MRCGP AKT Category: Cardiovascular Health

AKT-0429

During a late-night shift at an urgent care centre, you encounter a 30-year-old woman who complains of experiencing pain and swelling in her right leg for the past three days. She denies having chest pain or difficulty breathing and is currently taking the combined oral contraceptive pill.

Upon examination, you notice that her right leg is swollen and tender to the touch. Her heart rate and pulse oximetry are both normal. After calculating a Wells deep vein thrombosis (DVT) score of 2, you advise her to visit her GP surgery the next morning for urgent blood tests, including a d-dimer, and to be monitored by the duty GP at her practice. You also instruct her to stop taking her contraceptive pill in the meantime.

What would be the most appropriate course of action to take in this situation?

AKT-0430

A 67-year-old man who experiences Stokes-Adams attacks has received a pacemaker that is functioning properly. What guidance should he be provided regarding driving?

AKT-0415

A 56-year-old man with a history of smoking, obesity, prediabetes, and high cholesterol visits his GP complaining of chest pains that occur during physical activity or climbing stairs to his office. The pain is crushing in nature and subsides with rest. The patient is currently taking atorvastatin 20 mg and aspirin 75 mg daily. He has no chest pains at the time of the visit and is otherwise feeling well. Physical examination reveals no abnormalities. The GP prescribes a GTN spray for the chest pains and refers the patient to the rapid access chest pain clinic.

What other medication should be considered in addition to the GTN?

AKT-0431

A 67-year-old man who had a stroke 2 years ago is being evaluated. He was prescribed simvastatin 40 mg for secondary prevention of further cardiovascular disease after his diagnosis. A fasting lipid profile was conducted last week and the results are as follows:

Total cholesterol 5.2 mmol/l
HDL cholesterol 1.1 mmol/l
LDL cholesterol 4.0 mmol/l
Triglyceride 1.6 mmol/l

Based on the latest NICE guidelines, what is the most appropriate course of action?

AKT-0416

You are evaluating an 80-year-old patient who has recently been diagnosed with heart failure. Her left ventricular ejection fraction is 55%. She has been experiencing orthopnoea and ankle swelling. The cardiology team has referred her to you for medication initiation.

During the assessment, her vital signs are blood pressure 120/80 mmHg and heart rate 82/min.

What should be the initial consideration in her management?

AKT-0432

A 50-year-old man with a medical history of type II diabetes mellitus presents with hypertension on home blood pressure recordings (155/105 mmHg). His medical records indicate a recent hospitalization for pyelonephritis where he was diagnosed with renal artery stenosis. What is the most suitable medication to initiate for his hypertension management?

AKT-0417

A 14-year-old girl comes to the clinic complaining of repeated episodes of collapsing. She reports that these episodes happen suddenly while she is playing sports. The patient has no significant medical history or family history. During the physical examination, an ejection systolic murmur is detected. Her blood pressure is 106/70 mmHg, and her pulse is 78 beats per minute. What is the probable cause of her symptoms?

AKT-0418

A 56-year-old man comes in for a follow-up on his angina. Despite taking the maximum dose of atenolol, he still experiences chest discomfort during physical activity, which is hindering his daily routine. He wishes to explore other treatment options. He reports no chest pain at rest and his vital signs are within normal limits.

What would be the most suitable course of action for managing his condition?

AKT-0419

A 50-year-old man comes in for a check-up. He is of Afro-Caribbean heritage and has been on a daily dose of amlodipine 10 mg. Upon reviewing his blood pressure readings, it has been found that he has an average of 154/93 mmHg over the past 2 months. Today, his blood pressure is at 161/96 mmHg. The patient is eager to bring his blood pressure under control. What is the most effective treatment to initiate in this scenario?

AKT-0420

A 75-year-old male comes to the Emergency Department complaining of increased swelling in his right leg. He has a medical history of right-sided heart failure. During the examination, his right calf is found to be 3 cm larger than his left and he has bilateral pitting oedema up to the knee. A positive D-dimer result prompts the initiation of apixaban. However, an ultrasound scan of his leg comes back negative.

What would be the most suitable course of action?