MRCGP AKT Category: Cardiovascular Health

AKT-0148

A 25-year-old woman presents with recurrent syncope following aerobics classes. On examination, a systolic murmur is heard that worsens with the Valsalva manoeuvre and improves on squatting. What is the most probable diagnosis?

AKT-0133

A 50-year-old woman is visiting the clinic several months after experiencing a heart attack. She has been prescribed medications to lower her risk of cardiovascular disease and has made dietary changes to promote healthy living. However, she has recently reported experiencing muscle aches and pains and her CK levels are elevated. Which of the following foods or substances may have contributed to the increased risk of statin-related myotoxicity?

AKT-0149

What is true about jugular venous pulsation (JVP)?

AKT-0118

A 50-year-old lady comes to the clinic with tortuous, dilated, superficial leg veins. These have been present for a few years and do not cause any discomfort, but she is unhappy with their appearance.

Upon examination, there are no skin changes, leg ulcers, or signs of thrombophlebitis.

What is the MOST SUITABLE NEXT step in management?

AKT-0119

A 75-year-old gentleman with type 2 diabetes and angina is seen for review.

He has been known to have ischaemic heart disease for many years and has recently seen the cardiologists for outpatient review. Following this assessment he opted for medical management and they have optimised his bisoprolol dose. His current medications consist of:

Aspirin 75 mg daily

Ramipril 10 mg daily

Bisoprolol 10 mg daily

Simvastatin 40 mg daily, and

Tadalafil 5 mg daily.

He reports ongoing angina at least twice a week when out walking which dissipates quickly when he stops exerting himself. You discuss adding in further treatment to try and reduce his anginal symptoms.

Assuming that his current medication remains unchanged, which of the following is contraindicated in this gentleman as an add-on regular medication?

AKT-0120

A 35-year-old woman presents to her General Practitioner with a 3-year history of increasing dyspnoea with strenuous exercise. She has also had occasional chest pain on exertion.
On examination, she has an ejection systolic murmur. Following an examination and electrocardiogram (ECG) in primary care, she is referred for a cardiology review and hypertrophic cardiomyopathy is diagnosed.
Which of the following is the most appropriate screening method for her sister?

AKT-0121

A 40-year-old man comes to the clinic for a hypertension review, as recommended by the practice nurse. Despite taking ramipril 10 mg, amlodipine 5 mg, and atenolol 50 mg, his blood pressure remains elevated at 150/90 mmHg. Upon checking his U&E, his sodium level is 140, potassium level is 3.4, and creatinine level is 110. What is the most probable diagnosis?

AKT-0122

A 45-year-old male with type 2 diabetes is struggling to manage his hypertension. Despite being on atenolol, amlodipine, and ramipril, his blood pressure consistently reads above 170/100 mmHg. During examination, he was found to have grade II hypertensive retinopathy. His test results show sodium levels at 144 mmol/L (137-144), potassium at 3.1 mmol/L (3.5-4.9), urea at 5.5 mmol/L (2.5-7.5), creatinine at 100 mol/L (60-110), glucose at 7.9 mmol/L (3.0-6.0), and HbA1c at 53 mmol/mol (20-46) or 7% (3.8-6.4). Additionally, his ECG revealed left ventricular hypertrophy. What potential diagnosis should be considered as a cause of his resistant hypertension?

AKT-0123

A 72-year-old woman who is increasingly short of breath on exertion is found to have a 4/6 systolic murmur heard best on her right sternal edge.
What is the single most appropriate investigation?

AKT-0124

A 60-year-old businessman has noticed a constricting discomfort in his throat, left shoulder and arm for the past few weeks when he exercises at the gym. He stops exercising and it goes away within five minutes. He has taken glyceryl trinitrate and finds it relieves the pain. His blood pressure is 158/94 mmHg and examination of the cardiovascular system and upper limbs is normal. He smokes 20 cigarettes per day.
Which of the following investigations is most appropriate to confirm this patient’s most likely diagnosis?