Archives: MRCGP AKT

AKT-6001

A 31-year-old woman presents to surgery with a flare-up of her ulcerative colitis.

She was seen four days ago with abdominal pain and bloody diarrhoea and has returned today as her symptoms have worsened. She currently complains that over the last two days she has been passing at least eight loose stools a day all of which have be associated with the passage of fresh blood.

On examination, her temperature is 37.4°C, pulse rate is 104 b.p.m., and blood pressure is 98/72 mmHg. Abdominal examination reveals diffuse tenderness on deep palpation but no peritonism or masses.

Blood tests performed yesterday show a modest anaemia with a haemoglobin 109 g/L (normal range 115-135), an ESR of 23 mm/hr (normal range <15) and an albumin of 35 g/L (normal range 35-50). Which of the following parameters in this instance is an indication of severe colitis and should prompt consideration of hospital admission?

AKT-5992

A 48-year-old-man presents with right sided loin pain radiating to the tip of his penis. Urinalysis shows non-visible haematuria. He has a past history of renal calculi.

On examination he is hydrated and is taking fluids orally but has not eaten anything for the past 24 hours. He has a temperature of 38.1°C.

Which of the following features in the history and examination should prompt admission to hospital?

AKT-6000

A 30-year-old male comes to the clinic with a deep wound on his hand caused by a terrier bite. The wound is accompanied by swelling. After receiving tetanus immunisation and wound cleaning, what would be the most suitable antibiotic regimen for this patient?

AKT-5994

A 20-year-old man presents with headache and chills, accompanied by a persistent dry cough. The cough has been present for some weeks. He is off his food and feels very lethargic. Temperature is 37.8°C and he has a rash consistent with erythema multiforme.

Respiratory examination reveals scattered wheeze throughout both lung fields.

Investigations show:

Haemoglobin 119 g/L (135-180)

White cell count 10.1 ×109/L (4-10)

Platelets 189 ×109/L (150-400)

Sodium 139 mmol/L (134-143)

Potassium 4.5 mmol/L (3.5-5)

Creatinine 120 µmol/L (60-120)

ESR 62 s (<10) CXR Left lower lobe consolidation Which of the following is the most likely diagnosis?

AKT-5996

Whilst doing morning housecalls, you are phoned to visit the home of a 47-year-old man who is known to suffer from benign paroxysmal vertigo. The visit was requested by a relative on the basis of his ongoing dizziness but upon arrival, it becomes clear that he has sustained a head injury.

Whilst fixing a shelf in his garage, he became dizzy and fell to the ground.

Which of the following symptoms require immediate referral to the emergency ambulance services (i.e. 999) for emergency transportation to the emergency department?

AKT-5998

A 50-year-old male presents with increasing shortness of breath and ascites.

On examination, he is hypotensive, has an elevated JVP which rises on inspiration, (Kussmaul’s sign) and has a ‘knock’ on auscultation of the heart.

Past history of note includes TB which was treated with aggressive quadruple therapy some three years ago.

Which of the following is the most likely diagnosis?

AKT-5993

A 30-year-old patient with Addisons disease phones the surgery for advice.

He feels mildly unwell with a sore throat and a temperature of 37.8 degrees. There is no vomiting, no headache and no diarrhoea. He says that his children and wife have recently been unwell with a similar illness, thought to be viral in origin and that they have since fully recovered.

He asks for advice about his medication.

What would you advise?

AKT-5997

You are investigating a 70-year-old patient with suspected heart failure. The NT-proBNP result arrived today as 2200 ng/litre.

Which of the following would be the most appropriate management step?

AKT-5995

You are seeing a middle-aged patient in your morning clinic. You suspect he had a TIA three days ago. He has no neurological deficit at present and is otherwise well.

Which of the following does NICE advise as the next step of management?

AKT-5999

A 75-year old woman with diabetes and end stage renal failure is visited for a home visit. She is receiving at-home dialysis through a Tenckhoff catheter. She has been feeling increasingly unwell for the past 24 hours, experiencing vomiting and abdominal pain. She had a normal bowel movement this morning.

During the examination, she appears to be dehydrated with a blood pressure of 96/68 mmHg and a pulse rate of 108. Her temperature is 38.1℃. She experiences diffuse abdominal pain and general tenderness throughout the abdomen upon superficial palpation.

What is the most probable cause of her symptoms?