MRCGP AKT Category: Cardiovascular Health

AKT-0250

A 45-year-old woman presents to her General Practitioner with a 3-month history of progressive exercise intolerance. Four weeks ago, she experienced an episode suggestive of paroxysmal nocturnal dyspnoea. Examination reveals a jugular venous pressure (JVP) raised up to her earlobes, soft, tender hepatomegaly and bilateral pitting oedema up to her ankles. Chest examination reveals bibasal crepitations and an audible S3 on auscultation of the heart. The chest X-ray shows cardiomegaly with interstitial infiltrates. Echocardiography shows global left ventricular hypokinesia with an ejection fraction of 20–25%. She has no other significant medical history.
Which of the following is the most likely underlying causal factor in this patient?

AKT-0251

A 55-year-old man visits his General Practitioner after undergoing primary coronary angioplasty for a non-ST elevation myocardial infarction. He has been informed that he has a drug-eluting stent and is worried about potential negative consequences.
What is accurate regarding these stents?

AKT-0252

Which patient with cardiac issues would you deem suitable for air travel?

AKT-0253

A 60-year-old man with no medication history comes in with three high blood pressure readings of 155/95 mmHg, 160/100 mmHg, and 164/85 mmHg.

What is the probable diagnosis?

AKT-0254

A 55-year-old woman presents to you for a follow-up blood pressure check. She has been evaluated by two other physicians in the past three months, with readings of 140/90 mmHg and 148/86 mmHg. Her current blood pressure is 142/84 mmHg. She has no familial history of hypertension, her BMI is 23, and she is a non-smoker. Based on the most recent NICE recommendations, what is the recommended course of action?

AKT-0255

What is the only true statement about high blood pressure from the given list?

AKT-0256

A 6-year-old boy is found to have a systolic murmur.
Select from the list the single feature that would be most suggestive of this being an innocent murmur.

AKT-0257

A 65-year-old woman presents to the General Practitioner with intermittent cramp-like pain in the buttock, thigh and calf. The symptoms are worse on walking and relieved by rest. She had a stent placed in her coronary artery three years ago. On examination, both legs are of normal colour, but the pedal pulses are difficult to palpate. Sensation is mildly reduced in the right foot.

What is the most suitable course of action?

AKT-0258

A 72-year-old man presents with intermittent bilateral calf pain that occurs when walking. He has a medical history of type II diabetes mellitus, hypertension, and a past myocardial infarction (MI). What additional feature, commonly seen in patients with intermittent claudication, would be present in this case?

AKT-0243

A 35-year-old woman of African origin comes in for a routine health check. She is a non-smoker, drinks 14 units of alcohol per week, is physically fit, active, and enjoys regular moderate exercise and a balanced diet. Her BMI is 26.8 kg/m2. Her average BP measured by home monitoring for 7 days is 160/95.
What is the most suitable initial course of action?