Archives: MRCGP AKT

AKT-5701

A 47-year-old male presents with frequent episodes of waking up in distress. He reports feeling breathless and his heart racing late at night. These episodes are causing him significant worry. His wife notes that he snores loudly and sometimes stops if he changes position. Additionally, he has been taking short naps during the day which is impacting his work as an IT technician. The patient has a history of type 2 diabetes and obesity.

What is the most appropriate diagnostic test for this patient’s condition?

AKT-5684

A 67-year-old woman presents with a 4 week history of increasing shortness of breath, fatigue, and unintentional weight loss. She has a medical history of hypertension, chronic obstructive pulmonary disease, and is a former smoker. On physical examination, there are no significant findings. The following investigations were obtained:

Chest x-ray: Hyperinflated lung fields, normal heart size
Bloods: Sodium 131 mmol/l, Potassium 3.4 mmol/l, Urea 7.2 mmol/l, Creatinine 101 µmol/l, Hb 10.4 g/dl, MCV 91 fl, Plt 452 * 109/l, WBC 3.7 * 109/l

What is the most appropriate management plan for this patient?

AKT-5683

What is the primary factor in deciding whether a patient with COPD, who is elderly, should be provided with long-term oxygen therapy?

AKT-5685

Can you interpret the post-bronchodilator spirometry results of a 54-year-old woman who has been experiencing gradual shortness-of-breath?

FEV1/FVC 0.60
FEV1% predicted 60%

AKT-5682

A 54-year-old man with hypertension and obesity has been diagnosed with obstructive sleep apnoea after a visit to the sleep clinic. His AHI falls under the mild category with 12 apnoea/hypopnoea events/hour, and his Epworth score indicates mild excessive daytime sleepiness. As a group 1 driver, he is concerned about the impact on his driving and when he should inform the DVLA. When is it necessary to notify the DVLA?

AKT-5700

Liam, a 19-year-old boy, comes in for his annual asthma review. He has generally well-controlled asthma, with only one exacerbation requiring steroids this year. He takes 2 puffs of his beclomethasone inhaler twice daily, and salbutamol as required, both via a metered-dose inhaler (MDI).

You decide to assess his inhaler technique. He demonstrates removing the cap, shaking the inhaler and breathing out before placing his lips over the mouthpiece, pressing down on the canister while taking a slow breath in and then holding his breath for 10 seconds. However, he immediately repeats this process for the second dose without taking a break.

How could he improve his technique?

AKT-5699

A 25-year-old man comes in for his regular asthma check-up. He is currently taking salbutamol and formoterol-beclomethasone (Fostair) for his asthma, but he informs you that he is not experiencing any relief from either medication. He was diagnosed with asthma through spirometry testing recently. He claims to be using the inhalers as prescribed but has some doubts about how to use them correctly. Both of his inhalers are pressurised metered-dose inhalers.

What is the most suitable advice to give to this patient?

AKT-5698

Sara is a 26-year-old woman who has presented to her GP with difficulty breathing. She has a history of asthma and has been using her salbutamol inhaler regularly, but it has not been effective. Upon examination, bilateral wheezing is heard. Her oxygen saturation is 93%, and her peak expiratory flow is 190 L/min. Her usual peak flow is 400 L/min. After administering a nebulizer, her peak flow only increases to 200 L/min.

What is the next step in managing this patient?

AKT-5686

A 27-year-old man presents with sudden difficulty breathing and a known history of asthma. You are evaluating the severity of his asthma attack and suspect it may be classified as acute severe. What is a characteristic of this classification?

AKT-5696

After the 2014 National Review of Asthma Deaths, what is the minimum number of salbutamol prescriptions in the last 6 months that should trigger an immediate assessment of a patient’s asthma management?