MRCGP AKT Category: Children And Young People

AKT-0585

A 6-year-old girl presents with a rash and joint pain. The rash has developed over the past few days, with the joint pain starting today. She also reports intermittent abdominal pain that has been occurring since before the rash appeared. On examination, she is afebrile with a blood pressure of 110/70 mmHg. There is a symmetrical purpuric rash over the extensor surfaces of her arms and legs and over her buttocks, while her trunk is unaffected. The child complains of pain in her knees and ankles, which appear slightly swollen. Her abdomen is soft with mild periumbilical tenderness on palpation. Which test would be most helpful in guiding further management of this patient?

AKT-0586

A 6-year-old boy complaining of acute abdominal pain is brought to see you by his mother. His mother tells you that he has been having bouts of abdominal pain for the last few days that she thought would settle with time. In addition, she tells you that he has also developed a rash on his legs and has been complaining that his knees and ankles are sore. He is opening his bowels normally and passing urine normally. Prior to the last few days he has been entirely well. He has no significant past medical history and is not on any regular medications.

You examine him and he is afebrile and alert. His blood pressure is 118/82 mmHg. There is no significant lymphadenopathy. His abdomen is soft with no masses. He has some mild tenderness on deep palpation around the umbilicus and lower abdomen. There is an obvious purpuric rash over the extensor surfaces of his legs and buttocks. You also notice a few similar lesions on the extensor surfaces of his arms. His trunk is unaffected by the rash.

He has full range of movements in his joints which are not inflamed, however there is discomfort when manipulating his knees and ankles and his ankles appear slightly puffy.

Which of the following tests is most useful in guiding further management of this patient?

AKT-0587

A 9-year-old boy comes to see you with his father; they have returned from a holiday to Egypt and the father is very concerned as his son is lethargic, tired and has most recently become jaundiced, with dark urine. He is nauseated all the time and hardly able to eat.

On examination he is pyrexial 38.2°C, with jaundice and evidence of scratch marks on his skin.

Investigations show:

Haemoglobin 118 g/L (135 – 180)

WCC 8.2 ×109/L (4 – 10)

Platelets 190 ×109/L (150 – 400)

Sodium 140 mmol/L (134 – 143)

Potassium 4.7 mmol/L (3.5 – 5.0)

Creatinine 105 µmol/L (60 – 120)

Bili 142 (<26) ALT 680 (<36) Which one of the following is true of his condition?

AKT-0588

The practice health visitor informs you that a mother of a 6-month-old baby is coming to seek advice. The mother was diagnosed with Hepatitis B during pregnancy, and the baby received a vaccination before being discharged. What is the recommended Hepatitis B vaccine schedule for the baby?

AKT-0589

A mother attends the surgery to ask about vaccination of her child who is coming up to six months old and due to start the primary schedule.

She recognises from the immunisation list what diseases most of the vaccines prevent but she doesn’t recognise ‘Hib’. She wants to talk about which diseases it can prevent.

Which of the following conditions is most likely to be prevented by Hib vaccination?

AKT-0590

A three-month-old boy presents to the clinic with a scrotal mass that his mother has noticed. Upon examination, you observe a smooth, soft swelling on the right side of the scrotum. The testicle cannot be felt separately, and the lump is contained within the scrotum. You are able to palpate above the mass, and transillumination testing is positive. What is the most suitable course of action at this stage?

AKT-0591

A mother has noticed that her 2-year-old daughter takes little interest in other children. She comes to clinic concerned the child may have autism.
Which of the following features is most suggestive of a diagnosis of autistic spectrum disorder in a child of this age?

AKT-0592

A 9-month-old boy has a temperature of 38.5°C. You first saw the child two days ago and the child has been febrile since then. He now has a faint erythematous macular rash that blanches on pressure. The parents are anxious.
Which option would be MOST IMPORTANT in making the decision to admit the child to hospital?

AKT-0593

A 4-year-old boy has developed a maculopapular rash. His mother wants to know what condition he has developed.
Which of the following features is most suggestive of a diagnosis of rubella rather than measles?

AKT-0594

A 6-year-old child is brought to see you by his parents. They have noticed that he has developed a skin rash and bruising over last 24-36 hours.

The parents report that he has previously been a well child with no serious past medical problems or hospital admissions. The only time they have sought medical attention in the past has been for the occasional upper respiratory tract infection but these have been infrequent.

He last had a viral upper respiratory tract infection about 7-10 days ago. The parents managed this at home without the need for medical assessment as the symptoms were not severe.

On examination he appears well in himself with no temperature, and is interacting and playful. However there is marked superficial bruising and purpura over his trunk and legs. You also note four blood blisters on his tongue. There is no lymphadenopathy or hepatosplenomegaly and the remainder of the clinical examination is unremarkable with normal urine on dipstick testing.

What is the most likely diagnosis?