Archives: MRCGP AKT

AKT-0719

You are working an out-of-hours session one evening when a mother brings her 3-month-old child in for assessment.
The child has been well up until two days ago and has no significant past medical history. She tells you that the child has had a ‘cold’ and congestive symptoms. The mother has brought the child this evening because a cough has developed.
On further questioning, the child is feeding satisfactorily. On examination, you find a temperature of 37.8°C and a sharp cough is noted. The infant is hydrated and comfortable at rest with no respiratory distress. Auscultation of the chest reveals diffuse fine end-inspiratory crackles and an occasional wheeze, heart sounds are normal and there is no peripheral oedema. Oxygen saturations are measured at 97% in air.
What is the most appropriate management plan?

AKT-0720

A 6-month-old child is brought to see you with a nappy rash.

On examination, the baby has a well defined erythematous rash around the perianal skin and in the skin creases. A few satellite lesions are also noted. The child is otherwise well but has a coated, white tongue.

What treatment should be prescribed for the nappy rash?

AKT-0721

A 5-year-old girl presents with intermittent leg pains, which have been occurring for four weeks. They occur at night and wake her from sleep. The pain is relieved when her mother rubs her legs. The girl is otherwise well and examination is normal.
What is the most likely diagnosis?

AKT-0722

You have been informed by the local hospital that a 5-year-old boy from your practice has been admitted with definite meningococcal septicaemia. There have not been any previous cases. You need to organise appropriate prophylaxis.
What is the most appropriate group to treat in this case?

AKT-0723

A 14-year-old boy presents with lethargy, abdominal bloating and loose stools. He has lost 5 kg in weight over the last six months. Examination confirms a thin teenager with obvious pallor.
What is the most appropriate test to investigate possible malabsorption?

AKT-0724

A 6-month-old boy is brought to the surgery for his first measles, mumps and rubella (MMR) vaccination.
What is the most likely contraindication to his receiving the vaccine today?

AKT-0725

A 10-week-old child is about to receive vaccination with pertussis. You are assessing his suitability for vaccination.

In which of the following situations should the vaccine be postponed?

AKT-0726

A middle-aged couple attend clinic after the birth of their first grandchild and are worried about cot death as friends of theirs suffered a cot death.

Which of the following actions could you advise that would reduce the risk of cot death?

AKT-0727

A 12-month-old boy has a history of recurrent chest infections requiring antibiotics. In addition, his weight gain is poor, dropping from 50th centile at birth to 5th currently. His mother reports that his stools are always loose. His mother and father are well and he has no siblings.
What is the single most likely diagnosis?

AKT-0728

A 4-week-old boy comes for his 4-week check. You wish to examine for developmental dysplasia of the hip.
Which of the following options is most suggestive of developmental dysplasia in the hip when being examined?