Archives: MRCGP AKT

AKT-1809

A 65-year-old man with advanced lung cancer is an inpatient in his local hospice for symptom control. He is currently unable to swallow medication. A General Practitioner (GP) who works at the hospice one day a week is on call when the patient has his first seizure. It has not resolved after five minutes. Resuscitation equipment is available and the GP is aware that the patient wants active treatment should a seizure occur at home or in the hospice but is not for admission to hospital.
Which of the following is the most appropriate management option?

AKT-1797

A 70-year-old man comes to the clinic for a review of his cancer. He has advanced and progressive prostate cancer but is currently able to get out of the house with his family.
Which of the following features would most strongly suggest that he has entered the final stage of the illness and that death is near?

AKT-1798

A 65-year-old woman with advanced ovarian cancer has recently started taking oral opiates for pain relief. On the previous day, she took modified-release morphine 20 mg 12-hourly and required four 5 mg rescue doses of immediate-release morphine for breakthrough pain. She had been advised that she could take the rescue doses every 2-4 hours, if necessary.
What is the most suitable analgesic regimen for her?

AKT-1799

A 67-year-old woman visits the local radiotherapy suite, where she is undergoing radiotherapy treatment for endometrial cancer after a radical hysterectomy. She reports that both of her legs have been swollen for some weeks but that, in the last day, her right calf has become more swollen and is slightly painful on weight-bearing.
On examination, she can weight bear and there is no change in the left leg. The right calf is 36 cm when measured 10 cm distal to the tibial tuberosity, compared with 32 cm on the left. There is mild pitting oedema on the right ankle and medial calf tenderness.
What is the most appropriate scoring tool to use in this case?

AKT-1800

A 62-year-old businessman presents with bilateral leg weakness that has suddenly become worse over the last 12 hours. Some 8 months ago he had a lobar resection for a stage-II squamous-cell carcinoma followed by radiotherapy and adjuvant chemotherapy. On examination there is reduced power and altered sensation in both legs.
Select the single most likely cause of the current problem.

AKT-1791

An 87-year-old woman with metastatic breast cancer who is in the last days of life is having difficulty drinking due to swallowing problems. Her main symptoms of pain and nausea are being managed with a syringe driver. She complains of thirst despite frequent mouth care.
Which is the most appropriate treatment option?

AKT-1792

A 64-year-old man is seen by the District Nurse at home, where he is being looked after by his family as he has advanced prostate cancer with bone metastases. His pain has been well controlled; he has a catheter in situ and can take oral medication. In the last week, he has not been eating and drinking much. His urine output is reduced; hence, his urine looks concentrated.

Over the last two days, he has become very confused, especially in the evening. He has been trying to get out of his bed and he has been pulling his catheter. He has been shouting at the family. His wife is very distressed. She asks for some sedation.

On examination by the District Nurse, his temperature is 37 oC. His pulse is 90 bpm and regular, while his blood pressure is 112/78 mmHg. His oxygen saturation is 96% on air. A urine dipstick is positive for protein.

What is the most appropriate initial management option for this patient’s symptoms?

AKT-1793

A 27-year-old man was diagnosed with a melanoma six weeks after being referred to the Dermatology Department by his General Practitioner (GP). His friends call his GP, concerned that he has withdrawn to his room over the last four weeks, has stopped playing basketball, has appeared to lose weight, and has missed his hospital appointments. There is a letter in his medical records informing the practice that he has missed two surgery appointments.
He later attends the surgery with a friend. He is dressed scruffily and doesn’t make eye contact during your conversation. His Patient Health Questionnaire-9 score is 15.
What is the most likely diagnosis?

AKT-1794

An elderly patient has a terminal illness and it is likely that the end stage of this is approaching. The General Medical Council (GMC) has produced guidance concerning treatment and care of patients coming towards the end of life.
Which of the following options conforms to the principles described by the GMC regarding end-of-life care?

AKT-1795

In a 78-year-old man with dementia, which feature is the LEAST suggestive of approaching end of life (within the next 12 months)?