Archives: MRCGP AKT

AKT-5509

You are visiting a local nursing home to see a new resident who is complaining of an itchy rash when you get an urgent call to see a 78-year-old lady who has collapsed in the dining room.

The relief staff at the home tell you that she is a diabetic and has had a stroke some years ago, but they do not know much else about her.

On examination, she is lying in the recovery position on the floor and her BP is 115/70 mmHg, pulse 95 she is bathed in sweat and is unresponsive. She has adequate air entry on auscultation of the chest and there is no danger in the immediate vicinity. Trained nursing staff are at hand to help you with her management and take any further action.

What would be your first action in this situation?

AKT-5511

An 80-year-old woman presents for a check-up. She complains of feeling fatigued and drained and requests some tests. She has a medical history of hypertension treated with valsartan, chronic atrial fibrillation and chronic heart failure managed with digoxin and furosemide, and asthma for which she uses salbutamol. During the examination, her potassium level is measured and found to be low at 3.1 mmol/l. Which medication is the probable culprit for her hypokalaemia?

AKT-5512

A cardiologist has written to you about the result of an echocardiogram of an 85-year-old patient, whom she has recently seen in clinic. Your patient has been diagnosed with severe heart failure and the cardiologist has written to you to ask that you initiate treatment with spironolactone.

The most recent renal function tests taken four months earlier do not preclude treatment with spironolactone.

With regard to monitoring electrolytes (including potassium and creatinine) after initiation, and assuming there is no further dose increase, what would you advise?

AKT-5515

A 58-year-old man presents with complaints of leg pains. He has a medical history of hypertension and hypercholesterolaemia, and is a smoker of 20 cigarettes a day.

He reports experiencing pain in his right calf after walking about 50 yards, which occurs every time he walks. The pain subsides when he stops and sits down, but returns upon further walking. He denies any pain at rest and has only experienced symptoms while walking.

Upon examination, no pulses can be palpated in the right foot, but there is no evidence of acute ischaemia. Femoral and popliteal pulses are present, and capillary refill time in the right foot is three to four seconds. There are no ulcers or tissue loss affecting the feet. The patient is otherwise well, with a blood pressure of 154/92 mmHg and a regular pulse rate of 72 bpm.

In addition to referring the patient for ankle-brachial pressure index measurements to confirm the clinical diagnosis, what other assessments should be performed as part of his primary care evaluation?

AKT-5516

An 82-year-old man and his wife come to see you with concerns about his memory. He has forgotten how to do simple tasks in the kitchen and has become confused about his whereabouts. His medical history is unremarkable except for hypertension, which is managed with ramipril. On examination, he appears well with a BP of 142/84 mmHg, a pulse of 75 regular, and an MMSE score of 22. You are fortunate to be in the catchment area for the local university hospital and have access to further investigations. What is the best approach to managing his condition?

AKT-5519

A 72-year-old man presents to his GP with a complaint of rapidly worsening shortness of breath over the past four to five weeks. He reports bilateral ankle swelling and has experienced two episodes of gasping for breath in the past week. The patient has a history of hypertension and takes indapamide and amlodipine. On examination, his BP is 122/72, his pulse is 90 and regular, and he has bibasal crackles on chest auscultation and bilateral pitting edema. Laboratory investigations reveal a hemoglobin level of 122 g/L (135-177), white cells of 8.3 ×109/L (4-11), platelets of 182 ×109/L (150-400), sodium of 141 mmol/L (135-146), potassium of 4.7 mmol/L (3.5-5), creatinine of 122 μmol/L (79-118), and BNP of 520 pg/mL (<100). Based on the latest NICE guidance, what is the most appropriate next step?

AKT-5518

A 78-year-old man has cerebrovascular disease and his memory has been getting slowly worse for the past three years. He is diagnosed with an abdominal aortic aneurysm and ideally should have an operation.

Which one of the following is correct?

AKT-5507

You are summoned to the residence of an 82-year-old man who is receiving home care for advanced prostate cancer. His condition has been declining for the past week and he has been under the care of community nurses. The nurses inform you that he has become increasingly ‘bubbly’ in the last 24 hours. Upon examination, you observe that he is experiencing uncontrollable respiratory secretions at the end of his life. What is the most suitable course of action to alleviate these symptoms?

AKT-5517

What is the most suitable first-line medication for a 75-year-old woman with depression in primary care, assuming there are no contraindications?

AKT-5502

An 85-year-old man patient of yours is discharged from hospital after receiving treatment for a urinary tract infection.

Three days after discharge the lab calls you to say that they received a urine sample before his discharge and there was E. coli present in the urine. However, there are no signs of infection. You call the man back to your surgery to check that he is okay. He has no pain while urinating and says he feels much better.

Which of the following is the best course of action?