Archives: MRCGP AKT

AKT-4733

You are reviewing routine blood test results for Maria, who is a 68-year-old Hispanic female. Her HbA1c has come back as 56mmol/mol. Her previous result for HbA1c was 44 mmol/mol. Maria has a past medical history of hypertension and hypercholesterolaemia and her body mass index is 32kg/m².

You have a telephone consultation with Maria. She tells you that she feels well in herself and has no symptoms of thirst, weight loss or recurrent infection.

What is the most appropriate information to give to Maria?

AKT-4736

A 55-year-old male with a history of osteoarthritis and psoriasis has recently been diagnosed with type 2 diabetes. He has expressed reluctance to take medications, but despite dietary changes, his HbA1c has risen to 60mmol/mol. The patient was prescribed standard-release metformin at a dose of 500mg twice daily with meals. However, after two weeks of taking metformin, he reported experiencing severe side effects such as nausea and diarrhea.

What would be the most appropriate course of action in managing this patient’s condition?

AKT-4735

You receive the blood tests which were requested by the practice nurse in advance of the annual diabetes review of Mrs. Johnson, a 50-year-old patient. Mrs. Johnson was diagnosed with type 2 diabetes about 4 years ago, and after 2 years of attempting to control it with lifestyle measures, she commenced metformin and is now prescribed 1g BD. Her full blood count, renal profile and liver function tests are normal, her total cholesterol is 5.3mmol/L. Her HbA1c is 60mmol/mol.

As per NICE guidelines, what should be done regarding Mrs. Johnson’s blood sugar control?

AKT-4727

You are assisting in the care of a 65-year-old man who has been hospitalized for chest pain. He has a history of hypertension, angina, and currently smokes 20 cigarettes per day. Upon admission, blood tests were performed in the Emergency Department and revealed the following results:

Na+ 133 mmol/l
K+ 3.3 mmol/l
Urea 4.5 mmol/l
Creatinine 90 µmol/l

What is the most likely explanation for the electrolyte abnormalities observed in this patient?

AKT-4737

A 32-year-old woman presents with irregular periods and abnormal thyroid function tests. All other blood tests are normal, and she is not pregnant or planning to conceive. Her vital observations and neck examination are unremarkable, and she takes no regular medication. Pelvic ultrasound shows no abnormalities. Thyroid tests are repeated 3 months later, revealing a positive result for thyroid peroxidase antibodies. What is the optimal course of action for this patient?

AKT-4739

A 5-year-old girl with type 1 diabetes is rushed into the emergency room by her father as she is extremely restless. He suspects that she is experiencing a ‘hypo’ and has attempted to give her sugary drinks and snacks, but to no avail. The child is uncooperative and agitated. Upon examination, she appears sweaty and anxious, but her airways are clear and she is breathing normally. Physical examination is unremarkable, and her vital signs are normal. A blood glucose test reveals a reading of 3.2 mmol/L. The child weighs 20kg. What is the next course of action?

AKT-4741

A 54-year-old man with insulin-dependent type 2 diabetes mellitus has visited his GP after experiencing his second severe hypoglycaemic episode. During both episodes, he had limited awareness and required his wife to administer glucose gel. He currently holds a group 1 driving licence. What advice should be given regarding his ability to drive?

AKT-4743

You are a pediatrician who is visiting a children’s hospital. A new patient is admitted and the nurse is looking through his medications which he has brought with him from home. The patient is a 10-year-old with type 1 diabetes and on his insulin box it says ‘insulin lispro (Rapid-acting analogue)’, unfortunately the instructions for administration have rubbed out.

The nurse asks you how insulin lispro is usually administered:

Given just prior to meal
46%

Given just after meal
9%

Given 30 minutes before meal
31%

Given 30 minutes after meal
6%

Given only if blood sugar is found to be greater than 10mmol/L
7%

Insulin lispro is a fast acting insulin analogue. Its levels peak 0-3 hours after injection and last 2-5 hours. It should therefore be given just prior to meals.

The April 2015 AKT feedback report stated:

Diabetes and prediabetes are increasingly common, and we frequently feed back concerning lack of knowledge in these areas?

AKT-4740

A 55-year-old man with a history of type 2 diabetes mellitus is being seen in the diabetes clinic. His HbA1c was 83 mmol/mol (9.7%) a year ago despite taking the maximum dose of oral hypoglycaemic medication. He was started on insulin and his latest HbA1c is 66 mmol/mol (8.2%). He is contemplating applying for a commercial driver’s license and seeks guidance. What is the best advice to give him?

AKT-4742

A 46-year-old man with poorly controlled type 2 diabetes is prescribed insulin by the diabetic specialist nurses. He holds a group 1 driving licence and drives to his job as an accountant and auditor. Occasionally, he has to travel longer distances for work, which can involve 4-hour car rides.

The nurses advise him to check his blood glucose before starting his car journey and to monitor it during longer trips. What is the recommended frequency for this patient to check his blood glucose?