MRCGP AKT Category: Cardiovascular Health

AKT-0368

A 67-year-old man presents for follow-up. He has a medical history of small cell lung cancer and ischemic heart disease. His cancer was detected five months ago and he recently finished a round of chemotherapy. In terms of his heart health, he experienced a heart attack two years ago and underwent primary angioplasty with stent placement. He has not had any angina since then.

Over the past week, he has been experiencing increasing shortness of breath, particularly at night, and has an occasional non-productive cough. He has also noticed that his wedding ring feels tight. Upon examination, his chest appears normal, but he does have distended neck veins and periorbital edema. What is the most probable diagnosis?

AKT-0353

A 55-year-old man with Tourette’s and poorly controlled type 2 diabetes presents to you with concerns about intermittent chest pain on exertion. He drinks 21 units of alcohol per week and smokes 20 cigarettes a day. His father died of a myocardial infarction at the age of 56 years. You refer him for suspected angina, provide advice on what to do if he experiences chest pain, and prescribe a GTN spray for use as needed. While prescribing the GTN spray, you notice a medication on his prescription list that he should avoid taking while being investigated for chest pain or using the GTN spray. What medication is this referring to?

AKT-0354

A 65-year-old Indian man with recently diagnosed atrial fibrillation is started on warfarin. He visits the GP clinic after 5 days with unexplained bruising. His INR is measured and found to be 4.5. He has a medical history of epilepsy, depression, substance abuse, and homelessness. Which medication is the most probable cause of his bruising from the following options?

AKT-0355

A 70-year-old man with a medical history of chronic heart failure due to ischaemic cardiomyopathy is being evaluated. He was released from the hospital two weeks ago after experiencing a heart attack. An echocardiogram conducted during his hospitalization revealed a left ventricular ejection fraction of 40%, but no valve abnormalities were detected.

Despite his current regimen of furosemide, ramipril, carvedilol, aspirin, and simvastatin, he continues to experience shortness of breath with minimal exertion, such as walking 30 meters. On examination, his chest is clear, and there is minimal peripheral edema. What is the most appropriate next step in managing his condition?

AKT-0356

A 38-year-old man presents to clinic for a routine check-up. He is concerned about his risk for heart disease as his father had a heart attack at the age of 50. He reports a non-smoking history, a blood pressure of 128/82 mmHg, and a body mass index of 25 kg/m.

His recent blood work reveals the following results:

– Sodium: 142 mmol/L
– Potassium: 3.8 mmol/L
– Urea: 5.2 mmol/L
– Creatinine: 78 mol/L
– Total cholesterol: 6.8 mmol/L
– HDL cholesterol: 1.3 mmol/L
– LDL cholesterol: 4.5 mmol/L
– Triglycerides: 1.2 mmol/L
– Fasting glucose: 5.1 mmol/L

Based on these results, his QRISK2 score is calculated to be 3.5%. What is the most appropriate plan of action for this patient?

AKT-0357

The use of beta-blockers in treating hypertension has decreased significantly over the last half-decade. What are the primary factors contributing to this decline?

AKT-0342

A 72-year-old woman is being seen for a routine medical check-up at her new GP practice. During the examination, her blood pressure is found to be 146/94 mmHg, which is confirmed on a second reading. According to the latest NICE recommendations, what would be the most suitable course of action?

AKT-0343

Samantha is a 64-year-old woman who presents to you with a new-onset headache that started 3 weeks ago. Samantha’s medical history includes type 2 diabetes and hypercholesterolaemia, and she has a body mass index of 29 kg/m².

During your examination, you measure Samantha’s blood pressure which is 190/118 mmHg. A repeat reading shows 186/116 mmHg. Upon conducting fundoscopy, you observe evidence of retinal haemorrhage.

What would be the most appropriate initial management?

AKT-0344

A patient with a history of heart failure experiences mild physical activity limitations. While at rest, she is comfortable, but everyday tasks like walking to nearby stores cause fatigue, palpitations, or dyspnea. Which New York Heart Association class accurately characterizes the extent of her condition?

AKT-0345

An 80-year-old man with a history of hypertension and ischaemic heart disease comes for a check-up. He had a heart attack two decades ago but has been stable since then. His current medications include bisoprolol, ramipril, atorvastatin, and clopidogrel. He has been experiencing dizziness lately, and an ECG reveals that he has atrial fibrillation. What is the appropriate antithrombotic medication for him now?