Archives: MRCGP AKT

AKT-0619

A 16-year-old girl is seen with a two to three month history of poor sleep, tiredness, reduced appetite and weight loss. She reports low mood and anxiety worse on waking in the mornings.

She has a history of self harm and you can see evidence of recent deliberate self harm with several superficial cuts to her forearms. She admits to recent suicidal thoughts but has not acted on these and has no acute suicidal intent. She has no psychotic symptoms.

Following your assessment you make a diagnosis of moderate depression.

What is the most appropriate approach in this instance?

AKT-0620

A 3-year-old boy has a seizure associated with a temperature of 38.5°C. The seizure lasts for three minutes and he regains consciousness. He has symptoms suggestive of an upper respiratory infection but has no abnormal physical signs.
Which option is MOST LIKELY to influence a doctor in favour of managing him at home?

AKT-0621

A mother brings her 2-year-old child to see you. The child has had diarrhoea and been vomiting for the last 48 hours.

On further questioning, the child has had four very loose stools today and vomited three times. The child has no significant past medical history and is usually well. There has been no blood in the faeces. There is no history of foreign travel. On examination the child has a temperature of 37.5°C, is not dehydrated and has a soft abdomen with no focal findings. You diagnose gastroenteritis.

What is the most appropriate way of managing this child?

AKT-0622

A 7-month-old girl presents with diarrhoea and vomiting. She has vomited twice and had about four diarrhoea stools in the previous 24 h. There is no obvious sign of dehydration. She was born at 37 weeks’ gestation with a low birthweight but has gained weight adequately since then.
What is the most appropriate next management choice?

AKT-0623

You see a 9-year-old boy with his mother. She reports that her son initially had a temperature of 37.8 °C along with a sore mouth. She then noticed some new skin lesions on his palms and soles.

On examination, you note some healing ulcers in the mouth. You note several grey vesicles on the child’s palms and soles. He has a reduced appetite but is still drinking plenty of fluids. No amber/red flags are noted.

What is the SINGLE MOST appropriate NEXT management step?

AKT-0624

A 6-year-old boy is brought to the clinic by his father who reports that he has been experiencing nocturnal coughing for the past three months. The father has observed that his son frequently wakes up at night due to coughing fits. Despite two previous rounds of antibiotics, the cough has not improved. The child is generally healthy, has a good appetite, and has met all developmental milestones for his age. On examination, there are no notable findings. What would be your plan of action?

AKT-0625

A seven-year-old girl comes to the clinic with a 2-day history of fever, urinary frequency, and dysuria. A urine dipstick test is done on a fresh urine sample which shows positive for nitrites and negative for leucocytes. She has no signs of systemic illness and no abdominal or loin symptoms. The child has been healthy in the past and has never had a urinary tract infection. What is the best initial management plan?

AKT-0626

A young woman who is ten weeks pregnant comes to you with an erythematous rash, mild fever and enlarged glands in her neck. You suggest taking a blood test to check if she is immune to rubella since there is no record of her being immunised. She asks about the potential risk to her baby if she does have rubella. What is the percentage of infants that may develop congenital rubella syndrome and potential birth defects if a woman contracts rubella at ten weeks gestation?

AKT-0627

You have diagnosed measles in a 7-year-old child who did not receive the MMR vaccine when younger.

The child’s father has called the clinic to inquire about when his child can return to school because he needs to plan for childcare arrangements and it is affecting his work schedule.

What is the recommended duration for a measles case to stay away from school or work?

AKT-0628

You see a 14-month-old boy in your clinic. He was seen by your colleague four days ago for fever, rhinitis and a cough. At that point, it was felt to be a viral upper respiratory tract infection. Today, his mother reports that his temperature has increased to 39.5c and the cough worsened. A new erythematous rash has appeared on his chest. On examination, you note some pale lesions on his oral mucosa.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.