MRCGP AKT Category: Cardiovascular Health

AKT-0395

A 70-year-old man comes in for his annual heart failure check-up. He reports feeling physically well and is able to perform all his daily activities without any chest symptoms.

All his vital signs are within normal limits, with a heart rate of 76 beats per minute and blood pressure of 135/80 mmHg. His weight has remained stable since his last visit.

During the examination, his pulse is regular, and his heart sounds are normal. There is no raised JVP, and his chest is clear. There is minimal pitting edema around both ankles.

Reviewing his heart failure medications, he is currently taking:

– Ramipril 10 mg once daily
– Bisoprolol 10 mg once daily
– Furosemide 40 mg once a day

Assuming there are no contraindications and with the patient’s consent, what would be the most appropriate next step to take during his review?

AKT-0396

A 68-year-old woman with a history of atrial fibrillation presents for a follow-up appointment. She recently experienced a transient ischemic attack and is currently taking bendroflumethiazide for hypertension. Her blood pressure at the appointment is 130/80 mmHg. As you discuss management options to decrease her risk of future strokes, what is her CHA2DS2-VASc score?

AKT-0397

A 67-year-old man with type 2 diabetes has recently been initiated on insulin therapy. He has a history of a heart attack 3 years ago and is currently taking a beta-blocker, calcium channel blocker, ace-inhibitor, statin, and GTN-spray. Which of his medications may cause a decreased recognition of hypoglycemic symptoms after starting insulin treatment?

AKT-0398

A 63-year-old male is being seen at the heart failure clinic by a nurse. Despite being treated with furosemide, bisoprolol, enalapril, and spironolactone, he experiences breathlessness with minimal exertion. Upon examination, there is minimal ankle edema and clear chest auscultation. Recent test results show sinus rhythm with a rate of 84 bpm on ECG, cardiomegaly with clear lung fields on chest x-ray, and an ejection fraction of 35% on echo. Isosorbide dinitrate with hydralazine was attempted but had to be discontinued due to side effects. What additional medication would be most effective in alleviating his symptoms?

AKT-0399

The nurse practitioner approaches you with a query after the clinic. A 50-year-old patient had visited her for a regular diabetes check-up and disclosed a history of a minor stroke during a trip abroad a few years ago. The nurse observed that this information was not included in the problem list, so she updated the record with a coded diagnosis. As a result, a computer alert was triggered since the patient was not taking any antiplatelet therapy. The nurse seeks your advice on the preferred antiplatelet medication for this patient.

AKT-0400

You have a phone review scheduled with Mrs. Johansson, a 55-year-old woman who has recently been diagnosed with hypertension, which had been detected during a routine check-up. Subsequent ambulatory home blood pressure monitoring showed an average home BP of 148/84 mmHg.

You arranged an ECG, urine albumin-creatinine ratio (ACR), and some blood tests, and scheduled the appointment to discuss the findings. The ACR and blood tests are within normal limits. The ECG shows sinus rhythm with a rate of 70 beats per minute. You entered her cholesterol results into a cardiovascular risk calculator, which estimates a 10-year CV risk of 6.5%.

What is the appropriate management plan for her hypertension?

AKT-0386

An 80 year old male underwent an ECG due to palpitations and was found to have AF with a heart rate of 76 bpm. Upon further evaluation, you determine that he has permanent AF and a history of hypertension. If there are no contraindications, what would be the most suitable initial step to take at this point?

AKT-0387

You are about to start a patient in their 70s on lisinopril for hypertension. Which one of the following conditions is most likely to increase the risk of side-effects?

AKT-0388

You assess a 62-year-old man who has been discharged after experiencing a ST-elevation myocardial infarction (MI) and receiving percutaneous coronary intervention. What is the appropriate timeframe for him to resume sexual activity after his MI?

AKT-0389

As a GP, what tests should be performed for an 80-year-old man with a history of atrial fibrillation who has been started on amiodarone?