MRCGP AKT Category: Cardiovascular Health

AKT-0325

An 85-year-old man is seen in the hypertension clinic with a blood pressure reading of 144/86 mmHg, consistent with recent readings. His annual blood work shows:

– Na+ 141 mmol/l
– K+ 4.1 mmol/l
– Urea 7.2 mmol/l
– Creatinine 95 µmol/l
– HbA1c 39 mmol/mol (5.7%)
– Total cholesterol 4.3 mmol/l
– HDL 1.0 mmol/l

He is currently taking ramipril 10 mg od, indapamide MR 1.5 mg od, amlodipine 10 mg od, and simvastatin 20 mg on. As his healthcare provider, which change, if any, should you discuss with the patient?

AKT-0310

How long should a patient refrain from driving after undergoing an elective cardiac angioplasty?

AKT-0311

A 56-year-old man is admitted with ST elevation myocardial infarction and treated with thrombolysis but no angioplasty. What guidance should he receive regarding driving?

AKT-0312

A 58-year-old man presents to the rapid access transient ischaemic attack clinic after experiencing three episodes of transient left-sided weakness in the past two weeks. What advice should be given regarding driving?

AKT-0313

A 57-year-old bus driver presents for his yearly hypertension evaluation. What are the regulations of DVLA regarding hypertension for Group 2 operators?

AKT-0314

The following patients all attend for a medication review in your afternoon clinic. They all have atrial fibrillation (AF) and are taking multiple medications.

Which patient should discontinue anticoagulation?

AKT-0301

An 80-year-old man comes to the clinic complaining of occasional palpitations without any accompanying chest pain, shortness of breath, or lightheadedness. He has no notable medical history and is not taking any medications at present. Physical examination and vital signs are normal except for an irregular heartbeat, which is later diagnosed as atrial fibrillation. What is the suggested preventive therapy for a stroke?

AKT-0302

A 65-year-old patient presents at the local walk-in centre with central crushing chest pain. The nurse immediately calls 999 and performs an ECG which reveals ST elevation in leads II, III and aVF. The patient’s blood pressure is 130/70 mmHg, pulse rate is 90 beats per minute, and oxygen saturation is 96%. What is the most suitable course of action to take while waiting for the ambulance to arrive?

AKT-0303

Mr. Johnson is brought into the clinic by his son, Mark, who is concerned about his father’s uncontrolled blood pressure (BP). Mr. Johnson has mild vascular dementia and Mark understands the importance of managing cardiovascular risk factors in this condition.

They have brought some home BP readings which are consistently around 155/85 mmHg. You review Mr. Johnson’s medication list and see that he is prescribed ramipril 10 mg and indapamide 2.5mg. He had previously experienced ankle swelling with amlodipine, so it was discontinued. You consider the possibility of non-compliance, but Mark assures you that he reminds his father to take his medications every day.

You measure Mr. Johnson’s BP in both arms and find it to be 160/90 mmHg. A standing BP is lower, at 138/80 mmHg, and Mr. Johnson reports no symptoms of dizziness or fainting. His pulse is 84 and regular. You review his recent blood tests and note that his potassium level is 3.7mmol/L.

What is the appropriate treatment for Mr. Johnson’s hypertension?

AKT-0304

A 68-year-old patient has a cholesterol level of 5.1 mmol/L and a QRISK score of 11%. They lead an active lifestyle and have no significant medical history. What is the best course of action for managing these findings?