Archives: MRCGP AKT

AKT-5448

A slightly overweight 44-year-old man and his spouse visit the GP with concerns about his recent behavior. The wife reports that he has been acting strangely for the past 2 months, becoming easily irritated and frequently criticizing her and their children. Initially, the changes were subtle, but now arguments occur every other day. The husband doesn’t acknowledge any issues, and you observe that he struggles to initiate conversations and often pauses mid-sentence. There is no significant family history, and the husband is not on any regular medications.

What is the probable underlying diagnosis?

AKT-5442

A 56-year-old man with a history of poorly controlled type 1 diabetes presents with worsening neuropathic pain in his legs despite being on amitriptyline hydrochloride. His HbA1c is 82 mmol/mol. What would be the next step in managing his painful diabetic neuropathy?

AKT-5458

A 70-year-old male presents with bilateral paraesthesia in the radial aspects of both hands, over the thumbs and first fingers, as well as paraesthesia in the lateral aspects of both forearms and lower limb spasticity. His HBA1c level is 46 mmol/mol and nerve conduction studies and EMG show evidence of denervation. What is the most probable diagnosis?

AKT-5445

A 37-year-old woman presents at the clinic for a medication review. She was previously seen by a neurologist three months ago due to regular and debilitating headaches. The pain was short-lasting (lasting only a few minutes) and located behind her right eye. She experienced right-sided tearing and nasal congestion, but no sensitivity to light. The attacks occurred over thirty times and could happen up to eight times a day. The neurologist prescribed indomethacin, which has successfully stopped the attacks. What is the probable cause of her symptoms?

AKT-5456

During your weekly ward round at the local neurological rehabilitation care centre you see a 34-year-old man who has a background of depression, asthma and a traumatic spinal cord injury. The nurses report him being more distressed and agitated over the last two days.

On examination he is profusely sweating in the upper body and face, his blood pressure is 180/110mmHg, heart rate 60/min, oxygen saturations 99%, chest clear to auscultation and Glasgow coma scale 15, calves soft and non-tender, pupils equal and reactive. He admits to drinking 15 units/week and smokes 10 cigarettes/day. Regular medications include salbutamol, oxycodone, co-codamol 30/500 as required and prophylactic dose low molecular weight heparin.

What is the most likely underlying cause of the patient’s symptoms?

AKT-5446

A 67-year-old woman presents with a progressive ‘numbness’ in her lower legs over the past 4 months, described as feeling like walking on cotton wool. She has a medical history of hypertension, rheumatoid arthritis, depression, and recurrent urinary tract infections, and is currently taking citalopram, ramipril, amlodipine, atorvastatin, methotrexate, and nitrofurantoin. Upon examination, she exhibits bilateral loss of sensation to fine touch up to her knees. Which medication is most likely responsible for this symptom?

AKT-5459

A 26-year-old woman presents to your clinic for a same-day appointment. She complains of experiencing a sudden and severe headache during sexual intercourse the night before. The pain lasted for several hours before gradually subsiding. She had a similar episode two weeks ago but did not seek medical attention at the time. The patient reports that the headache has now completely resolved. She denies any history of medical conditions and illicit drug use. She is currently using a nexplanon implant for contraception.

What would be the best course of action in this case?

AKT-5452

You are conducting a headache history with a 10-year-old girl who you suspect may be experiencing migraines. What feature is more prevalent in younger patients with migraines compared to older ones?

AKT-5444

You assess a 75-year-old patient who presents with a tremor in their right hand. What are the common symptoms observed in Parkinson’s disease?

AKT-5457

A 68-year-old man who is being treated for Parkinson’s disease is evaluated. What symptom should raise suspicion for a different diagnosis?