localised proctitis, with no inflammation detected further up the gastrointestinal tract. Based on these findings, the patient is diagnosed with ulcerative colitis and receives appropriate counselling.

What would be the most effective drug management approach for this patient’s current symptoms?