MRCGP AKT Category: End Of Life

AKT-1777

A 68-year-old man has metastatic prostate cancer. Because he is now experiencing excessive fatigue, some routine blood tests are performed.
Which of the following findings would raise the most concern?

AKT-1762

A 72-year-old man has prostate cancer with bony metastases. He is being treated with gonadorelin analogue injections and he feels reasonably well. He complains of excessive sweating, particularly at night, that often requires him to change clothes and bedding. This is a chronic problem.
Which of the following is the most likely cause of the patient’s presentation?

AKT-1778

A 63-year-old man currently under the care of local cancer services, and being treated with chemotherapy for Non-Hodgkin’s lymphoma, presents to the general practice clinic with a cough and sore throat, which have persisted for two days.
On examination, his temperature is 38.2 oC. His pulse is 88 bpm, while his blood pressure (BP) is 110/65 mmHg. His respiratory rate is 20 breaths per minute, while his oxygen saturations are 97% on air. He is alert and his chest examination is normal. He has no known allergies.
What is the most appropriate next step in this patient’s management?

AKT-1763

A 68-year-old woman in the terminal stages of cancer becomes delirious and restless.
Which of the following is the LEAST likely cause?

AKT-1764

A 60-year-old man is terminally ill with carcinoma of the pancreas. He has abdominal and back pain and his analgesic combination of full doses of paracetamol and codeine is no longer controlling this.
Which of the following is the most appropriate medication?

AKT-1765

For a person with a certain condition, what is the most probable prognostic indicator of nearing end of life (within 12 months)?

AKT-1766

A 58-year-old woman has terminal lung cancer. Her level of pain is sufficient to commence treatment with a strong opioid analgesic by mouth. Her only other medication is paracetamol 1 g 6-hourly.
Which of the following additional drugs should be routinely started at this stage?

AKT-1767

A 58-year-old man presents to the General Practitioner with mouth issues. He is currently undergoing chemotherapy for lung cancer. Upon examination, the doctor observes an ulcerated, erythematous, and sore mouth. The patient mentions that he can still consume solid food. What is the most probable reason for this patient’s symptoms?

AKT-1768

A 83-year-old woman is terminally ill with metastatic breast cancer. Her General Practitioner (GP) reviews her at her home, with her family present. There is a discussion around treatment escalation, and a ‘just-in-case box’ is prescribed. The GP explains that in the last days of life, a syringe driver may be helpful to control symptoms such as pain, agitation, breathlessness or nausea.
Which of the following drugs is suitable for continuous subcutaneous infusion?

AKT-1769

Which option represents good practice in end-of-life care for a Primary Healthcare Team from the following list?