MRCGP AKT Category: End Of Life

AKT-1793

A 27-year-old man was diagnosed with a melanoma six weeks after being referred to the Dermatology Department by his General Practitioner (GP). His friends call his GP, concerned that he has withdrawn to his room over the last four weeks, has stopped playing basketball, has appeared to lose weight, and has missed his hospital appointments. There is a letter in his medical records informing the practice that he has missed two surgery appointments.
He later attends the surgery with a friend. He is dressed scruffily and doesn’t make eye contact during your conversation. His Patient Health Questionnaire-9 score is 15.
What is the most likely diagnosis?

AKT-1794

An elderly patient has a terminal illness and it is likely that the end stage of this is approaching. The General Medical Council (GMC) has produced guidance concerning treatment and care of patients coming towards the end of life.
Which of the following options conforms to the principles described by the GMC regarding end-of-life care?

AKT-1779

A 65-year-old man has carcinoma of the prostate with metastases in bone. His adjusted serum calcium on routine testing on two occasions is 2.7 mmol/L (normal range 2.15-2.65 mmol/L). He has no symptoms to suggest hypercalcaemia. He still has a reasonable quality of life and is expected to live for several months more. He would prefer not to go into hospital.
Which of the following options is the most appropriate initial management for this patient?

AKT-1795

In a 78-year-old man with dementia, which feature is the LEAST suggestive of approaching end of life (within the next 12 months)?

AKT-1780

An 82-year-old man with advanced pancreatic cancer is experiencing widespread pruritus and has tried several emollients, including one with menthol. He is jaundiced and has declined a biliary stent. What is the next most suitable medication to try for his symptoms?

AKT-1796

A 66-year-old man presents to the General Practitioner with spinal pain. He has a history of bronchial carcinoma. Which of the following signs is LEAST indicative of spinal metastases?
Select ONE answer only.

AKT-1781

A 72-year-old man visits his General Practitioner, complaining of profound fatigue. This has developed during and since he completed adjuvant chemotherapy for prostate cancer. He finds that he is low in energy despite getting around seven hours of sleep a day.
Recent blood tests including a full blood count, prostate-specific antigen (PSA), thyroid function tests, vitamin D, iron studies and renal function are all normal. He requests advice on how he can address his symptoms.
What is the most appropriate advice to give this patient?

AKT-1782

A 70-year-old woman has terminal breast cancer. Her General Practitioner visits her at home. Until her diagnosis five years ago, she had no significant medical history. She is known to have liver metastases and is quite breathless. Her oxygen saturations are 92% in air, and her respiratory rate is 28 breaths per minute. She is alert, but very frail.
Which of the following treatments is most likely to be of benefit for this patient’s dyspnoea?

AKT-1783

A 55-year-old woman, who is receiving endocrine therapy for advanced breast cancer, presents to her General Practitioner complaining of fatigue. Clinical examination reveals no additional information. Sodium, potassium, calcium, magnesium and glucose levels, renal function, C-reactive protein, albumin levels and liver and thyroid function are all normal. A full blood count is also normal. She denies depression or any problem with sleep.
Which of the following is the most appropriate prescription?

AKT-1784

A 67-year-old man presents to the General Practitioner for a consultation. He has been diagnosed with lung cancer and is experiencing persistent minor haemoptysis which is causing him anxiety. He has also coughed up a larger amount of blood on one occasion. What is the most suitable initial treatment for his persistent bleeding?