Archives: MRCGP AKT

AKT-5709

A 28-year-old woman presents with a two week history of feeling unwell, characterised by one week of catarrhal illness, followed by a dry hacking cough, which is now paroxysmal, and she has vomited twice after coughing.

On examination, she is afebrile, and her chest sounds clear. She was previously well, but she is unsure of her vaccination history as she lived abroad as a child.

She lives with her husband and two children, aged 18 months and 8. The children have not been immunised against pertussis. You suspect she may have pertussis.

While awaiting confirmation, who should be offered antibiotics?

AKT-5708

A 25-year-old female develops a wheeze and extensive rash whilst eating a Chinese take-away chicken satay.

On examination, she has extensive wheeze and stridor, with urticaria covering her upper and lower limbs and trunk. Her BP is 80/45 mmHg.

What is the likely diagnosis?

AKT-5724

What interventions can be used to identify asthma when there is diagnostic uncertainty or coexistence of COPD and asthma?

AKT-5716

A 38-year-old woman with symptoms of anxiety presents to the clinic with complaints of intermittent pleuritic chest pain. She reports experiencing the pain particularly when she is stressed at work or unexpectedly exercising. On one occasion, she has fainted, and she sometimes experiences pins and needles around her mouth and in both hands. She has a history of mild asthma and uses PRN salbutamol. All tests, including ECG, peak flow rate, full blood count, thyroid function, and pulse oximetry, are normal. What is the most appropriate plan for her?

AKT-5714

A 55-year-old woman presents with shortness of breath, haemoptysis, and pleuritic chest pain.

Her medical history includes a deep vein thrombosis affecting the right leg eight years ago. She is not on any current regular medication.

On examination, her heart rate is 108 bpm, blood pressure is 104/68, respiratory rate is 24, oxygen saturations are 94% in room air and she is afebrile. She has no calf or leg swelling.

You suspect she might have a pulmonary embolism and there is nothing to find to suggest an alternative cause.

You calculate her two-level PE Wells score.

What is the most appropriate management plan?

AKT-5710

A 42-year-old man with known asthma visits your clinic with a complaint of worsening wheezing over the past few hours. He seldom attends asthma clinic and you observe that his previous best peak flow readings were 400 L/min. What is the threshold that indicates acute severe asthma in this patient?

AKT-5718

A 22-year-old male college student comes to the clinic complaining of shortness of breath during physical activity that has been going on for two months. He denies any other symptoms and is a non-smoker. On examination, there are no abnormalities, and his full blood count and chest x-ray are normal. What is the most useful test to confirm the suspected diagnosis?

AKT-5717

What is the most probable characteristic of asthma in children?

AKT-5723

A 50-year-old man presents with a one week history of a productive cough. He has no past medical history of any cardiorespiratory disease and is a lifelong non-smoker. He reports that his cough is not improving and that he is now coughing up some ‘thick green phlegm’. He denies any coughing up blood.
Upon examination, he is alert and oriented, with a temperature of 37.6°C, a regular pulse rate of 94 bpm, a respiratory rate of 16, and a blood pressure of 124/68 mmHg. Chest auscultation reveals coarse crepitations in the left lower zone with some bronchial breath sounds.
What is the most appropriate course of action?