AKT-5552
A 72-year-old man who has recently been diagnosed with metastatic prostate cancer presents for review. He has heard he may be eligible for benefits to help with personal care. What is the most appropriate form to fill in?
Archives: MRCGP AKT
AKT-5539
A 87-year-old nursing home resident is being treated for a urinary tract infection. She is found wandering outside the nursing home in an agitated state during the night. Despite receiving proper antibiotic therapy, nursing care, and environmental modifications, she continues to be aggressive and agitated, posing a potential danger to herself. What is the best course of action for managing her condition?
AKT-5554
A 55-year-old woman comes to you for her annual medication review. She expresses worry about her likelihood of developing cancer since her father had a history of bladder cancer.
What is the most significant factor that increases a person’s chances of developing bladder cancer?
AKT-5537
When conducting a yearly evaluation for a senior living facility resident with multiple comorbidities, you observe that he has a heart rate of 57, indicating bradycardia. Which of his medications could be causing this side effect?
AKT-5525
A 68-year-old male patient mentions to you, in passing, that he is worried he might have a stroke.
Which of the following is the single, strongest risk factor for developing a stroke?
AKT-5524
You are evaluating a 79-year-old patient with suspected heart failure. He was seen a few days ago with gradual onset exertional breathlessness over the last few months and a clinical diagnosis of cardiac failure was made.
He reports reduced exercise tolerance, being easily fatigued and some mild breathlessness lying flat in bed at night. He has never smoked and aside from a 10 year history of hypertension is otherwise fit and well with no other medical problems. He takes lisinopril 10 mg OD.
On examination he is comfortable at rest sitting in a chair with no appreciable shortness of breath. He has very subtle pitting pedal oedema and some scattered bibasal crepitations on auscultation of the chest. Heart sounds are normal. Pulse rate is 72 bpm, blood pressure is 150/90 mmHg, oxygen saturations are 95% in room air.
On reviewing the patient today with some initial investigations you can see that his chest x ray has been reported as ‘cardiothoracic ratio is at the upper limit of normal with clear lung fields’ and his ECG shows sinus rhythm with no evidence of previous myocardial infarction and no left ventricular hypertrophy or bundle branch block.
His blood tests show a ‘raised’ brain natriuretic peptide (BNP) level of 900 ng/l.
What is the next step in your management?
AKT-5527
A 79-year-old woman has neuropathic pain and has recently been prescribed amitriptyline. What is the most frequent side effect of this medication?
AKT-5538
An 80-year-old man is accompanied by his family who are worried about his memory and behavior in the last six months. To rule out any reversible causes, a cognitive assessment is conducted which appears to validate the family’s apprehensions. A set of blood tests are ordered, including a complete blood count, liver function tests, urea and electrolytes, and bone profile. What other blood tests should be requested?
AKT-5529
A 78-year-old male presents with cognitive impairment and is diagnosed with dementia.
Which of the following is the most probable cause of the dementia?
AKT-5526
You are seeing a 63-year-old gentleman with a diagnosis of chronic obstructive pulmonary disease (COPD).
His most recent spirometry done six weeks ago shows an FEV1 of 62% predicted and doesn’t appear to vary very much over time. He is currently using an inhaled short-acting beta agonist as required. He tells you that despite using his inhaler up to four times a day he feels persistently breathless.
He stopped smoking five years ago. He denies any acute infective symptoms or haemoptysis. On reviewing the history and the clinical record he has not been treated for an acute exacerbation in the last year.
On examination there is some global reduction in air entry bilaterally but no other focal chest signs. Heart sounds are normal and there is no peripheral oedema. A recent chest x ray is reported as being unchanged from one performed 18 months previously.
Which of the following is the next most appropriate step in his pharmacological management?