Archives: MSRA

MSRA-0473

A 67-year-old woman is brought to the Emergency Department after being found near-unconscious by her husband. Her husband indicates that she has a long-term joint disorder for which she has been taking oral steroids for many years. She has recently been suffering from depression and has had poor compliance with medications.
On examination, she is responsive to pain. Her pulse is 130 beats per minute, and her blood pressure is 90/60 mmHg. She is afebrile.
Basic blood investigations reveal the following:
Investigation Patient Normal value
Haemoglobin (Hb) 121 g/l 135–175 g/l
White cell count (WCC) 6.1 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 233 × 109/l 150–400 × 109/l
Sodium (Na+) 129 mmol/l 135–145 mmol/l
Potassium (K+) 6.0 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 93 μmol/l 50–120 µmol/l
Glucose 2.7 mmol/l < 11.1 mmol/l (random)
What is the most likely diagnosis?

MSRA-0474

A 63-year-old man presents to his General Practitioner with a 1-month history of lethargy, extreme thirst and increased urinary frequency. Two days ago, he also started to experience a dull pain in his left flank, which seems to occasionally radiate down into his groin. He has also not opened his bowels for four days and he is usually fairly regular.
On examination, he is found to have a blood pressure of 115/85 mmHg. The rest of the examination is unremarkable.
Which of the following is the most likely diagnosis?

MSRA-0475

A 42-year-old woman visits her primary care physician complaining of sudden headaches accompanied by sweating and palpitations. During the examination, the patient appears anxious and has a pale complexion. Her blood pressure is measured at 230/190 mmHg, and a 24-hour urine collection shows elevated levels of catecholamines. What is the most probable reason for this woman’s hypertension?

MSRA-0476

A 35-year-old woman presents to her General Practitioner with headaches. Her blood pressure is 170/96 mmHg. Routine investigations reveal the following results:
Investigation Result Normal value
Sodium 148 mmol/l 137–144 mmol/l
Potassium 2.8 mmol/l 3.5–4.9 mmol/l
Chloride 103 mmol/l 95–107 mmol/l
The renin level is undetectable and aldosterone levels are raised. The urea and creatinine are normal.
Which of the following is the most likely cause of her hypertension?

MSRA-0477

A 21-year-old is brought unconscious to the Emergency Department. An alert ambulance attendant notes that the patient’s breath smells like fruit punch. The patient was found holding a glass containing a clear liquid, and the ambulance attendant had noted a syringe on the patient’s coffee table and a pool of vomit near the patient.
With which of the following would this presentation be most consistent?

MSRA-0478

A 70-year-old man with metastatic lung cancer visits the general practice clinic complaining of lethargy and nausea. His full blood count, thyroid function test, calcium and liver function tests all come back normal. However, his urea and electrolytes reveal significant hyponatraemia, while the rest of the results are normal. He has a reduced plasma osmolality and increased urine osmolality. He is haemodynamically stable and euvolaemic.
What is the most probable diagnosis from the options below?

MSRA-0479

A 35-year-old man presents to his General Practitioner with weight loss, dry eyes and palpitations. He reports feeling jittery and nervous for the past few weeks. Upon examination, a fine tremor, regular pulse of 105 bpm, exophthalmos and a moderate, smooth goitre are noted. The results of his thyroid function tests are as follows:
Investigation Result Normal Value
Thyroid-stimulating hormone (TSH) 0.03 mU/l 0.25–4.0 mU/l
Free T4 38.5 pmol/l 12.0–22.0 pmol/l
Free T3 11.8 pmol/l 3.1–6.8 pmol/l
Thyroid peroxidase (TPO) antibodies Positive
What is the most likely diagnosis?

MSRA-0480

A 35-year-old man presents with complaints of frequent headaches. He also admits to experiencing erectile dysfunction and decreased sex drive that has progressively worsened over the past six months. Visual field examination reveals a bitemporal hemianopia. Laboratory examination reveals an elevation in serum prolactin, while serum luteinizing hormone (LH) and testosterone are decreased.
What is the most probable diagnosis?

MSRA-0481

A 38-year-old woman visits her GP with complaints of weight gain and irregular menstrual cycles. She reports feeling weak and depressed. During the examination, the doctor notices multiple purplish striae on her abdomen and bruises on her lower extremities. Laboratory tests show normal thyroid hormone levels and TSH, but elevated cortisol secretion. If the patient has adrenal hyperfunction, what other symptom may also be present?

MSRA-0482

A 21-year-old female medical student, who is an insulin-dependent diabetic, went on a weekend trip to visit some friends at another university. She forgot to pack her insulin.
When she returned, she went to visit her General Practitioner.
Which of the following blood results would be expected?