Archives: MRCGP AKT

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?

AKT-1828

A geriatric patient with terminal illness is currently receiving 60mg of modified release morphine every 12 hours. Due to difficulty in swallowing, you plan to switch to a 24 hour subcutaneous infusion of morphine. The morphine ampoules available are of 10 mg/ml strength. What would be the required volume of morphine (in ml) to be added to the syringe driver for a 24 hour period?

AKT-1801

A 65-year-old man with pancreatic cancer comes to the clinic for a review of medication. He reports that his pain is no longer managed with paracetamol and 240 mg oral codeine per day. The doctor decides to initiate an opiate.
Which of the following is the most suitable choice?

AKT-1802

A 68-year-old man presents to the General Practitioner with worsening shortness of breath. He was recently diagnosed with small cell lung cancer and is awaiting treatment. On examination, he has a red face, stridor, dilated veins over his upper body and face, and swelling in his arms.

What is the most suitable course of action for managing his condition at this point?

AKT-1803

What is NOT a precondition of the doctrine of double effect, which states that intentionally causing death is unacceptable but prescribing high doses of sedatives and opioids to relieve pain is permissible even if death may result?

AKT-1804

A 78-year-old woman comes to the General Practitioner for a consultation. She has chronic obstructive pulmonary disease (COPD) and is concerned about the impact on her life expectancy.
Which of the following features is most likely to suggest that the end of life is approaching (ie within the next 12 months)?

AKT-1805

What is the Gold Standards Framework (GSF) and what does it enable for people nearing the end of their lives?

AKT-1806

A 50-year-old woman has advanced ovarian cancer with peritoneal metastases and ascites. She is experiencing nausea, vomiting, abdominal colic and constipation. During examination, her General Practitioner notes hyperactive bowel sounds. Which treatment option is most likely to provide relief for her symptoms?

AKT-1807

A 70-year-old man with advanced colonic cancer becomes cachectic. He is still living at home and is troubled by his lack of appetite and rapid weight loss. There are no obvious reversible problems (eg pain, medication, vomiting, reflux), and his examination shows no acute issues such as bowel obstruction. Blood tests are unremarkable, other than long-standing anaemia and low albumin levels.
Which of the following drugs is most likely to be beneficial for patients with anorexia/cachexia?

AKT-1808

A 78-year-old man with advanced pancreatic cancer is experiencing bothersome widespread pruritus. He is also jaundiced and has refused a biliary stent. Despite trying various emollients, including one with menthol, he has not found relief.
What medication would be the most suitable to test for this patient’s pruritus symptoms?
Choose ONE answer only.