Archives: MSRA

MSRA-0197

A 45-year-old woman presents to the Emergency Department with a 2-day history of pleuritic chest pain. She states that this started in the evening and has gotten worse since then. The pain is central and seems to improve when she leans forward. She has a past medical history of hypertension.
An electrocardiogram (ECG) is performed which shows widespread concave ST-segment elevation and PR interval depression. Extensive investigations reveal no underlying cause.
Given the likely diagnosis, which of the following is the best treatment option?
Select the SINGLE best treatment option from the list below.

MSRA-0198

A 45-year-old otherwise healthy man presents to his General Practitioner (GP) with complaints of chest pain and shortness of breath on minimal exertion that have been worsening over the past few months. Investigations reveal normal angiogram and chest x-ray results, but an echocardiogram shows severe aortic stenosis. What is the most suitable management option?

MSRA-0199

A 45-year-old man with known permanent AF (atrial fibrillation) on warfarin has a fast, irregularly irregular pulse. He has no other past medical history. The ECG confirms AF with a rate of 132 beats/min. He is haemodynamically stable and well. He denies any history of palpitations, shortness of breath or syncope.
Which of the following is the most appropriate intervention?

MSRA-0200

A 65-year-old woman with a history of hypertension and heart failure presents with atrial fibrillation. She is stable with a ventricular rate of 70. Which of the following drug options would be the most suitable for her?

MSRA-0180

A 35-year-old man is being monitored by his general practitioner for primary prevention of cardiovascular disease. He is a smoker and has a strong family history of premature death from ischaemic heart disease. Following lifestyle modifications, his fasting cholesterol concentration is 7.2 mmol/l. Upon consulting the local guidelines, it is found that his Qrisk2 score is > 17%. What drug therapy would you recommend?

MSRA-0181

A 68-year-old man with hypertension has an annual review. He is medicated with amlodipine 10 mg once daily. He has never smoked and does not have diabetes. His past medical history is unremarkable. He has a blood pressure of 126/74 mmHg, total cholesterol:HDL-cholesterol ratio of 6.3, and QRISK2-2017 of 26.1%.
Target blood pressure in people aged <80 years, with treated hypertension: <140/90 mmHg.
Target blood pressure in people aged ≥80 years, with treated hypertension: <150/90 mmHg.
Total cholesterol: HDL-cholesterol ratio: high risk if >6.
You decide to initiate statin therapy for primary prevention of cerebrovascular disease (CVD).
Which of the following drugs is most appropriate for this patient?
Select the SINGLE drug from the slit below. Select ONE option only.

MSRA-0182

A 35-year-old woman visits her general practice surgery to discuss her plans to become pregnant. She is taking medication for hypertension but is otherwise fit and well. She has not had any previous pregnancies.
On examination, her blood pressure (BP) is 120/78 mmHg.
Which of the following drugs can this patient continue to take during pregnancy?

MSRA-0183

A 42-year-old woman is brought to the Emergency Room with a 3-day history of flu-like symptoms. She is now experiencing severe central chest pain that worsens with coughing and improves when she sits upright. Upon examination, she has a rapid heart rate and a temperature of 38.5 °C. A third heart sound is heard upon auscultation.
What is the probable cause of this patient’s chest pain?

MSRA-0184

A 32-year-old woman attends her booking appointment with the community midwife. She is at 14 weeks gestation in her second pregnancy. She has no underlying medical conditions.
Which of the following haemodynamic changes is most likely to present in this patient?

MSRA-0185

A 45-year-old man attends for a truck driver medical assessment. His blood pressure (BP) is noted to be 190/100 mmHg. He is a heavy drinker. He is feeling generally well in himself. You request blood tests:
Result Normal
Sodium (mmol/l) 138 135-145
Potassium (mmol/l) 4.0 3.5-5.0
Urea (mmol/l) 4.8 1.7-8.3
Creatinine (µmol/l) 152 59-104
You decide to perform a work-up to exclude a secondary cause for his hypertension. An ultrasound scan of the renal tract reveals a small atrophic left kidney.
Which of the following is the most likely diagnosis?