MRCGP AKT Category: Cardiovascular Health

AKT-0346

Which of the following patients is most likely to have their actual risk of cardiovascular disease underestimated by QRISK2?

AKT-0347

An 80-year-old man who is currently taking warfarin inquires about the feasibility of switching to dabigatran to eliminate the requirement for regular INR testing.

What would be a contraindication to prescribing dabigatran in this scenario?

AKT-0332

A 48-year-old man comes to your GP clinic complaining of feeling generally unwell and lethargic. His wife notes that he has been eating less than usual and gets tired easily. He has a history of hypertension but no other significant medical history. He drinks alcohol socially and has a stressful job as a banker, which led him to start smoking 15 cigarettes a day for the past 13 years. He believes that work stress is the cause of his symptoms and asks for a recommendation for a counselor to help him manage it. What should be the next step?

AKT-0348

A 50-year-old woman is diagnosed with proximal deep vein thrombosis four weeks after being treated for a fractured femur caused by a motorcycle accident. She is prescribed warfarin (initially covered with low molecular weight heparin) with a target INR of 2.0-3.0.

What other treatment option should be offered to this patient in addition to warfarin?

AKT-0333

A 54-year-old man has scheduled a meeting to discuss his struggles with poor concentration and feeling sleepy while working. He works as a truck driver and frequently has to operate heavy machinery. His spouse has noticed that he experiences brief pauses in breathing while sleeping at night and occasionally makes choking sounds.

The patient is currently receiving treatment for hypertension and benign prostatic hyperplasia. His Epworth sleepiness scale score is 16.

Considering his condition, what is the best course of action for the patient to take regarding operating heavy machinery?

AKT-0349

A 72-year-old man presents with palpitations and feeling dizzy. An ECG reveals atrial fibrillation with a heart rate of 130 beats per minute. His blood pressure is within normal limits and there are no other notable findings upon examination of his cardiorespiratory system. He has a medical history of controlled asthma (treated with salbutamol and beclomethasone) and depression (managed with citalopram). He has been experiencing these symptoms for approximately three days. What is the most suitable medication for controlling his heart rate?

AKT-0334

You assess a 70-year-old man who has been diagnosed with hypertension during his annual review for chronic obstructive pulmonary disease (COPD). In the clinic, his blood pressure measures 170/100 mmHg, and you initiate treatment with amlodipine 5mg once daily. What guidance should you provide regarding driving?

AKT-0335

A 68-year-old man with lung cancer is diagnosed with deep vein thrombosis. He is seen in the hospital clinic and prescribed a direct oral anticoagulant (DOAC). What would be the best course of treatment?

AKT-0336

A 50-year-old man with high blood pressure visits his GP for a check-up. His blood pressure has been consistently high, with a reading of 154/82 during his last visit. The GP arranged for ambulatory blood pressure monitoring, which showed an average daytime blood pressure of 140/88 mmHg. Despite being on the highest dose of ramipril, his blood pressure remains elevated. What would be the most suitable second-line medication to add?

AKT-0337

You receive blood test results for a patient who has been taking atorvastatin 10 mg for secondary prevention of cardiovascular disease. The patient’s lipid profile before starting the medication was as follows: cholesterol 6.2 mmol/L, triglycerides 1.8 mmol/L, HDL cholesterol 1.2 mmol/L, LDL cholesterol 4.5 mmol/L, non HDL cholesterol 5.0 mmol/L, and total cholesterol/HDL ratio 5.2 mmol/L. The liver profile was also normal. After three months of treatment, the lipid profile results are as follows: cholesterol 4.8 mmol/L, triglycerides 1.5 mmol/L, HDL cholesterol 1.5 mmol/L, LDL cholesterol 2.8 mmol/L, non HDL cholesterol 3.3 mmol/L, and total cholesterol/HDL ratio 3.2 mmol/L. What is your recommended course of action based on these results?