Archives: MRCGP AKT

AKT-1098

Your friend and colleague, a 60-year-old nurse at the practice, asks for your help. She reports dysuria and frequency. These symptoms are typical of previous UTIs which she typically gets once a year. There is no haematuria, fevers or loin pain and she feels systemically well. She reports that it is difficult to get an appointment with her own practice and doesn’t want to take time off work. She says she will see her GP but doesn’t want to delay treatment as it has become worse in the past.

What would be the most appropriate next step for a 60-year-old nurse who reports dysuria and frequency, typical of previous UTIs, but is having difficulty getting an appointment with her own practice and doesn’t want to take time off work? She feels systemically well and there is no haematuria, fevers or loin pain, but doesn’t want to delay treatment as it has become worse in the past.

AKT-1099

You usually get a box of chocolates every birthday from a particular friend’s family. This year, you receive a deluxe collection from an expensive retailer from the family and you are astonished to see that it costs £110.

What would be the next most appropriate step?

AKT-1100

An 80-year-old gentleman comes in seeking benefits due to his poor vision. He has been experiencing this for quite some time and had to give up driving a few months ago as he felt it was no longer safe.

Regarding the registration of sight impairment, who is authorized to issue a certificate of vision impairment?

AKT-1081

A 54-year-old bus driver presents for routine medication review for his hypertension. Upon reviewing his records, you discover that he was recently admitted to the hospital due to a possible seizure. His wife witnessed unusual jerking movements while he was asleep, and he is currently undergoing investigations to rule out epilepsy. The consultant neurologist has advised him not to drive, but you saw him driving his bus just three days ago. When confronted, he admits to still driving and refuses to inform DVLA as he has not received a definite diagnosis and believes there is no issue. Despite informing him of his legal duty to inform DVLA, he still refuses. As a doctor, what is your duty in this situation?

AKT-1082

A 50-year-old lady with type II diabetes, which has been poorly controlled with metformin.

You recently started her on gliclazide, a sulphonylurea. She had an episode late one afternoon, when she felt shaky and disorientated. She was at home at the time and her husband had to help her sit down in a chair. He took her BM, which was 4.2 and gave her a sugary drink and a biscuit, after which her symptoms quickly resolved. She had not suffered similar episodes in the past.

Physical examination is normal and a recent HBA1c is 75 mmol/mol.

She would like advice about driving her car.

What will you tell her?

AKT-1083

A 22-year-old student has presented to you after being hospitalized with a seizure a few days after completing her final exams. The discharge summary and follow-up letter from the neurologist both indicate that this was an alcohol-related seizure. Despite having normal CT and EEG results, the student admits to consuming a large amount of alcohol before the seizure. She denies any previous alcohol misuse and has normal liver function tests. She has not consumed alcohol since the episode and has been advised to inform the DVLA. As a motorcyclist, she is concerned about any potential restrictions. How long should she refrain from using her motorcycle after experiencing a single alcohol-induced seizure?

AKT-1084

A 45-year-old bus driver has a past medical history of an isolated seizure. He has notified the DVLA and has stopped driving his bus. He holds a full driving licence and has never taken medication. He has undergone a recent assessment by a neurologist and, following initial investigations, is thought to have no continuing increased risk of seizures.
Assuming he remains free of epileptic attacks, when, if at all, can he resume driving a group 2 bus or lorry?

AKT-1085

A 60-year-old man is admitted to hospital after an episode of mildly impaired speech and left leg weakness.

An ECG reveals atrial fibrillation and a CT scan shows a small area of infarction in the territory of the middle cerebral artery on the right. He is started on warfarin and simvastatin and makes a full recovery within two days.

For how long should he refrain from driving his car?

AKT-1086

Samantha is a 35-year-old teacher with no symptoms. She mentions that her mother died last year, after suffering for many years with Alzheimer’s.
Samantha has two sons, one of whom is starting college soon. She was offered a genetic test at the time her mother was diagnosed, but declined it. Now she is reconsidering.
Which is the single, most appropriate next step?

AKT-1087

A 62-year-old patient attends for a routine blood pressure check. He is fit and well with good blood pressure control. He says he has heard that he will have to re-apply for his motor car driving licence at some stage.

To what age is a Group 1 licence (motorcars and motorcycles) valid provided there is no medical disqualification from driving?