MRCGP AKT Category: Cardiovascular Health

AKT-0163

A 48-year-old male attends a well man clinic.

On review of his history he has a strong family history of ischaemic heart disease and is a smoker of 10 cigarettes per day and drinks approximately 20 units of alcohol per week.

On examination, he is obese with a BMI of 32 kg/m2 and has a blood pressure of 152/88 mmHg.

His investigations reveal that he has a fasting plasma glucose of 10.5 mmol/L (3.0-6.0), HbA1c of 62 mmol/mol (20-46) and his cholesterol concentration is 5.5 mmol/L (<5.2). Which of the following would be expected to be most effective in reducing his cardiovascular (CV) risk?

AKT-0164

A patient with long-standing chronic obstructive pulmonary disease (COPD) who is in their 60s now presents with symptoms of right heart failure. Upon examination, they are in sinus rhythm but have peripheral edema, a raised JVP, and a loud pulmonary second heart sound. The diagnosis is cor pulmonale. What is the recommended treatment for right heart failure that develops as a result of lung disease?

AKT-0165

You see a 65-year-old man in a ‘hypertension review’ appointment. You have been struggling to control his blood pressure. He is now taking valsartan 320 mg (his initial ACE inhibitor, Perindopril, was stopped due to persistent coughing), amlodipine 10 mg and chlorthalidone 12.5 mg. He is also taking aspirin and simvastatin for primary prevention. His blood pressure today is 158/91. His recent renal function (done for annual hypertension) showed a sodium of 138, a potassium of 4.7, a urea of 4.2 and a creatinine of 80. His eGFR is 67. He is otherwise well in himself.

Which of the following options would be appropriate for him?

AKT-0134

A 65-year-old lady is on warfarin for stroke prevention in atrial fibrillation. She comes in with a significantly elevated INR. Which of the following drugs is the most probable cause?

AKT-0150

A 38-year-old man suffers a myocardial infarction (MI) and is prescribed aspirin, atorvastatin, ramipril and bisoprolol upon discharge. After a month, he experiences some muscle aches and undergoes routine blood tests at the clinic. His serum creatine kinase (CK) activity is found to be 650 u/l (normal range 30–300 u/l). What is the probable reason for the elevated CK levels in this individual?

AKT-0135

A 67-year-old lady with mitral valve disease and atrial fibrillation is on warfarin therapy. Recently, her INR levels have decreased, leading to an increase in the warfarin dosage. What new treatments could be responsible for this change?

AKT-0151

A 68-year-old man with a history of cardiovascular disease presents with worsening shortness of breath on exertion. You suspect left ventricular failure. Identify the single test that, if normal, would make the diagnosis of heart failure highly unlikely.

AKT-0136

A 42-year-old woman, who is a frequent IV drug user, presents with a 2-week history of intermittent fever and fatigue. During examination, her temperature is 38.5 °C, heart rate 84 bpm and blood pressure 126/72 mmHg. A soft pansystolic murmur is detected along the right sternal margin and there is an area of tenderness and cellulitis in the left groin.
What is the most suitable first step in managing this patient?

AKT-0152

Which treatment for hypercholesterolaemia in primary prevention trials has been shown to reduce all cause mortality?

AKT-0137

A 60-year-old woman undergoes successful DC cardioversion for atrial fibrillation (AF).
Select from the list the single factor that best predicts long-term maintenance of sinus rhythm following this procedure.