MRCGP AKT Category: Children And Young People

AKT-0966

Sophie is a 2-year-old girl who is brought in by her father. She has had a fever overnight, along with a sore throat and cough. Her father is worried that she seems more tired than usual today. During the examination, you note the following:

Temperature 38.5 degrees
Heart rate 160 bpm
Respiratory rate 40 / min
Oxygen saturation 95%

The lungs are clear, but there is inflammation and redness in the throat, and there are swollen lymph nodes in the neck.

According to the NICE traffic light system for assessing fever in children, which of the following is considered ‘amber’?

AKT-0967

In your morning clinic, a 13-month-old girl is brought in by her father. She has been unwell for 2 days with a fever that has been over 39ºC. She has a cough and has been refusing to eat. Although she has been drinking normal amounts of milk, her urine output is less than usual. Her nose has been very runny, and she keeps rubbing her left ear. Her father is most worried about her cough and breathing and is wondering if she needs antibiotics.

During the examination, she appears alert but coryzal. Her temperature is 39.2ºC. Her heart rate is 150 beats per minute. Her respiratory rate is 60 breaths per minute. Her capillary refill time is < 2 seconds, and her mucous membranes are moist. You can hear transmitted sounds from her upper airway throughout her chest, but nothing focal. She has no visible rashes. Her throat is red with enlarged tonsils, and her left ear has a red, bulging tympanic membrane. You consult the NICE traffic light system for feverish children. What observation is considered a red symptom, requiring admission to the hospital for further evaluation?

AKT-0968

A mother of a 9-month-old seeks guidance. Initially, she opted out of the oral rotavirus vaccine for her child to limit the number of immunisations. However, due to an outbreak at her baby’s daycare, she now desires the vaccine. What should she do?

AKT-0969

A 6-year-old boy is brought in by his parents. He has had 3 episodes of acute otitis media in the past year and his teachers have noticed that he seems to be having difficulty hearing. His medical history includes a diagnosis of ADHD. During the examination, you observe a dull left-sided tympanic membrane and diagnose otitis media with effusion. What would be the most suitable course of action?

AKT-0970

A 10-year-old boy is presented by his father with a widespread skin rash. The itching started 3 days ago and he has been experiencing fevers. Upon examination, the rash is composed of macules, papules, crusted lesions, and vesicles that are present on most of his body. The father has been administering ibuprofen to alleviate his son’s fever and discomfort.

What is the probable diagnosis and why is ibuprofen not advisable in this case?

AKT-0971

Samantha brings her 18-month-old daughter to the clinic for her routine immunisations. The healthcare provider informs her that her daughter will require four different vaccines, including a pneumococcal booster. Samantha inquires about when her daughter received the pneumococcal vaccine previously in the schedule.

AKT-0972

A 12-year-old girl presents to your clinic with her mother, complaining of a rash of small red dots on both arms that has been gradually worsening over the past month. The patient reports feeling generally well, but has been experiencing increased fatigue lately. Upon examination, you note a petechial rash on both forearms and her left calf, as well as hepatomegaly and splenomegaly (3 cm and 2cm below the costal margin, respectively). What is the best course of action for managing this patient?

AKT-0973

A 2-year-old boy is brought to surgery with a fever and poor appetite. Upon examination, his temperature is 38.5ºC and there is no clear source of infection. The mother was able to collect a urine sample using a collection pad, which tested positive for both leucocytes and nitrites. As a result, the child was started on a course of trimethoprim and the urine sample was sent for culture. After three days, the urine culture results reveal the growth of Pseudomonas aeruginosa. What is the most appropriate course of action?

AKT-0974

As a GP in a busy clinic, you are conducting a 2-month check on an infant. During the examination of the genital area and buttocks, you observe a rash. The rash doesn’t affect the gluteal cleft and is made up of well-defined, merging red patches that have a beefy red appearance. Additionally, there are some isolated papules. The mother has been using Sudocrem daily for almost two weeks, but the issue has not been resolved.

What would be the most appropriate course of action for managing this patient?

AKT-0943

A 12-year-old boy is diagnosed with haemophilia A after being evaluated for a haemarthrosis. Among his family members, who is the most probable to have the same condition?