Sophie is a 12-week-old infant who has been brought in by her mother due to recurrent episodes of regurgitation after feeds and frequent crying during feeding for the past week. She is otherwise well.
Sophie was born at term and is formula-fed. Her mother explains that each feed is around 180ml and she has 5-6 feeds over a 24 hour period. Sophie’s current weight is 5.5kg.
After a full assessment, you suspect that this is gastro-oesophageal reflux disease.
What is the most appropriate next step?
AKT-0773
You assess a 5 month old girl who was hospitalized due to a urinary tract infection and showed improvement after receiving antibiotics within 48 hours. She was discharged after 2 days. As per NICE guidelines, what follow-up (if any) should be scheduled?
AKT-0774
A father brings his 5-year-old daughter to the clinic. Despite the MMR scare, he had her immunised. However, he is concerned about the recent increase in measles cases and wonders if she needs a booster shot. What should be done in this situation?
AKT-0775
You are working in Out of Hours. A 3-year-old girl is brought in by her parents. From the waiting room, you can hear a loud barking cough and as she is brought in you hear that her breathing is mildly stridulous and a tracheal tug is visible. Observations show that her temperature is 38.1ºC, heart rate is 140 beats per minute and respiratory rate is 30 breaths per minute. Oxygen saturations are 98% in room air and the girl is easily distracted with her toy doll. What medication do you prescribe?
AKT-0776
As the duty doctor, you are presented with a 3-year-old girl and her mother in an emergency appointment. The child has been experiencing vomiting and diarrhoea for the past 4 days, and her mother is growing increasingly concerned as her symptoms do not seem to be improving. The child is now very pale and vomits every time she eats or drinks anything. She is having watery stools 6-8 times a day, and her nappies are only about 50% of normal. She has not had a fever or any rashes, and she is typically healthy and developing normally.
Upon examination, the child appears tired and pale, sitting on her mother’s lap without smiling. She looks ill. Her heart rate is 120 bpm, and her capillary refill time is 2-3 seconds. She has dry mucous membranes and reduced skin turgor. Her temperature is 37.1ºC, and her respiratory rate is 35 breaths per minute. Her abdomen is soft and doesn’t appear tender.
You suspect that the child has viral gastroenteritis, but you are concerned that she is dehydrated and may require admission for rehydration. Before calling the paediatric team at your local hospital, you compare the child’s observations to the NICE traffic light system for feverish children.
Which observation is scoring red (high risk)?
AKT-0777
A 28-year-old mother contacts the on-call doctor, concerned about her two daughters (aged 4 and 6) who attend the same school. She reports that both girls have been complaining of an itchy scalp for the past week, but she has not noticed any visible signs of rash or irritation. After conducting a dry combing of their hair, she has found live lice on her younger daughter.
What advice would you give as the on-call doctor?
AKT-0778
You are assessing a 16-month-old boy with croup. What sign should indicate the need for referral to a hospital for further evaluation?
AKT-0779
A 5-year-old boy comes to your morning clinic with his father. His father reports that he has been feeling unwell for the past 24 hours with a fever, sore throat and eating less than usual. This morning he developed a rash. His father has been encouraging fluids and has given paracetamol. He has no significant medical history and is up to date with his immunisations.
On examination, he is alert and talkative but looks slightly flushed. His temperature is 37.5 ºC, heart rate 95 bpm, respiratory rate 22/min, capillary refill time 1 second. He has moist mucous membranes, his tonsils are not inflamed, he has a strawberry tongue. There is a rough, pinpoint, erythematous blanching rash on his torso.
You prescribe a 10-day course of penicillin V and give adequate safety netting. His father asks if he can return to school as he feels he is well enough.
When can he go back to school?
AKT-0780
A father contacts the clinic regarding his 3-year-old daughter who was recently diagnosed with strep throat and prescribed antibiotics. He neglected to inquire about the duration of time she should stay home from preschool. What guidance should be provided?
AKT-0781
Which one of the following statements regarding the pertussis vaccine is accurate?