Archives: MRCGP AKT

AKT-1818

Ms. Smith is a 62-year-old woman with lung cancer. She has a husband and two children; her son has been closely involved in decision making regarding her care throughout her illness and she has previously conferred Power of Attorney for Health and Welfare to him, whereas her daughter only visits very infrequently.
Ms. Smith has been very clear that she wishes not to receive artificial ventilation if she were to lose capacity. She is worried that her daughter will want to do anything she can to keep her alive. Therefore, Ms. Smith completed an Advance Decision to Refuse Treatment (ADRT) stating she wishes not to receive artificial ventilation at the end of life.
What conclusions can you draw regarding the ARDT?

AKT-1819

You are seeing a 58-year-old woman who has been diagnosed with early invasive breast cancer which is oestrogen-receptor-positive.

Her oncologist is treating her with anastrozole 1 mg daily.

Which one of the following is the most common side effect of anastrozole?

AKT-1820

You are conducting a cancer care assessment on an elderly woman with an advanced brain tumor. She has previously undergone radiotherapy and chemotherapy, but these treatments did not have a significant effect on her condition. Her primary concerns are vertigo and nausea.

Which antiemetic would be the most suitable to recommend?

AKT-1821

A 55-year-old woman has terminal breast cancer. She has liver metastases but her pain is well controlled.

Her main symptom, however, is anxiety. She feels nervous all the time and has a tremor. She says she feels tense about almost anything. She has read that beta blockers can help people like her and asks whether they would be worthwhile.

What symptoms are beta blockers most likely to alleviate in a 55-year-old woman with terminal breast cancer and anxiety?

AKT-1822

You are seeing a 65-year-old man with locally advanced prostate cancer which has been considered by his oncologist to be at a high risk of progression.

He is taking bicalutamide 150 mg daily.

What is the most common side effect of this medication?

AKT-1823

You are asked to prescribe a syringe driver for a palliative care patient with pain who is now struggling to swallow tablets.
Her pain has been well controlled on morphine sulphate tablets, 60 mg twice a day, and severadol (quick release morphine) 20 mg three times a day.
You decide to prescribe morphine, subcutaneously, via the syringe driver.
Which of the following dosing regime would be appropriate?

AKT-1824

A 76-year-old patient comes to you complaining of intense pain in their right shoulder. After an X-ray examination, it is discovered that they have a pathological fracture in their proximal humerus. Which primary solid tumor cancer groups are most prone to metastasizing to bone?

AKT-1825

You are asked to see a 64-year-old woman known to have breast cancer.
Her family has become worried as yesterday she seemed to be behaving ‘oddly’. They tell you that her behaviour has become inappropriate and that she has been walking around the house naked and been swearing a lot in conversation. Prior to yesterday she was her ‘usual self’.
The family also report that she seems to be passing urine and opening her bowels as per usual and that she has been eating and drinking fine.
Examination reveals that the patient is alert and uncomplaining. Temperature is 37.1°C, blood pressure is 118/78 mmHg and pulse rate is 86 regular. Systems examination doesn’t reveal anything acute aside from the patient swearing frequently and talking about inappropriate topics of conversation. Urine dipstick testing reveals ‘trace’ of blood and protein.
Which if the following investigations will confirm the underlying diagnosis?

AKT-1826

A 65-year-old man with oesophageal cancer is having difficulties with taking regular oral morphine medications. After consulting with the oncology team, it is decided to switch him to transdermal fentanyl patches. He is currently taking 50 mg twice daily of modified-release oral morphine which has been effectively managing his pain. You prescribe a fentanyl ’25’ patch which provides the same level of pain relief. What instructions do you give the patient when starting to use the patches?

AKT-1827

You are requested by district nurses to visit a patient at home to assess his medication. He is an 80-year-old man with terminal prostate cancer and widespread metastases. His pain is currently well managed by taking Morphine Sulphate SR tablets, 60mg twice a day. However, his overall condition has deteriorated, and he is experiencing difficulty swallowing the tablets, as well as increased agitation. Your recommendation is to initiate a syringe driver containing Diamorphine and a small dose of Midazolam subcutaneously to replace the oral Morphine tablets. What would be the appropriate dosage of sc Diamorphine to prescribe over a 24-hour period?