AKT-5713
What is the recommended course of action in the management of an adult with asthma who is on low dose inhaled corticosteroid (ICS) but doesn’t show improvement after the introduction of a long acting beta agonist (LABA)?
Archives: MRCGP AKT
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-5712
You see a 50-year-old lady who complains of a chronic cough, often with yellow sputum that has persisted months. She thinks she is more breathless than her previous baseline. She reports no weight loss, no night sweats and is a non-smoker.
On examination, she has coarse crackles in the lower lung zones. A trial of amoxicillin was started but did not improve her symptoms so a sputum sample was sent which grew Pseudomonas aeruginosa. A chest X ray was normal.
What is the most likely diagnosis?
AKT-5707
A 72-year old woman with a recent diagnosis of chronic obstructive pulmonary disease (COPD) is seen.
Her spirometry shows an FEV1 of 42% predicted with an FEV1: FVC ratio of 64%. Her current treatment consists of a short-acting beta agonist (SABA) used as required which was started when a clinical diagnosis was made following the spirometry.
On reviewing her symptoms she needs to use the SABA at least four times a day and despite this still feels persistently breathless. In addition, she tells you that over the last few years she gets attacks of ‘bronchitis’ requiring antibiotics two to three times a year.
According to NICE guidance, which of the following is the next most appropriate step in her pharmacological management?
AKT-5717
What is the most probable characteristic of asthma in children?
AKT-5704
A 68 year old woman with chronic asthma has been using a lot of salbutamol including via a nebuliser. She has a tremor, headache and tachycardia.
Select from the list the single most likely biochemical finding.
AKT-5702
A 62-year-old woman with a history of myasthenia gravis and COPD presents with increasing fatigue and shortness of breath despite inhaled therapies. She denies chest pain or cough and has a 20-pack-year smoking history. There are no notable occupational exposures. On examination, her cardiorespiratory system appears normal. Blood tests and chest x-ray are unremarkable, but spirometry reveals the following results:
FEV1 (L): 3.5 (predicted 4.5)
FVC (L): 3.8 (predicted 5.4)
FEV1/FVC (%): 92
What is the most likely underlying cause of her symptoms?
AKT-5705
A 23-year-old woman is barely responsive in the waiting area. What single feature would indicate possible opioid overdose?
AKT-5703
You are working in the out-patient respiratory clinic where a 65-year-old male patient attends for follow-up. He has a diagnosis of COPD (FEV1/FVC= 0.68, FEV1=46% predicted) and currently smokes 30 cigarettes per day. He has noted progressive ankle swelling over last year but has not suffered any exacerbations in this time. He currently takes a tiotropium inhaler as well as a combination inhaler of salmeterol/fluticasone with a salbutamol inhaler when required, his inhaler technique has been assessed as good. In the clinic, his arterial blood gas results on air give a pO2 of 7.3kPa and 7.8kPa respectively from today and from clinic two months ago. He continues to smoke despite being offered smoking cessation therapy.
The patient would like to be considered for home oxygen therapy. According to current NICE guidelines, what advice should you give him?
AKT-5706
You encounter a 28-year-old man who has asthma. He informs you that he has visited you today because one of the partners is unwilling to modify his inhaler treatment until he quits smoking. He is presently using a salbutamol inhaler as needed, but he is experiencing frequent wheezing episodes and has developed a cough at night. What is the best course of action?