MRCGP AKT Category: Cardiovascular Health

AKT-0108

An 80-year-old man presents to the clinic with complaints of recurrent falls and syncopal attacks. He reports that a few of these episodes have occurred while he was getting dressed for church, putting on his shirt and tie; others have happened while he was out shopping, and one at the church itself. He explains that sometimes he doesn’t actually lose consciousness, but just feels extremely dizzy, and on other occasions he passes out completely.

The patient has a medical history of hypertension, which is being managed with amlodipine, and dyslipidaemia, for which he takes 10 mg of atorvastatin. On examination, his blood pressure is 150/88, his pulse is 65 and regular, and his heart sounds are normal. His chest is clear.

Investigations reveal a haemoglobin level of 130 g/L (135-180), a white cell count of 4.9 ×109/L (4-10), platelets of 222 ×109/L (150-400), sodium of 139 mmol/L (134-143), potassium of 5.0 mmol/L (3.5-5), and creatinine of 139 μmol/L (60-120). His ECG shows sinus rhythm with an inferior lead Q wave (lead III only), and a 72-hour ECG doesn’t identify any significant rhythm disturbance.

What is the most likely diagnosis?

AKT-0109

A 60-year-old man is known to have high blood pressure.
Choose from the options the one drug that is expected to increase his blood pressure even more.

AKT-0110

A 65-year-old man comes to the clinic with a diastolic murmur that is most audible at the left sternal edge. The apex beat is also displaced outwards. What condition is commonly associated with these symptoms?

AKT-0111

A 72-year-old man presents as he has suffered two episodes of syncope in the past three weeks and is feeling increasingly tired. On examination, his pulse is 40 bpm and his BP 100/60 mmHg. An ECG reveals he is in complete heart block.
What other finding are you most likely to find?

AKT-0101

A 59-year-old male is referred to you from the practice nurse after an ECG shows he is in atrial fibrillation.

When you take a history from him he complains of palpitations and he has also noticed some weight loss over the last two months. On examination, he has an irregularly irregular pulse and displays a fine tremor.

What is the next most appropriate investigation to perform?

AKT-0087

A patient who is 65 years old calls you from overseas. He was recently discharged from a hospital in Spain after experiencing a heart attack. The hospital did not report any complications and he did not undergo a percutaneous coronary intervention. What is the minimum amount of time he should wait before flying back home?

AKT-0088

You are requested to finalize a medical report for a patient who has applied for life insurance. Two years ago, he began treatment for hypertension but stopped taking medication eight months later due to adverse reactions. His latest blood pressure reading is 154/92 mmHg. During the patient’s visit to your clinic, he requests that you omit any reference to hypertension as everything appears to be fine now. What is the best course of action?

AKT-0089

A 78-year-old gentleman visited his GP last week and was referred for 24 hour ambulatory blood pressure monitoring. The results showed a daytime average of 144/82 mmHg. He is currently taking amlodipine 10 mg once a day and ramipril 10 mg once a day. What would be the best course of action for managing this patient?

AKT-0090

A 65-year-old woman came to the clinic with a complaint of intermittent swelling of her tongue and face that has been occurring for the past ten weeks. The episodes last for 36 hours and then resolve on their own. She has tried taking oral antihistamines but they did not help. Her medical history is significant for hypertension which was diagnosed and treated with appropriate medications six months ago. There is no other relevant medical or family history. What medication is most likely causing her symptoms?

AKT-0091

A 65-year-old lady presents with a brief history of sudden onset severe left lower limb pain lasting for three hours. The pain started while she was at rest and there was no history of injury or any previous leg or calf pain.
Upon examination, her pulse rate is irregular and measures 92 bpm. The left lower limb is cold and immobile with decreased sensation. No pulses can be felt from the level of the femoral pulse downwards in the left leg, but all pulses are palpable on the right. There are no abdominal masses or bruits, and chest auscultation is normal.
What is the probable diagnosis?