Archives: MSRA

MSRA-0660

A 30-year-old woman visits her GP after a staging CT revealed the presence of gallstones in her gallbladder, following her recent diagnosis of renal cell carcinoma (RCC). She is interested in discussing the available management options. The patient reports no history of abdominal pain and is in good health otherwise. She is scheduled to undergo a left-sided nephrectomy for her RCC in three weeks. During the examination, the GP notes tenderness over the left flank, but no palpable masses. What is the appropriate course of action for this patient?

MSRA-0661

You perform a home visit on an 80-year-old man, whose son is concerned by increased confusion in the last 3 days. His past medical history includes mild cognitive impairment, ischaemic heart disease and diverticular disease.

When you arrive, he reports feeling well and denies any recent health problems. However, you suspect he may not be giving an accurate account of his health as he appears slightly confused about his surroundings.

During the examination, he complains of mild lower abdominal discomfort. On deep palpation, you feel a fullness in the left iliac fossa. All observations are within normal limits.

What is the most likely cause of this man’s confusion?

MSRA-0662

A 23-year-old woman visits the GP clinic to receive the results of her recent blood tests. She has been experiencing fatigue, bloating, and flatulence. The blood test results are as follows:

– Hb: 110 g/L (normal range for females: 115-160 g/L)
– Platelets: 201 * 10^9/L (normal range: 150-400 * 10^9/L)
– WBC: 10.2 * 10^9/L (normal range: 4.0-11.0 * 10^9/L)
– Ferritin: 25 ug/L (normal range: 15-200 ug/L)
– Deaminated gliadin IgG: 14 U/mL (normal range: <7 U/mL)
– Tissue transglutaminase IgA: 21 U/mL (normal range: <7 U/mL) What additional tests or criteria would be necessary to make a definitive diagnosis of her condition?

MSRA-0663

A 14-year-old girl presents to a gastroenterology clinic with a history of diarrhoea, bloating, and severe abdominal pain for the past 8 months. Her full blood count results are as follows:
Hb 118 g/L Male: (135-180)
Female: (115 – 160)
Platelets 190 * 109/L (150 – 400)
WBC 7.5 * 109/L (4.0 – 11.0)

What would be the most appropriate next investigation?

MSRA-0631

An 80-year-old man presents to the Emergency Department with a history of vomiting blood earlier in the day. What is the most significant factor indicating an upper gastrointestinal bleed?

MSRA-0632

A 62-year-old male presents to the liver clinic with persistently abnormal liver function tests over the past 2 months. He recently completed a course of co-amoxiclav for a respiratory tract infection. The patient has a history of intravenous drug use, hypertension, and type two diabetes mellitus. His BMI is 31 kg/m², and he consumes 15 units of alcohol per week. A liver ultrasound showed increased hepatic echogenicity. The following liver function tests and virology report were obtained:

– Bilirubin: 22 µmol/L (3 – 17)
– ALP: 118 u/L (30 – 100)
– ALT: 170 u/L (5 – 30)
– AST: 63 u/L (10 – 40)
– γGT: 52 u/L (8 – 60)
– Albumin: 32 g/L (35 – 50)
– HBsAg: Negative
– Anti-HBs: Positive
– Anti-HBc: Negative
– Anti-HCV: Negative
– HCV PCR: Negative

What is the most likely cause of this patient’s abnormal liver function tests?

MSRA-0633

As a healthcare professional, you are providing dietary recommendations to a middle-aged patient who has been diagnosed with type 2 diabetes mellitus and is struggling with obesity. According to the latest NICE guidelines, which of the following should not be promoted?

MSRA-0634

A 28-year-old female patient complains of symptoms that suggest coeliac disease. What is the primary test that should be employed for screening individuals with coeliac disease?

MSRA-0635

A 68-year-old man presents with persistent dyspepsia that is alleviated by omeprazole. He has been taking omeprazole 20 mg daily for the past 2 years. What is a drawback of using a proton-pump inhibitor (PPI) for an extended period of time?

MSRA-0636

A 57-year-old accountant has presented to her GP with a 5-day history of heartburn, nausea and a metallic taste in her mouth. She has a good appetite and has lost 2kg in the last month. She has a past medical history of hypertension, gastro-oesophageal reflux disease and osteoporosis. She takes amlodipine 5mg OD, risedronate 35 mg OD and lansoprazole 30 mg OD.

On examination, her abdomen is soft and nontender and there are no palpable masses. Her observations are normal.

What is the most appropriate management for this patient from the following options?