MRCGP AKT Category: Children And Young People

AKT-0519

A 3-year-old child is brought to see you by their parents. They report that for the last couple of days the child has been unwell with a runny nose and ‘wheezy cough’. There is no history of apnoea.

The child was born at 37 weeks via a normal vaginal delivery. There is no significant antenatal or postnatal history. The parents tell you that this is the first time the child has been significantly unwell.

The child usually eats well but over the last two days has been eating less and becoming breathless during meals. Despite the reduced amounts taken per meal, the child is maintaining their eating frequency.

On examination, the child looks comfortable at rest. Temperature is recorded as 37.9°C. There is no respiratory distress and no nasal flaring or grunting. Respiratory rate is 38/minute. Auscultation of the chest reveals fine inspiratory crackles and a slight high pitched wheeze heard throughout both lung fields. Oxygen saturations are 96% in room air.

Which of the following factors in this case should prompt acute hospital admission for paediatric assessment?

AKT-0520

You are seeing a 6-year-old male with no significant medical history who has presented with lower abdominal pain and urinary frequency.

Urine dipstick testing is positive for nitrites and shows 2+ leucocytes. He has a low grade fever but doesn’t require hospital admission. You decide to treat him with a course of trimethoprim for a urinary tract infection.

He weighs 22 kilograms and trimethoprim should be prescribed at a dose of 4 mg/kg (maximum 200 mg) twice daily. Trimethoprim suspension is dispensed at a concentration of 50 mg/5 ml.

What is the correct dosage in millilitres to be prescribed?

AKT-0505

A 6-year-old girl has been suffering from constipation and soiling for many months and her mother feels that something needs to be done now that she is starting school. She was born after a normal delivery and had no problems until the age of three. On physical examination, the only obvious abnormality is a loaded colon.

What is the most appropriate next step?

AKT-0521

A 7-year-old girl has recently been seen by the dermatologists.
She had some scalp scrapings and hair samples sent to the laboratory for analysis following a clinical diagnosis of tinea capitis. The laboratory results confirmed the diagnosis of tinea capitis and the dermatologists faxed through a letter asking you to prescribe griseofulvin suspension at a dose of 12 mg/kg once daily.
The child weighs 20 kg. Griseofulvin suspension is dispensed at a concentration of 125 mg/5 ml.
What is the correct dosage of griseofulvin in millilitres to prescribe?

AKT-0506

An 8-year-old boy comes to the General Practitioner with his father complaining of bed-wetting, thirst and increasing lethargy for the past 2 weeks. The father reports that his son has lost some weight. The patient appears healthy and the examination is normal. Urinalysis reveals 4+ glucose and moderate ketones. His capillary blood glucose level is 16 mmol/l.
What is the most suitable course of action?

AKT-0522

A 6-year-old boy with a medical history of asthma is seen as an emergency with an acute exacerbation.

He has widespread wheeze on auscultation of the chest despite regular use of his salbutamol inhaler via a spacer. There is no respiratory distress and he is suitable to be managed in the community. You decide to prescribe him a three day course of prednisolone.

He weighs 20 kg. You decide to give him a dose of 2 mg/kg once daily. Prednisolone soluble tablets come as 5 mg tablets.

What is the correct dosage of prednisolone soluble tablets to prescribe?

AKT-0501

A 7-year-old girl is playing outside when she trips and falls, landing on the outside of her left foot. She immediately cries out in pain and looks for help. There is no significant family or personal medical history. She is assisted by a neighbor as she limps inside. She is able to put weight on her foot.
Upon examination, her left ankle is swollen, warm, and shows signs of bruising. She has limited range of motion, particularly with internal rotation, and experiences tenderness along the lateral aspect of the ankle joint below the lateral malleolus, although there is no point tenderness over the malleolus itself.
What is the most probable diagnosis?

AKT-0502

Select from the list the single patient who might benefit from receiving antibiotics if they are 65 years old.

AKT-0503

A 4-month-old boy presents with a temperature of 39oC. He attends a morning surgery. The mother reports improvement with paracetamol, but this has worn off and he is miserable again. He looks flushed, but there are no focal symptoms or signs. He is not dehydrated, and there are no other worrying features.
What is the most appropriate management option at this time?

AKT-0504

A 5-year-old boy has a temperature of 39°C and symptoms of an upper respiratory tract infection, but there are no high-risk signs to suggest that admission to hospital is necessary and it is decided that the child should be looked after at home.
What is the most appropriate piece of advice to give to the parents regarding antipyretic interventions?