MRCGP AKT Category: Cardiovascular Health

AKT-0206

A 55-year-old man presents to the surgery with intermittent palpitations, occurring for approximately 60 minutes every five to six days.

Careful questioning reveals no clear precipitating factors, and he is otherwise an infrequent attender to the surgery. On examination, his BP is 140/80 mmHg, his pulse irregular at 100 bpm, but otherwise cardiovascular and respiratory examination is unremarkable.

You arrange for an ECG the following day with the practice nurse, which is normal.

What is the next most appropriate step?

AKT-0207

A 55-year-old man presents to his General Practitioner to discuss the uptitration of his medication as advised by cardiology. He suffered an anterior myocardial infarction (MI) four weeks ago. His history reveals that he is a smoker (20 per day for 30 years) and works in a sedentary office job, where he often works long days and eats ready meals to save time with food preparation.
On examination, his heart rate is 62 bpm and his blood pressure is 126/74 mmHg, body mass index (BMI) is 31. His bisoprolol is increased to 5 mg and ramipril to 7.5 mg.
Which of the following is the single non-pharmacological intervention that will be most helpful in reducing his risk of a future ischaemic event?

AKT-0208

A 67-year-old man with diabetes is seen for his annual check-up. He is generally in good health, but experiences occasional cramping in his calf after walking about a mile on flat ground. He continues to smoke five cigarettes per day. During the examination, his blood pressure is measured at 166/98 mmHg, with a pulse of 86 bpm and a BMI of 30.2. Neurological examination is normal, and his fundi appear normal. Examination of his peripheral circulation reveals absent foot pulses and weak popliteal pulses. He was started on antihypertensive therapy, and his U+Es were measured over a two-week period, with the following results:

Baseline:
Sodium – 138 mmol/L
Potassium – 4.6 mmol/L
Urea – 11.1 mmol/L
Creatinine – 138 µmol/L

2 weeks later:
Sodium – 140 mmol/L
Potassium – 5.0 mmol/L
Urea – 19.5 mmol/L
Creatinine – 310 µmol/L

Which class of antihypertensives is most likely responsible for this change?

AKT-0209

A 55-year-old male with diabetes is diagnosed with hypertension.

You discuss starting treatment and initiate ramipril at a dose of 1.25 mg daily. His recent blood test results show normal full blood count, renal function, liver function, thyroid function and fasting glucose.

His other medications are: metformin 500 mg TDS, gliclazide 80 mg OD and simvastatin 40 mg ON.

What blood test monitoring should next be performed?

AKT-0210

A 55-year-old woman suffers from angina and fibromyalgia. She finds ibuprofen more effective than simple analgesics for her fibromyalgia pain.
Select from the list the single true statement regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular disease.

AKT-0198

A patient is at highest risk of developing venous thromboembolism due to which of the following options? Please select only one.

AKT-0199

A man attends the surgery for an ‘MOT’ having just had his 55th birthday. He is keen to reduce his risk of cardiovascular disease and asks about being started on a ‘statin’.

He has no significant past medical history and takes no medication. His father had a ‘heart attack’ aged seventy, but his father was obese and a heavy smoker. There is no other family history of note. There is no suggestion of a familial lipid condition.

What is the most appropriate management approach at this point?

AKT-0200

Which Antihypertensive medication is banned for use by professional athletes?

AKT-0191

A 35-year-old man is referred by the practice nurse following a routine health check. He is a smoker with a strong family history of premature death from ischaemic heart disease. His fasting cholesterol concentration is 7.2 mmol/l and his estimated 10-year risk of a coronary heart disease event is >30%.
Select from the list the single most suitable management option in this patient.

AKT-0192

A 65-year-old gentleman, with stable schizophrenia and a penicillin allergy, had a routine ECG which showed a QTc interval of 420 ms. He takes oral quetiapine regularly. He was started on a course of clarithromycin for a recently suspected tonsillitis and has now recovered. He reported no new symptoms and was otherwise well. Blood tests including electrolytes were normal.

Which is the SINGLE MOST appropriate NEXT management step?