Archives: MRCGP AKT

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-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?

AKT-4731

A man in his early 50s with type 2 diabetes mellitus is being evaluated. Despite losing weight and taking metformin and gliclazide, his HbA1c remains at 68 mmol/mol (8.4%). The patient consents to begin insulin treatment. As per NICE recommendations, what type of insulin should be attempted first?

AKT-4728

You encounter a 49-year-old man who has just been diagnosed with type 2 diabetes by your GP colleague. The patient has been prescribed gliclazide and has experienced one instance of mild hypoglycaemia since commencing this medication. The patient inquires about driving his vehicle. What guidance should be given?

AKT-4738

A 65-year old woman comes to your clinic concerned about the possibility of having diabetes. She is overweight and has a significant family history of type 2 diabetes. Due to her chronic kidney disease, you opt to conduct an oral glucose tolerance test instead of testing her HbA1c. What outcome would indicate that she has impaired glucose tolerance?

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-4715

A 56-year-old man presents for follow-up in the diabetes clinic. He was diagnosed with type 2 diabetes mellitus (T2DM) approximately 8 years ago and is currently taking gliclazide and atorvastatin. Two years ago, he underwent successful treatment for bladder cancer. However, a recent trial of metformin was discontinued due to gastrointestinal side-effects. He works as an accountant, doesn’t smoke, and has a BMI of 31 kg/m². His annual blood work reveals the following results:

– Sodium (Na+): 138 mmol/l
– Potassium (K+): 4.1 mmol/l
– Urea: 4.3 mmol/l
– Creatinine: 104 µmol/l
– HbA1c: 62 mmol/mol (7.8%)

What would be the most appropriate course of action for his management?

AKT-4717

You assess a 65-year-old man with type 2 diabetes mellitus in the diabetes clinic. His current blood pressure is 150/86 mmHg. His diabetes is well managed and there is no indication of end-organ damage. What is the recommended target blood pressure for him?

AKT-4718

A 58-year-old woman presents with a 6-month history of lethargy, weight gain, and cold intolerance. She had abnormal thyroid function tests 1 year ago. On examination, there are no significant findings. Repeat thyroid function tests are ordered.

1 year ago: Result Reference Range
Thyroid-stimulating hormone (TSH) 5.9mU/L (0.5-5.5)
Free thyroxine (FT4) 14.2pmol/L (9.0 – 18)

Now:
TSH 6.1mU/L (0.5-5.5)
FT4 17.1pmol/L (9.0 – 18)

What is the most appropriate course of action?

AKT-4716

You visit Mrs. Jones, an elderly woman who is suffering from an acute diarrhoeal illness she picked up from her grandchildren. Her past medical history includes: hypertension, type 2 diabetes, hyperlipidemia, and osteoporosis. Her medications are amlodipine 5mg OD, lisinopril 10 mg OD, aspirin 81mg, omeprazole 20 mg OD, metformin 500mg BD, atorvastatin 20 mg ON, and acetaminophen 650mg PRN. Her pulse is 88/min, blood pressure 146/78 mmHg, oxygen saturations 98%, respiratory rate 18/min. Her tongue looks a little dry, abdomen is soft and non-tender, with very active bowel sounds. After examining her, you feel she is well enough to stay at home, and you prescribe some rehydration sachets and arrange telephone review for the following day.

What immediate changes should you advise regarding her medication?