Archives: MRCGP AKT

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-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-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-1032

You are a GP working in general practice. Aisha is a 3-year-old girl who is seen on your emergency list with her dad. She has a three-day history of runny nose, dry cough and a low-grade fever. During the examination, you observe a palpable abdominal mass. The rest of her examination is normal.

What would be your next course of action?

AKT-1011

A 9-month-old girl is presented to your clinic by her foster parents, reporting an atypical sequence of movements observed in their daughter. They recorded a video of the episode, and upon reviewing it, you observe mild bilateral flexion of her neck and legs, succeeded by extension of her arms. She repeats this pattern approximately 40 times before ceasing.

What is the probable diagnosis for this scenario?

AKT-1012

A father brings his 15-month-old daughter into surgery. Since yesterday she seems to be straining whilst passing stools. He describes her screaming, appearing to be in pain and pulling her knees up towards her chest. These episodes are now occurring every 15-20 minutes. This morning he noted a small amount of blood in her nappy. She is taking around 50% of her normal feeds and vomiting ‘green fluid’ every hour. On examination, she appears irritable and lethargic but is well hydrated and apyrexial. On examination, her abdomen seems distended but no discrete mass is found.

What is the most likely diagnosis?