MRCGP AKT Category: End Of Life

AKT-1770

A 68-year-old man is evaluated after being bedridden due to severe heart failure and chronic obstructive pulmonary disease. He has been immobile in bed and his wife is struggling to care for him. During the examination, his blood pressure is 110/80 mmHg, heart rate is 85 bpm and regular. Bilateral crackles and wheezing are heard on chest auscultation, and he has pitting edema on both knees and over the sacrum. Which scoring system is utilized to assess his risk of developing pressure ulcers?

AKT-1771

An 80-year-old man complains to the palliative care team of increasing fatigue and breathlessness over the past four weeks. He is under their care and has ceased any active treatment; his preferred care plan is for symptom-related treatment only. He is living independently at home and has been reasonably well over the last six months.
On examination, he is pale, with a pulse of 96 bpm at rest. He becomes breathless after undressing for the examination. There is a palpable spleen.
Investigations:
Investigation Result Normal values
Haemoglobin (Hb) 66 g/l 130–175 g/l
White cell count (WCC) 1.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 34 × 109/l 150–400 × 109/l
Neutrophils 0.5 × 109/l 2.0–7.5 × 109/l
Lymphocytes 0.6 × 109/l 1.0–4.5 × 109/l
What is the most likely underlying diagnosis?

AKT-1772

The guidance produced by the General Medical Council (GMC) pertains to the treatment and care provided during the end of life. Which of the following options aligns best with this guidance?

AKT-1773

A 65-year-old woman presents to the General Practitioner with worsening symptoms over a brief period. She reports experiencing anorexia, thirst, nausea, constipation, and polyuria. The patient has a history of breast cancer and bone metastases. What is the most suitable investigation to determine the cause of her current condition? Choose ONE answer.

AKT-1774

A 68-year-old man is brought to the doctor by his wife because of a 2-week history of increasing confusion. He has advanced prostate cancer. He reports constipation, passing urine more frequently and feeling nauseous. He has no signs of infection, and urine testing is negative. He is taking ibuprofen and paracetamol for backache and receives gonadorelin analogue injections for his cancer, but takes no other medications. The clinical examination is unremarkable.
Which of the following is the most likely cause of this patient’s clinical presentation?

AKT-1743

A 51-year-old woman with motor neuron disease seeks guidance. She has come across the Mental Capacity Act and, after consulting with her spouse, has made the decision to decline ventilation if she experiences respiratory failure. What is the best course of action to take?

AKT-1759

A 50-year-old woman has metastatic breast cancer in her bones. Pain has been well controlled with modified-release morphine and she is still quite mobile. A palliative care nurse has given her a National Comprehensive Cancer Network (NCCN) Distress Thermometer for Patients. This is a visual analogue scale that records subjective distress on a scale of 0-10. She records 7-8 and most of this is recorded as being due to emotional issues (depression, nervousness, worry, loss of interest). She is assessed to have moderate depression with significant functional impairment. She declines psychological intervention, but would be happy to take medication.
Which of the following is the most appropriate medication?

AKT-1744

The director of a nearby assisted living facility reaches out to your practice to notify you of the sudden passing of an 80-year-old man. He had a medical history of hypertension, ischaemic heart disease, and advanced dementia. Your last interaction with him was during a home visit 2 months ago to discuss advanced care planning, which included avoiding hospitalization and establishing a do not resuscitate order.

What is the best course of action to take following his death?

AKT-1745

Which one of the following situations would not automatically require a doctor to contact the coroner to discuss the death?

AKT-1746

An 80-year-old patient passes away in a nursing home. You were familiar with her and are requested to fill out the death certificate. She has been experiencing a gradual decline over the past few weeks and died peacefully in her sleep. What could be a possible cause of death under certain conditions?