Archives: MRCGP AKT

AKT-0442

A 75-year-old man visits his GP for a follow-up appointment 6 weeks after undergoing catheter ablation due to unresponsive atrial fibrillation despite antiarrhythmic treatment. He has a medical history of asthma, which he manages with a salbutamol reliever and beclomethasone preventer inhaler, and type II diabetes, which he controls through his diet. The patient is currently receiving anticoagulation therapy in accordance with guidelines. There are no other significant medical histories.

What should be the next course of action in his management?

AKT-0443

A 67 year old male with a known history of heart failure visits his primary care physician for his yearly examination. During the check-up, his blood pressure is measured at 170/100 mmHg. He is currently taking furosemide and aspirin. Which medication would be the most suitable to include?

AKT-0444

A 68-year-old man with chronic heart failure due to ischaemic heart disease complains of knee pain. An x-ray has revealed osteoarthritis. What medication should be avoided if feasible?

AKT-0445

You see a 50-year-old type one diabetic patient who has come to see you regarding his erectile dysfunction. He reports a gradual decline in his ability to achieve and maintain erections over the past 6 months. After reviewing his medications and discussing treatment options, you suggest he try a phosphodiesterase (PDE-5) inhibitor and prescribe him sildenafil.

What advice should you give this patient regarding taking a PDE-5 inhibitor?

AKT-0446

Which of the following is the least acknowledged side effect of sildenafil?

AKT-0447

A 56-year-old man collapses after complaining of palpitations and is admitted to the Emergency Department (ED). He is found to be in ventricular tachycardia and is successfully cardioverted. Further investigations reveal an underlying long QT syndrome, and an implantable cardioverter-defibrillator (ICD) is inserted. The man works as an HGV driver. What advice should be given regarding his ability to drive HGV vehicles?

AKT-0448

A 70-year-old man with a history of hypertension only complains of worsening breathlessness and swollen ankles for the past 3 months. You plan to conduct a BNP test. What could cause a falsely low BNP result in this patient?

AKT-0449

A 75-year-old man with a history of type 2 diabetes mellitus and hypertension is seen in clinic. There is no evidence of diabetic retinopathy, chronic kidney disease or cardiovascular disease in his records.

He is currently taking the following medications:
simvastatin 20 mg once daily
ramipril 10 mg once daily
amlodipine 5mg once daily
metformin 1g twice daily

Recent blood results are as follows:

Na+ 142 mmol/l
K+ 4.4 mmol/l
Urea 7.2 mmol/l
Creatinine 86 µmol/l
HbA1c 45 mmol/mol (6.3%)

The urine dipstick shows no proteinuria. His blood pressure in clinic today is 134/76 mmHg.

What is the most appropriate course of action?

AKT-0450

A 65-year-old male on long-term warfarin for atrial fibrillation visits the anticoagulation clinic. Despite maintaining a stable INR for the past 3 years on the same dose of warfarin, his INR is found to be 5.4. What is the most probable cause of this sudden change?

AKT-0415

A 56-year-old man with a history of smoking, obesity, prediabetes, and high cholesterol visits his GP complaining of chest pains that occur during physical activity or climbing stairs to his office. The pain is crushing in nature and subsides with rest. The patient is currently taking atorvastatin 20 mg and aspirin 75 mg daily. He has no chest pains at the time of the visit and is otherwise feeling well. Physical examination reveals no abnormalities. The GP prescribes a GTN spray for the chest pains and refers the patient to the rapid access chest pain clinic.

What other medication should be considered in addition to the GTN?