new AKT Questions

1. A 50 year old man has a blood pressure of 158/88. He has no known atherosclerotic disease but is keen to prevent it. He asks if he should take aspirin. At which calculated absolute risk of a cardiovascular or cerebrovascular event is it appropriate to start aspirin 75mg?

a ) Greater than, or equal to, 10% over five years
b ) Greater than, or equal to, 10% over 10years
c ) Greater than, or equal to, 15% over five years
d ) Greater than, or equal to, 15% over 10 years
e ) Greater than ,or equal to, 20% over five years
f ) Greater than, or equal to, 20% over 10 years

Answer: F

Asymptomatic individuals, without established atherosclerotic disease, but with a calculated cardiovascular risk of more than, or equal to, 20% in 10 years, should be considered for aspirin 75mg daily.

2. A 40 year old woman presents with intermittent abdominal pain which she says is totally relieved by defaecation. Which one of the following symptoms would suggest further investigations are mandatory?

a ) Loose stools
b ) Blood in stools
c ) Feeling of incomplete evacuation
d ) Increased stool frequency
e ) Mucus in stools

Answer: B

According to the Manning Criteria for the diagnosis of irritable bowel syndrome, the diagnosis may be made if three or more of the following are present: abdominal pain, relief of pain with defecation, increased stool frequency with pain, looser stools with pain, mucus in stools and feeling of incomplete evacuation. If any of the following red flag symptoms are present a full GI work up is needed: being over 50 years old, having weight loss, blood in stools, anaemia or fever.

3. A 40 year old doctor, who has just returned from a six month sojourn in Central America, presents with a painless nodule of his right upper eyelid. It has been growing slowly over the last six weeks. What is the single most likely infected cause of the swelling?

a ) Leishmaniasis
b ) Leprosy
c ) Malaria
d ) Schistosomiasis
e ) Trypanosomiasis

Answer: A

He is presenting with a chalazion. With increasing international travel, it is important to take a travel history. Leishmaniasis is found in the rain forests of Central and Southern America. It can commonly present as an infected chalazion

4. A 54 year old man, with a moderate learning disability, is brought to see you by his carer. She states that his behaviour has been deteriorating over the last three weeks. He hasn’t been responding when spoken to and hasn’t been doing things when asked. He becomes aggressive when confronted. In particular, he has refused to turn down the volume on his TV and this is causing arguments with other residents. He has been well otherwise, with no change in eating or toilet habit. He has no relevant history or medication. He answers all questions with the response “I’m fine” but this is his usual. On examination, he is apyrexial, pulse and BP are normal. His chest and abdomen are normal. Which one of the following is the most likely diagnosis?

a ) Absence seizures
b ) Depression
c ) Ear wax
d ) Early onset dementia
e ) Urinary tract infection

Answer: C

Due to communication difficulties, people with learning disabilities may not complain of any sensory changes and, therefore, simple problems like a build up of ear wax can present in an unusual way. One must be alert to such atypical, and often simple, explanations.

5. OPTIONS:
a ) 2 weeks
b ) 4 weeks
c ) 6 weeks
d ) 8 weeks
e ) 12 weeks
f ) 26 weeks
g ) 52 weeks

INSTRUCTION: For each patient below who has had a Myocardial Infarction (MI), select the single most appropriate time scale above to fit their circumstances. Each option may be used once, more than once or not at all.

A. Mr A is 50 years old and has recently had an uncomplicated MI. This is his first cardiovascular event and he has made a straightforward recovery. For how long after the event should he be advised to refrain from driving his car? (He does not hold a PSV or HGV licence)

The Correct answer is b.
B. Mrs B is 50 years old and has recently had an uncomplicated MI. This is her first cardiovascular event and she has made a straightforward recovery. She works as a dinner lady. This involves a lot of lifting and carrying of heavy pots and pans as well as supervision of children. She misses the company at work and is keen to get back to her own job. According to the British Heart Foundation when should she be advised that she may return to her work?

The Correct answer is e.
C. 3 . Mr C is 45 years old and has recently had an uncomplicated MI. This is his first cardiovascular event and he has made a straightforward recovery. He is able to climb two flights of stairs without difficulty. His daughter has recently had a baby and he is keen to visit. This would involve a flight of three hours. How long after his MI do most airlines advise before he can fly?

The Correct answer is a.

Mrs B must be considered to be a heavy manual worker and as such should be advised to wait for three months before going back to her work. The British Heart Foundation has a useful leaflet on activity after an MI- Heart Information Series No7. Most airlines will not carry passengers for two weeks after an uncomplicated MI but will then do so if they can climb a flight of stairs without difficulty.

7. OPTIONS:

a ) Prostate cancer
b ) Bladder calculus
c ) Chronic prostatitis
d ) Urinary tract infection
e ) Urethritis
f ) Benign prostatic hypertrophy
g ) Urethral stricture

INSTRUCTION: Choose the single most likely option above for each of the scenarios below. Each option can be used once, more than once or not at all.


1 . A 58 year old patient, who has previously been catheterized and has undergone a T.U.R.P, complains of diminishing urine flow over a period of months. Rectal examination reveals no prostatic enlargement.

The Correct answer is g.
2 . A 65 year old patient presents with terminal dribbling, poor flow and hesitancy. Rectal examination reveals a smooth and symmetrical swelling. The surface is flattened and it is difficult to get the examining finger forward round each side.

The Correct answer is f.
3 . A 32 year old diabetic man presents with chronic, perineal pain of varying severity and frequency. It is exacerbated by sitting on a hard chair. He also describes low back pain extending down his left leg with bouts of fever and dysuria. Rectal examination reveals an enlarged, firm, and irregular prostate.

The Correct answer is c.

Prostate cancer is rare below the age of 50. Benign prostatic hypertrophy is a common condition in older men; it is unusual before 50 years of age and is most common between 60 and 70

8. A 67 year old woman, who is well known to you, has been diagnosed with Alzheimer’s disease and is in a care home. You are asked to see her because she has become aggressive and violent towards carers and other residents. Carers have followed NICE guidance on the management of aggression with no success. You manage to examine her and can find no obvious cause for her deterioration. You decide that she will need admission for further assessment in order to exclude other remediable causes for her agitation, and that it is justifiable to sedate her at this point. Which the single most appropriate drug for this purpose?

a ) IM haloperidol
b ) Oral diazepam
c ) Oral chlorpromazine
d ) IM lorazepam
e ) Oral lorazepam

Answr: E

Agitation and aggression should be managed by non-pharmacological methods where possible. The use of drugs is often unnecessary, and they can increase the risk of cerebrovascular events. If the risks have been considered and are justified, oral drugs are preferable to parenteral routes. Oral lorazepam, haloperidol or olanzapine in the lowest effective dose are the preferred drugs. Careful patient monitoring after sedation is mandatory.


10. A 23 year old man, who is a reformed intravenous drug misuser, was screened by the practice for blood borne viruses. He was found to be suffering from chronic Hepatitis C. He is accepted on to a treatment programme and is given pegylated Interferon and Ribavirin. He presents to you complaining of feeling extremely tired and not wanting to do anything. His appetite is poor and his bowel is looser than usual. He has lost weight. As a precaution you check his bloods. Which one of the following is the most likely diagnosis?

a ) Crohn’s disease
b ) Depression
c ) Gastric carcinoma
d ) Psychotic illness
e ) Renal failure

Answer: B

This combination of drugs has a very wide range of adverse side effects including effects on the liver, heart, kidney, gastrointestinal and haemopoietic systems. However, depression and flu-like symptoms are much more common.