MRCGP AKT Category: End Of Life

AKT-1849

When administering diamorphine, which drug should be given using a separate syringe driver?

AKT-1834

You do a house call to see a middle-aged gentleman with advanced colon cancer. He has been complaining of a sore mouth, retrosternal discomfort and dysphagia over the last one week.

On examination he has obvious oral thrush.

Which of the following management plans is most appropriate?

AKT-1835

You are requested to evaluate an elderly patient with advanced esophageal cancer. The patient has metastatic cancer and is receiving palliative care with home visits. The patient reports increasing trouble in swallowing over the past few weeks, which is now hindering their ability to consume food properly. The patient describes the feeling of food getting stuck while swallowing. There is no pain while swallowing. What is the most suitable treatment to alleviate these symptoms?

AKT-1836

A 50-year-old woman has a fungating metastatic breast cancer and is increasingly distressed by the malodorous discharge from the affected breast, which is causing considerable social embarrassment.

From the list below, choose the single treatment which would help alleviate this symptom.

AKT-1837

A 55-year-old woman has lung cancer. She saw her oncologist one month ago who told her that the prognosis was poor and that she was unlikely to survive for more than a year.

Now she comes to see you with pains in her back. Her corrected calcium is 3.5 mmol/l.

The normal calcium range is around 2.2 to 2.6 millimoles per litre (mmol/L).

What should you do first?

AKT-1838

The district nurses request your presence for a home visit to assess a 42-year-old woman with a fungating squamous cell skin carcinoma. She is receiving palliative care due to widespread metastatic disease.
The nurses have been attending to the wound dressing multiple times a week, but have observed that the tumour has become malodorous. What topical medications could be beneficial in this situation?

AKT-1823

You are asked to prescribe a syringe driver for a palliative care patient with pain who is now struggling to swallow tablets.
Her pain has been well controlled on morphine sulphate tablets, 60 mg twice a day, and severadol (quick release morphine) 20 mg three times a day.
You decide to prescribe morphine, subcutaneously, via the syringe driver.
Which of the following dosing regime would be appropriate?

AKT-1824

A 76-year-old patient comes to you complaining of intense pain in their right shoulder. After an X-ray examination, it is discovered that they have a pathological fracture in their proximal humerus. Which primary solid tumor cancer groups are most prone to metastasizing to bone?

AKT-1825

You are asked to see a 64-year-old woman known to have breast cancer.
Her family has become worried as yesterday she seemed to be behaving ‘oddly’. They tell you that her behaviour has become inappropriate and that she has been walking around the house naked and been swearing a lot in conversation. Prior to yesterday she was her ‘usual self’.
The family also report that she seems to be passing urine and opening her bowels as per usual and that she has been eating and drinking fine.
Examination reveals that the patient is alert and uncomplaining. Temperature is 37.1°C, blood pressure is 118/78 mmHg and pulse rate is 86 regular. Systems examination doesn’t reveal anything acute aside from the patient swearing frequently and talking about inappropriate topics of conversation. Urine dipstick testing reveals ‘trace’ of blood and protein.
Which if the following investigations will confirm the underlying diagnosis?

AKT-1810

A 55-year-old man presents to his General Practitioner reporting ongoing distress following the sudden death of his wife 12 months ago following a cardiac arrest. He took three months off work to ‘deal with’ his wife’s death and then returned to his full-time role. He lives alone and reports that he has been unable to ‘bounce back’. He thinks of his wife’s death often and it distresses and distracts him. He has been sleeping poorly, has missed several shifts and was finally dismissed from his job. He feels isolated and a sense of responsibility that he did not ‘look after his wife’.
What is the most likely underlying diagnosis?