Archives: MRCGP AKT

AKT-4645

A 54-year-old woman with established type 2 diabetes presents for her annual review. Her HbA1c has been stable on the maximal dose of metformin for the past few years and her BP has always been well controlled. She doesn’t take any other regular medications. Her HbA1c result 1 year ago was 52 mmol/mol.

The results of her most recent review are as follows:

HbA1c 59 mmol/mol
eGFR 91 ml/min/1.73m² (>90 ml/min/1.73m²)
Urine albumin:creatinine ratio (ACR) 2 mg/mmol (<3 mg/mmol)
BMI 25 kg/m²
QRISK score 6.8%

According to NICE guidelines, what is the most appropriate next step in managing her diabetes?

AKT-4642

A patient with type 1 diabetes who is 16 years old presents with diarrhoea and vomiting, along with reduced oral intake. In the past day, she has experienced increased thirst and urination. Her capillary blood glucose level is 19 mmol/L, and her blood ketones are 3.6 mmol/L.

What is the most appropriate course of action for managing this patient’s condition?

AKT-4640

A 45-year-old man comes to the surgery complaining of a productive cough. Upon examination, he has a fever and bronchial breathing in the right lower zone. The working diagnosis is pneumonia and amoxicillin is prescribed with a chest x-ray scheduled for the following day. The patient has a medical history of Addison’s disease and takes hydrocortisone (20 mg in the morning and 10 mg in the afternoon). What is the best course of action regarding his steroid dosage?

AKT-4647

You are evaluating a 32-year-old woman with type 1 diabetes mellitus. She is currently in good control and has no concurrent illnesses. What is the recommended frequency for monitoring her blood glucose levels?

AKT-4632

A 30-year-old man is being treated for an exacerbation of his asthma. His doctor prescribes him prednisolone 40 mg once daily for 5 days. What is the recommended course of action after the 5 day treatment?

AKT-4634

A 72-year-old male presents with weight loss and heat intolerance. He is taking multiple medications for atrial fibrillation, ischaemic heart disease and rheumatoid arthritis. Thyroid function tests are requested and the results are shown in the table below:

Thyroid stimulating hormone (TSH) 0.2 mU/L
Free T4 35 pmol/L

What is the most likely cause of these findings?

AKT-4641

Which drug, prescribed for the treatment of type 2 diabetes mellitus, has been cautioned by the Medicines and Healthcare products Regulatory Agency for its potential to cause severe pancreatitis and renal impairment?

AKT-4649

As a GPST1 in general practice, you encounter a 37-year-old woman who comes to your clinic seeking advice. She was recently diagnosed with premature menopause and has been advised to undergo hormone replacement therapy (HRT) until she reaches the age of 49. However, she expresses some concerns about this and wishes to know the reason behind the recommended treatment. How would you explain this to the patient?

AKT-4646

You are assessing a 54-year-old man who has recently been diagnosed with type 2 diabetes. As part of his diabetic evaluation, he was instructed to perform home blood pressure monitoring. The average daytime reading has returned as 152/84 mmHg.

The patient migrated to the UK from Sudan approximately two years ago and has no significant medical history other than a vitamin D deficiency, which is believed to be due to his dark skin.

Based on the current NICE guidelines, what would be the most appropriate course of action in managing this patient?

AKT-4648

A 42-year-old woman presents with complaints of constant fatigue and weight gain. She has no significant medical history and currently weighs 52 kg. Laboratory results reveal:

Free T4 6.9 pmol/l
TSH 10.8 mu/l

What is the best course of action to take in this situation?