MRCGP AKT Category: End Of Life

AKT-1818

Ms. Smith is a 62-year-old woman with lung cancer. She has a husband and two children; her son has been closely involved in decision making regarding her care throughout her illness and she has previously conferred Power of Attorney for Health and Welfare to him, whereas her daughter only visits very infrequently.
Ms. Smith has been very clear that she wishes not to receive artificial ventilation if she were to lose capacity. She is worried that her daughter will want to do anything she can to keep her alive. Therefore, Ms. Smith completed an Advance Decision to Refuse Treatment (ADRT) stating she wishes not to receive artificial ventilation at the end of life.
What conclusions can you draw regarding the ARDT?

AKT-1819

You are seeing a 58-year-old woman who has been diagnosed with early invasive breast cancer which is oestrogen-receptor-positive.

Her oncologist is treating her with anastrozole 1 mg daily.

Which one of the following is the most common side effect of anastrozole?

AKT-1820

You are conducting a cancer care assessment on an elderly woman with an advanced brain tumor. She has previously undergone radiotherapy and chemotherapy, but these treatments did not have a significant effect on her condition. Her primary concerns are vertigo and nausea.

Which antiemetic would be the most suitable to recommend?

AKT-1821

A 55-year-old woman has terminal breast cancer. She has liver metastases but her pain is well controlled.

Her main symptom, however, is anxiety. She feels nervous all the time and has a tremor. She says she feels tense about almost anything. She has read that beta blockers can help people like her and asks whether they would be worthwhile.

What symptoms are beta blockers most likely to alleviate in a 55-year-old woman with terminal breast cancer and anxiety?

AKT-1822

You are seeing a 65-year-old man with locally advanced prostate cancer which has been considered by his oncologist to be at a high risk of progression.

He is taking bicalutamide 150 mg daily.

What is the most common side effect of this medication?

AKT-1807

A 70-year-old man with advanced colonic cancer becomes cachectic. He is still living at home and is troubled by his lack of appetite and rapid weight loss. There are no obvious reversible problems (eg pain, medication, vomiting, reflux), and his examination shows no acute issues such as bowel obstruction. Blood tests are unremarkable, other than long-standing anaemia and low albumin levels.
Which of the following drugs is most likely to be beneficial for patients with anorexia/cachexia?

AKT-1808

A 78-year-old man with advanced pancreatic cancer is experiencing bothersome widespread pruritus. He is also jaundiced and has refused a biliary stent. Despite trying various emollients, including one with menthol, he has not found relief.
What medication would be the most suitable to test for this patient’s pruritus symptoms?
Choose ONE answer only.

AKT-1809

A 65-year-old man with advanced lung cancer is an inpatient in his local hospice for symptom control. He is currently unable to swallow medication. A General Practitioner (GP) who works at the hospice one day a week is on call when the patient has his first seizure. It has not resolved after five minutes. Resuscitation equipment is available and the GP is aware that the patient wants active treatment should a seizure occur at home or in the hospice but is not for admission to hospital.
Which of the following is the most appropriate management option?

AKT-1801

A 65-year-old man with pancreatic cancer comes to the clinic for a review of medication. He reports that his pain is no longer managed with paracetamol and 240 mg oral codeine per day. The doctor decides to initiate an opiate.
Which of the following is the most suitable choice?

AKT-1802

A 68-year-old man presents to the General Practitioner with worsening shortness of breath. He was recently diagnosed with small cell lung cancer and is awaiting treatment. On examination, he has a red face, stridor, dilated veins over his upper body and face, and swelling in his arms.

What is the most suitable course of action for managing his condition at this point?