Archives: MRCGP AKT

AKT-5406

A 70-year-old heavy smoker (40 cigarettes per day) has a past history of hypertension and atrial fibrillation. Over the past few months he has suffered a chronic cough and has lost approximately 2 stone (about 12.5 kg) in weight. He has been increasingly drowsy over the past few days and his relatives were unable to rouse him this morning. On examination he has a Glasgow Coma Score of 6 and you notice that he has been incontinent of urine and faeces.
What is the most likely diagnosis for this clinical presentation?

AKT-5412

A 65-year-old woman complains of tingling in her right hand that sometimes disturbs her sleep at night. She usually shakes her hand to alleviate the symptoms, which disappear entirely. She has a history of uncontrolled type 2 diabetes and breast cancer.

During the examination, there is no evidence of deformity or wasting, and she has good strength throughout her hand. The symptoms are reproduced by performing forced wrist flexion.

What is the best initial course of action?

AKT-5420

For which one of the following indications is carbamazepine least likely to be a useful management option?

AKT-5405

A 65-year-old woman with a past medical history of type 2 diabetes, hypertension and hypercholesterolaemia presents as an emergency. She was at home when she suddenly experienced weakness in her right arm and slurred speech. Her husband noticed that her face appeared droopy on one side and she had difficulty raising her right arm. The episode lasted for over an hour before things returned to normal. Her husband brought her to the clinic for evaluation. On examination, her blood pressure is 162/94 mmHg, she is in sinus rhythm at 72 bpm and there are no focal neurological findings. She reports feeling back to normal. The diagnosis is a transient ischaemic attack. What is the most appropriate management plan?

AKT-5413

A 67-year-old woman complains of a sensation of a shadow obstructing a portion of her left eye. She has been experiencing occasional headaches on the same side and reports discomfort in her jaw while eating.

During the assessment, the fundoscopy and eye examination reveal no abnormalities. However, there is slight tenderness on the left side of her head.

What condition is the most probable diagnosis?

AKT-5410

A 32-year-old man presents to the local General Practice out-of-hours service after experiencing a seizure earlier. He has a history of epilepsy since childhood. While waiting to be seen, he has another seizure, which has lasted for more than five minutes.
What is the most suitable initial pharmacological treatment option for this patient? Choose ONE answer only.

AKT-5419

An 88-year-old female presents to the Emergency Department with a 24 hours history of painless loss of vision of her left eye, which has resolved. She described the episode ‘like a curtain coming down across my eye’. She has a past medical history of coronary heart disease and diabetes. She is a non-smoker and she doesn’t drink. She currently takes no medication and has no past medical history of note. Fundoscopic examination is normal and an MRI is taken which shows volumetric loss of white and grey matter throughout with an area of mild white matter hyperintensity in the left frontal lobe on T2-weighted images.

What is her most likely diagnosis?

AKT-5403

What is the single correct statement concerning essential tremor from the list provided?

AKT-5401

An 81-year-old woman is brought to the clinic by her daughter. She lives independently, but her daughter has noticed that she has become increasingly forgetful over the last six months. There are no neurological abnormalities on examination.
Which of the following additional features would be most suggestive of a diagnosis of mild cognitive impairment (MCI)?

AKT-5402

A 26-year-old woman presents with weight loss and is diagnosed with hyperthyroidism. She is prescribed carbimazole but after 2 weeks reports gradual visual blurring. Her corrected visual acuities are 6/12 in both eyes and she experiences color vision impairment in both eyes. Mild proptosis is observed but her pupillary reactions are normal.
What is the most probable reason for her symptoms?