Archives: MRCGP AKT

AKT-4705

A 38-year-old man with type 1 diabetes visits the diabetes clinic for his yearly check-up. He possesses a Group 1 driving licence and reports to his specialist that he experienced two episodes of hypoglycaemia, one four months ago and the other one month ago. Both incidents occurred while he was awake after consuming several alcoholic beverages and required assistance from his partner. However, he typically has full hypoglycaemia awareness and practices appropriate glucose monitoring before and during driving. Additionally, he has never experienced hypoglycaemia while driving. What advice should he receive regarding his driving?

AKT-4687

A 50-year-old woman with a history of hypothyroidism presents with fatigue and a painful tongue. Her blood tests reveal the following results:

– Hemoglobin (Hb): 10.7 g/dl
– Mean corpuscular volume (MCV): 121 fl
– Platelet count (Plt): 177 * 109/l
– White blood cell count (WBC): 5.4 * 109/l

Further investigations reveal that her vitamin B12 levels are 64 ng/l (normal range: 200-900 ng/l) and her folic acid levels are 7.2 nmol/l (normal range: > 3.0 nmol/l). Antibodies to intrinsic factor are also detected. What is the most appropriate course of action?

AKT-4695

Mrs. Johnson is a 45-year-old civil engineer who was recently diagnosed with type 2 diabetes during her NHS over-40 health check. Your colleague started her on metformin two weeks ago, but she has requested a telephone consultation as she is still experiencing nausea with it. She has tried to persevere but now she has had enough and wants to stop it. Her HbA1c at diagnosis was 52mmol/l. Her body mass index is 30 kg/m². Her renal function is normal.

What is the most appropriate medication option to try next?

AKT-4691

Sophie is a 65-year-old woman who presents to you with a sore throat, cough and muscle pain that has been going on for 3 days. She has a medical history of type 2 diabetes and hypertension and is currently on a twice daily insulin regimen.

After conducting a thorough assessment, you inform Sophie that she is likely suffering from the flu and recommend that she rest, take regular paracetamol and increase her fluid intake.

Given her condition, what is the most appropriate advice to provide Sophie regarding her insulin management during her illness?

AKT-4690

A 25-year-old male presents to his GP with complaints of feeling tired and thirsty for the past week. He also reports experiencing vomiting and abdominal pain that started earlier today. Upon examination, his blood pressure is 99/71 mmHg, heart rate is 102/min, respiratory rate is 23/min, temperature is 36.4ºC, and oxygen saturation is 98%. His chest is clear, and his abdomen is soft with mild generalised tenderness. What investigation would be most useful in making a diagnosis?

AKT-4693

A 54-year-old woman with a BMI of 26 presents to the diabetic clinic with poor glycaemic control while on gliclazide 160mg bd. Her latest blood results reveal a HbA1c of 9.4%. Her laboratory values are as follows: Na+ 139 mmol/l, K+ 4.1 mmol/l, urea 8.4 mmol/l, creatinine 180 µmol/l, ALT 25 iu/l, and yGT 33 iu/l. What medication should be added to her treatment plan?

AKT-4694

A 75-year-old male with a history of insulin dependent diabetes presents with persistent abdominal bloating and vomiting. The gastroenterologist suspects gastroparesis. What would be the best initial course of action for management?

AKT-4697

You receive a discharge summary for Mr. Chen, a 65-year-old man, who has had an acute surgical admission with pancreatitis. The summary notes that it was thought to be drug-related. His past medical history includes atrial fibrillation and type 2 diabetes. His regular medications are ramipril, warfarin, metformin, sitagliptin, and atorvastatin. He also takes an over-the-counter vitamin D supplement.

Which of his medications might have caused this presentation and should be reported by Yellow Card?

AKT-4696

A 49-year-old woman is admitted to the surgical ward with severe loin to groin abdominal pain. A CT-KUB reveals a right-sided renal calculus. When you clerk her in she admits to you that she has not felt herself for the past few weeks with polyuria, polydipsia, constipation and altered mood.

Blood tests show:

Estimated glomerular filtration rate >60 ml/min
Adjusted calcium 3.1 mmol/l (2.1-2.6 mmol/l)
Phosphate 0.6 mmol/l (0.8-1.4 mol/l)
Parathyroid hormone 5.1 pmol/l (1.2-5.8 pmol/l)

What is the most likely cause of her symptoms?

AKT-4698

A 28-year-old female presents with a 2-month history of fatigue and nocturia. On further questioning she also admits to increased thirst. She doesn’t have dysuria or urgency, denies the possibility of pregnancy and has otherwise been well. Her sister was recently diagnosed with diabetes, although she is not sure which type. She has looked at the symptoms online and is worried about a possible diabetes diagnosis; she wants to know how she can distinguish between the types of diabetes.

Her body mass index (BMI) is 29 kg/m².

Which of the following tests would be best in differentiating these diagnoses?