Archives: MRCGP AKT

AKT-0859

A 6-year-old girl is referred to the enuresis clinic by her pediatrician. Her mother initially contacted the pediatrician concerned with ongoing bedwetting and it turns out that the girl has never had a ‘dry night’.

The pediatrician has provided general advice on diet, fluid intake, and toileting behavior, though the mother says the bedwetting has not resolved. Despite the use of a reward system, the girl still wets the bed at night and the mother is getting worried.

She speaks to the enuresis clinic and is sent home with an intervention.

What intervention is likely to be recommended?

AKT-0860

A 7-year-old girl is seen in clinic for nocturnal enuresis. Her parents have attempted a reward system, but there has been no notable progress. What is the best initial approach to management?

AKT-0861

A 7-year-old boy comes to the GP with his father complaining of bedwetting at night. He is wetting the bed almost every night. Despite trying to use the toilet before bedtime, limiting fluid intake before bedtime, and implementing a reward system for dry nights, there has been no improvement. What should be the next course of action for treatment?

AKT-0862

You are asked to organise a tutorial on child protection for nursing students attached to the pediatric ward. When discussing patterns of behaviour which may point towards child abuse, which one of the following is least likely to be relevant?

AKT-0863

A 4-month-old boy is presented by his father. He was exclusively breastfed for the first month of life before being switched to formula. Over the past eight weeks, he has been experiencing various issues such as vomiting, regurgitation, eczema, and diarrhea. Despite these problems, he has maintained his weight at the 50th percentile. Physical examination reveals no significant findings except for some dry skin on his chest. What is the probable diagnosis?

AKT-0864

During a routine examination at 4-6 weeks, a male infant is discovered to have an undescended left testicle that cannot be felt in the scrotum or inguinal canal. What is the best course of action?

AKT-0865

A 14 week old bottle fed baby is brought in by Mum due to concerns of unsettled behavior after feeds, vomiting, loose stools, and perianal redness. The baby has mild to moderate infantile eczema, but otherwise, the examination is normal. The baby’s growth is following the 50th centile. Mum suspects Cow’s milk protein allergy. What is the most suitable course of action?

AKT-0866

A mother brings her 4-year-old boy to see you with a sore throat, fever and rash. On examination he has a punctate rash, strawberry tongue and cervical lymphadenopathy. You diagnose him with scarlet fever and decide to start phenoxymethylpenicillin. Do you need to notify the local health protection team (HPT)?

AKT-0867

A 10-month-old baby girl comes to the emergency department with a 2 day history of high fevers and sensitivity to light. During the examination, her temperature is recorded as 40.2ºC. She has a rash that doesn’t disappear when pressed and appears lethargic.

What is the immediate medication that should be administered?

AKT-0868

You see a 10-month-old girl with her mother who is concerned as her daughter seems pale and has a high temperature. She states that she has been lethargic and not smiling for the last 24 hours. She has had a snotty nose and a cough for the last 2 days. Everyone at home also has a nasty cold. She is managing to drink milk well and has had a normal amount of wet nappies today. Her mother hasn’t noticed any rashes.

On examination, she looks pale and miserable but lets you examine her. Her temperature is 38.1ºC, she has moist mucous membranes and her capillary refill time is 3 seconds. You observe her heart rate to be 140 beats per minute. Her respiratory rate is 50 breaths per minute and her chest sounds clear. Her oxygen saturations are 98% in air. You undress her fully and there are no rashes and her abdomen is soft. Her throat is red with large tonsils and both her eardrums are bright red and bulging.

Which observation that you have made is normal in this age group?