MSRA-0447
What is the most probable adverse effect experienced by patients who are taking gliclazide?
Archives: MSRA
MSRA-0448
A 45-year-old woman presents to her general practitioner with a complaint of feeling tired and lethargic for the past six months. She also reports a weight gain of approximately 10 kg during this time. Upon conducting a blood test, the following results were obtained: Hb 141 g/l, Na+ 141 mmol/l, Bilirubin 7 µmol/l, Platelets 331 * 109/l, K+ 4.1 mmol/l, ALP 71 u/l, WBC 4.6 * 109/l, Urea 3.9 mmol/l, ALT 31 u/l, Neuts 3.1 * 109/l, Creatinine 86 µmol/l, γGT 51 u/l, Lymphs 1.2 * 109/l, TSH 0.1 mu/l, Albumin 41 g/l, Eosin 0.2 * 109/l, free-T4 3 nmol/l, and CRP 4.1 mg/l. What would be the most appropriate next investigation to determine the cause of her fatigue?
MSRA-0449
A 45-year-old man has been referred by his GP due to a history of uncontrolled hypertension. He has come in today to undergo an aldosterone: renin ratio test. The results indicate high levels of aldosterone and low levels of renin. Additionally, a CT scan has revealed bilateral adrenal gland hyperplasia.
What is the recommended management plan for this patient?
MSRA-0450
A 42-year-old man is being evaluated for possible diabetes mellitus and undergoes an oral glucose tolerance test using the standard WHO protocol. The results are as follows:
Time (hours) Blood glucose (mmol/l)
0 5.9
2 8.2
What is the interpretation of these findings?
MSRA-0451
A 25-year-old homeless man presents to the emergency department with altered consciousness and abdominal pain after being intoxicated a few hours prior. He has a history of alcohol and overdose admissions.
On examination:
A – Airway is clear.
B – Respiratory rate is 34 breaths per minute with deep labored inspiration. Oxygen saturation is 100%.
C – Heart rate is 124 beats per minute, blood pressure is 95/62 mmHg, and capillary refill is 4 seconds. Mucous membranes are dry.
D – Glasgow Coma Scale score is 10.
Lab results show a pH of 7.18 (normal range: 7.35-7.45), pCO2 of 4.3kPa (normal range: 4.5-6.0kPa), bicarbonate of 14 mmol/L (normal range: 22-28 mmol/L), glucose of 22.3mmol/L, and ketones of 4.5mmol/L.
What is the most likely diagnosis?
MSRA-0430
As the on-call FY2 covering the wards, you are asked to assess a 55-year-old woman who was admitted yesterday with community-acquired left basal pneumonia. Over the past 12 hours, she has deteriorated significantly with a temperature of 40.5ºC, blood pressure 160/95 mmHg, and heart rate of 130 bpm. On examination, she appears jaundiced, agitated, and confused. Her medical history includes hayfever and Graves’ disease, but she has been generally healthy otherwise. What is the most important initial treatment to start for this patient, given the likely diagnosis?
MSRA-0431
A 27-year-old female patient complains of tremors and excessive sweating. Upon conducting thyroid function tests, the results are as follows:
TSH <0.05 mU/l
Free T4 25 pmol/l
What is the leading cause of this clinical presentation?
MSRA-0432
A 70-year-old man with a history of hypothyroidism is admitted to the Emergency Department after experiencing chest pain. He is diagnosed with acute coronary syndrome and iron-deficiency anemia. A percutaneous coronary intervention is performed, and a coronary artery stent is inserted. Endoscopies of the upper and lower gastrointestinal tract are performed and reported as normal. Upon discharge, he is prescribed aspirin, clopidogrel, ramipril, lansoprazole, simvastatin, and ferrous sulfate in addition to his regular levothyroxine. Six weeks later, he reports feeling constantly fatigued to his GP, who orders routine blood tests. The results show a TSH level of 8.2 mu/l, which is elevated compared to the patient’s previous two years of TSH levels within range. Which of the newly prescribed drugs is most likely responsible for the raised TSH?
MSRA-0433
A 35-year-old woman has recently undergone blood monitoring for hypothyroidism. She is currently on a 100 micrograms dose of levothyroxine and her last blood tests showed normal levels of thyroid-stimulating hormone (TSH) and free thyroxine (ft4). However, her TSH has now risen to 8mU/L with ft4 slightly below the reference range. The patient confirms that she has been taking her levothyroxine as prescribed. You decide to review her recent medications to identify any potential causes for the suboptimal hypothyroidism treatment. What new medication could be responsible for this?
MSRA-0434
Which of the following outcomes confirms a diagnosis of diabetes mellitus?