Archives: MRCGP AKT

AKT-0459

A 28-year-old male has been diagnosed with Brugada syndrome following two episodes of cardiogenic syncope. During the syncope episodes, ECG monitoring revealed that he had a sustained ventricular arrhythmia. He has opted for an elective ICD insertion and seeks your guidance on driving. He is employed as a software programmer in a business park located approximately 10 miles outside the town center, and he typically commutes to and from work by car. What are the DVLA regulations concerning driving after an ICD implantation?

AKT-0460

A 78-year-old man is being evaluated for his hypertension. He has been taking bendroflumethiazide 2.5mg od for the past 8 years. His current blood pressure is 152/96 mmHg. Upon clinical examination, no significant findings were noted. An echocardiogram from three months ago revealed an ejection fraction of 40% and mild left ventricular hypertrophy. What is the best course of action for managing this patient’s condition?

AKT-0461

A 32-year-old man presents as a new patient at your clinic for his first appointment. He has had no major health issues and has never been hospitalised. He mentions that his father passed away from sudden cardiac death at the age of 35, and an autopsy revealed that he had hypertrophic cardiomyopathy. What is the likelihood that this patient has inherited the same condition?

AKT-0462

A 22 year old man is being investigated by a cardiologist for prolonged QT-syndrome. He visits your clinic with a 4 day history of cough with thick, green sputum, fever, and fatigue. During examination, his temperature is found to be 39ºC, oxygen saturation is 96% on air, and crackles are heard at the base of his left lung. Which medication should be avoided in treating his condition?

AKT-0463

A 72-year-old woman was recently diagnosed with atrial fibrillation during a routine pulse check. She has a medical history of fatty liver disease and well-managed hypertension, which is treated with amlodipine. Her weekly alcohol consumption is 14 units.

Her blood test results are as follows:

– Hb 110 g/L (115 – 160)
– Creatinine 108 µmol/L (55 – 120)
– Estimated GFR (eGFR) 57 mL/min/1.73 m² (>90)
– ALT 50 u/L (3 – 40)

To evaluate her bleeding risk before initiating anticoagulation therapy, her ORBIT score is computed.

What factors would increase this patient’s ORBIT score?

AKT-0464

A 75 year old woman comes to the Emergency Department with gradual onset of dyspnea. During the examination, the patient exhibits an S3 gallop rhythm, bibasal crackles, and pitting edema up to both knees. An electrocardiogram reveals indications of left ventricular hypertrophy, and a chest X-ray shows small bilateral pleural effusions, cardiomegaly, and upper lobe diversion.

Considering the probable diagnosis, which of the following medications has been demonstrated to enhance long-term survival?

AKT-0465

You are evaluating a 72-year-old woman with hypertension, type 2 diabetes and osteoarthritis. She is currently taking 10 mg of ramipril once a day, 10 mg of amlodipine once a day, indapamide 2.5 mg once a day, 500mg of Metformin twice a day, co-codamol PRN and atorvastatin 20 mg at night.

During her visit to the clinic, her blood pressure (BP) is consistently elevated and today it is 160/98 mmHg. As per the NICE guidelines, you want to initiate another medication to help lower her BP. Her K+ level is 4.2 mmol/l.

What would be the most suitable additional medication to prescribe?

AKT-0466

What is the typical target INR for a patient with a mechanical aortic valve?

AKT-0467

A 65-year-old man presents for follow-up at the hypertension clinic. He is currently on a regimen of amlodipine and ramipril and has no significant medical history. He regularly checks his blood pressure at home and brings in a printed spreadsheet of his readings. What is the recommended target blood pressure for these home measurements?

AKT-0468

You assess a 63-year-old man who has recently been released from a hospital in Hungary after experiencing a heart attack. He presents a copy of an echocardiogram report indicating that his left ventricular ejection fraction is 38%. During the examination, you note that his pulse is regular at 78 beats per minute, his blood pressure is 124/72 mmHg, and his chest is clear. He is currently taking aspirin, simvastatin, and lisinopril. What would be the most appropriate course of action regarding his medication?