MRCGP AKT Category: Cardiovascular Health

AKT-0214

A 85-year-old gentleman with advanced dementia was found to have bradycardia during a routine medical check-up. The patient did not show any symptoms and his general examination was unremarkable. He is currently taking atorvastatin and galantamine. An ECG taken at rest showed sinus bradycardia with a rate of 56 beats per minute. Blood tests, including electrolytes, calcium, magnesium, and thyroid function, were all within normal limits.

What is the MOST APPROPRIATE NEXT step in management? Choose ONE option only.

AKT-0215

A 50-year-old woman, who has a history of atrial fibrillation and is receiving warfarin and digoxin, tells you that she has been feeling low lately and has been self medicating with St John’s wort which she bought from a health store.

Which of the following interactions can be anticipated between St John’s Wort and her current medication?

AKT-0216

A 60-year-old man meets the criteria for initiating statin therapy for CVD prevention. He reports a history of persistent unexplained generalised muscle pains and so a creatine kinase (CK) level is checked on a blood test prior to starting treatment.

The CK result comes back and it is four times the upper limit of normal.

What is the most appropriate management approach in this instance?

AKT-0217

You are evaluating a 65-year-old new patient to the clinic who has a history of established cardiovascular disease (CVD), having suffered a myocardial infarction 12 months ago.

Previously, he declined taking a statin due to concerns about potential side effects, but he has since researched the topic and is now open to the idea.

He currently takes aspirin 75 mg daily, ramipril 5 mg once daily, and bisoprolol 2.5 mg once daily. He has no other significant medical history. Recent blood tests indicate normal renal, liver, and thyroid function.

What is the most appropriate course of action for management at this stage?

AKT-0218

A 58-year-old male with stable angina complains of muscle aches and pains. He has been on simvastatin 40 mg daily, atenolol 50 mg daily, and aspirin 75 mg daily for two years. He was recently hospitalized for acute coronary syndrome and additional therapies were added. His CPK concentration is 820 IU/L (50-200). What is the most probable cause of his statin-related myopathy?

AKT-0219

A 40-year-old man has a mid-diastolic murmur best heard at the apex. There is no previous history of any abnormal cardiac findings.
Select from the list the single most likely explanation of this murmur.

AKT-0220

A 56-year-old patient has recently been diagnosed with heart failure. Choose from the options the medical condition that would most likely prevent the use of ß-blockers in this patient.

AKT-0221

A 65-year-old man presents for review. He has been recently diagnosed with congestive heart failure. Currently, he takes digoxin 0.25 mg daily, furosemide 40 mg daily and amiloride 5 mg daily.

Routine laboratory studies are normal except for a blood urea of 8 mmol/l (2.5-7.5) and a serum creatinine of 110 μmol/L (60-110).

One month later, the patient continues to have dyspnoea and orthopnoea and has noted a 4 kg reduction in weight. His pulse rate is 96 per minute, blood pressure is 132/78 mmHg. Physical examination is unchanged except for reduced crackles, JVP is no longer visible and there is no ankle oedema.

Repeat investigations show:

Urea 10.5 mmol/L (2.5-7.5)

Creatinine 120 µmol/L (60-110)

Sodium 135 mmol/L (137-144)

Potassium 3.5 mmol/L (3.5-4.9)

Digoxin concentration within therapeutic range.

What would be the next most appropriate change to make to his medication?

AKT-0222

A 72-year-old man who rarely visits the clinic presents with several weeks of orthopnoea, paroxysmal nocturnal dyspnoea, and swollen ankles. His wife brings him in for examination. On assessment, he has bilateral basal crepitations and a resting heart rate of 110 beats per minute. An ECG shows sinus rhythm. Echocardiography confirms a diagnosis of heart failure. Despite receiving optimal doses of an ACE inhibitor and furosemide, he remains symptomatic and tachycardic.
Which of the following statements is the most accurate regarding his further management?

AKT-0223

You are reviewing current guidance in relation to the use of non-HDL cholesterol measurement with regards lipid modification therapy for cardiovascular disease prevention.
Which of the following lipoproteins contribute to ‘non-HDL cholesterol’?

You are reviewing current guidance in relation to the use of non-HDL cholesterol measurement with regards lipid modification therapy for cardiovascular disease prevention.

Which of the following lipoproteins contribute to ‘non-HDL cholesterol’?