MRCGP AKT Category: Children And Young People

AKT-1025

Sophie is a 4-year-old girl who has been brought in by her father with a 2 day history of cough and fever. Her father describes the cough sounds like a bark and today Sophie has appeared more breathless.

On examination, Sophie appears alert with moist mucous membranes. You observe nasal flaring and moderate intercostal recession. You check Sophie’s temperature which is 38.2°C and oxygen saturation is 97% in air. Her respiratory rate is 52 breaths per minute and heart rate is 138 beats per minute.

What red flag symptoms have you observed in Sophie?

AKT-1026

A mother brings in her six month-old daughter with constipation. Which of the following in the history and examination would require a referral to Paediatrics?

AKT-1027

A mother brings her baby to the GP for a check-up and seeks guidance on her child’s developmental milestones. She mentions that her baby was born prematurely at 34 weeks gestation. Considering the premature birth, at what age can the baby be expected to display a responsive social smile?

AKT-1028

A 12-week-old baby is brought to the clinic with persistent regurgitation that causes significant distress. The infant is exclusively breastfed and appears otherwise healthy. The baby was born a week before the due date through a normal vaginal delivery. The mother experienced significant blood loss during delivery and required overnight observation. She was found to be slightly anemic and was given ferrous sulfate supplementation. What initial treatment would you suggest for this baby?

AKT-1029

While working at an urgent care centre, a 3-year-old girl comes in with a typical barking cough of croup. As per the Wesley Croup Score, she has mild croup. After administering a dose of dexamethasone and observing her for a while, you discharge her. Her parents inquire if there are any remedies they can use at home to alleviate her symptoms. What suggestions should you offer to the parents?

AKT-1014

A father brings his 8-week old son for a baby check. Inspiratory stridor is noted on auscultation when he is laid on his back with audible stridor at the bedside too. He is otherwise thriving with normal length, weight and head circumference. His father notes that he has noisier breathing when he is feeding. You advise him of the likely diagnosis and refer him to a paediatrician for assessment.

The father asks how likely this condition is to resolve and whether surgery is required, how do you answer?

AKT-1030

A 14-month-old girl is brought to see you by her mother who is worried about her. She is usually healthy, but over the past few days, she has become increasingly unwell with lethargy, cough, and shortness of breath. It all started 3 days ago when she developed a runny nose, cough, and fever, but now she is struggling to breathe and is very tired.

Upon further questioning, her mother reports that she has been eating and drinking less than usual, only about 60% of her usual daily amount, and has been wetting fewer nappies. Her mother has also noticed that she has become more wheezy throughout the day.

During the examination, the girl appears unwell and is not responding appropriately to social cues. Her respiratory rate is 50 breaths per minute, oxygen saturation is 96%, and she has a global wheeze. Her heart rate is 150 beats per minute, her temperature is 37.9ºC, and her capillary refill time is 2 seconds.

What findings from the history and examination above would cause the most concern?

AKT-1015

A 6-year-old child is brought to the emergency room by her mother after she noticed a red rash on her daughter’s legs that doesn’t disappear when pressed. The child has been unwell with a fever and cough since yesterday, but her symptoms have worsened throughout the day. The mother is worried because her daughter is also complaining of a headache and has cold hands and feet. During the examination, the child is found to have a petechial rash on her lower legs and a temperature of 38.4ºC. The mother reports that her daughter is allergic to penicillin and had a rash and vomiting after taking amoxicillin for an ear infection 2 years ago. What is the most appropriate course of action?

AKT-1031

A 6-month-old is brought to your clinic with suspected reflux. The parents report that the baby has been experiencing regurgitation after feeds and becomes very distressed. The baby is fully formula-fed and has been difficult to feed. However, the baby is gaining weight well and is otherwise healthy. There is a family history of reflux, with the baby’s older sibling having had reflux in infancy. Upon examination, the baby doesn’t have tongue-tie, has a normal suck-reflex, and the abdominal examination is reassuring. What steps should be taken to address the suspected reflux?

AKT-1016

At what age is precocious puberty in females defined as the development of secondary sexual characteristics before?