Archives: MRCGP AKT

AKT-5501

You are called to a nursing home to see a 85-year-old lady who has become acutely confused.

She has a past medical history of hypertension and hypothyroidism. These are well controlled on bendroflumethazide 2.5 mg OD and thyroxine 100 mcg OD.

On arrival she is disoriented to time and place; and the nursing staff report that earlier she seemed to be hallucinating. On examination, she has a temperature of 38.1°C, pulse rate of 92 regular and a blood pressure of 108/88 mmHg. Blood sugar is 4.6.

What is the next most appropriate acute action?

AKT-5498

A 68-year-old man presents with ankle swelling and signs of heart failure. He has a past medical history of hypertensive heart disease and is currently taking amlodipine and bendroflumethiazide. He was recently treated for an infection at the hospital but cannot recall the name of the medication or the infection. What are some possible causes of heart failure in this patient?

AKT-5500

A pediatrics consultant has entered into a shared care agreement with you regarding a patient’s antibiotic prescribing and monitoring. She has initiated treatment with antibiotics and after a period of stable monitoring, has entered into a shared care agreement with you for ongoing prescribing and monitoring, with any future dose changes initiated by the consultant.
With regard to shared care prescribing, the legal responsibility for prescribing lies with:

AKT-5499

A 70-year-old man has a very poor memory. He makes up stories to account for gaps in his memory. He doesn’t realise what he is doing.

On examination he seems apathetic and has an unsteady gait. What is the most likely diagnosis?

AKT-5497

A 72-year-old man with treated cardiac failure comes to the GP surgery for a three month review after a recent admission for medication stabilisation.

He is currently taking ramipril 10 mg, bisoprolol 10 mg and 40 mg of furosemide. On examination his BP is 122/72, his pulse is 75 and regular. There are sparse crackles at both lung bases but there are no signs of peripheral oedema.

Haemoglobin 127 g/L (115-165)
White cells 6.9 ×109/L (4-11)
Platelets 208 ×109/L (150-400)
Sodium 139 mmol/L (135-146)
Potassium 4.1 mmol/L (3.5-5)
Creatinine 149 μmol/L (79-118)
BNP 230 pg/mL (<100)
Ejection fraction 38%

Which of the following is the NICE recommended next step?

AKT-5478

A 55-year-old man comes to his General Practitioner reporting a weight loss of 10 kg in the past four months. He has been experiencing increased fatigue but has not made any changes to his diet or exercise routine.
What is the most probable diagnosis?

AKT-5495

You are called to see a 77-year-old woman at home.
She is known to suffer with COPD and over the last one to two weeks has started coughing up purulent phlegm and feels more breathless than usual. She uses inhaled treatment only and is not on home oxygen. She lives alone, with no social support.
On examination, she is alert and oriented, oxygen saturations are 93% in air and she is mildly breathless. You diagnose an infective exacerbation of her COPD.
Which of the following factors in this patient’s history and examination should most strongly prompt consideration of admission to hospital?

AKT-5492

An 83-year-old man presents to your clinic complaining of breathlessness. He reports that a year ago he was able to do his gardening and play a round of golf, but in recent months he has been limited by breathlessness. He notes that the breathlessness settles with rest and denies any cough or chest pain. He doesn’t take any prescribed medication but reports taking ibuprofen from the supermarket for his knees. He has a history of osteoarthritis of the knees and occasional gout.

Upon examination, the patient appears well but mildly out of breath upon entering the room. His pulse is 86 bpm in sinus rhythm, and his blood pressure is 130/70 mmHg. Peak flow is 470 L/min, and heart sounds are normal. Chest auscultation reveals bilateral basal end-inspiratory crackles, and there is mild bilateral pitting edema to mid-shin.

What is the most appropriate next step in managing this patient?

AKT-5494

An 88-year-old female patient of yours has multiple medical problems.

She takes aspirin, paracetamol, bisoprolol, ramipril, codeine, omeprazole and nifedipine. She says she tries to remember to take her tablets but she doesn’t attend for repeat prescriptions as often as she should. When compliant, she is stable and well.

Which one of the following regarding this lady’s treatment is correct?

AKT-5496

A 75-year-old gentleman has just begun taking galantamine for his moderate dementia. He initially experienced a runny nose and dry cough. Presently, he is expressing concern about new mouth ulcers, a tender red rash on his trunk, and feeling generally unwell. When his skin is gently rubbed, blisters appear.

What is the MOST PROBABLE diagnosis?