Archives: MRCGP AKT

AKT-0604

You see a mother with her 3-month-old daughter. She is concerned as she had her weighed and found she had lost 5% of her body weight. She is exclusively breastfeeding. She reports that the health visitor reviewed her breastfeeding and was happy with the technique. She is passing urine and opening her bowels normally. There were no issues during the pregnancy and was delivered at term via vaginal delivery. She was born on the 50th centile. Examination was unremarkable.

What would be the next most appropriate step in her management?

AKT-0605

You see a 6-month-old baby girl who has been crying and pulling her legs up as if she is in pain. She has had some loose stools and has vomited twice today.
Her mother says that the last stool looked rather red as if there was blood in it. She looks pale and distressed.
What is the likely diagnosis?

AKT-0606

A child is born at term after an uneventful pregnancy and full antenatal care. The delivery is normal and the child was discharged after 48 hours. At five days old the child is jaundiced. There are no other worrying features.
According to the National Institute for Health and Care Excellence, what is the most appropriate first-line investigation?

AKT-0607

A 4-year-old child presents with a sore throat and cough. He vomited twice in the past 24 hours. He is drinking and passed urine four hours ago. He has no rash. He has had tonsillitis twice in the past and his mother now requests antibiotics. There is nil of note in past medical history, and he is not on any medications.

On examination, the child is alert. His temperature is 38.9°C, HR 130, RR 30, and CRT<2 sec. There are no recessions or rash, chest clear, eardrums pink, tonsils large and red with fine white exudate, normal cervical lymph nodes. Based on the NICE ‘traffic light’ system, what is the most appropriate management for this 4-year-old child?

AKT-0608

The parents of a 6-year-old girl with asthma are worried about potential side-effects from asthma treatment. Upon examination, you notice that her asthma has been poorly managed for the past six months and she has been frequently visiting the nurse-led asthma clinic. She is currently taking 100 micrograms of beclomethasone twice daily, but her asthma remains uncontrolled. What is the best course of action for managing this child’s asthma?

AKT-0609

A concerned mother brings her 6-month-old baby daughter to see you because her testicles seem to be absent from the scrotum. Her father has a history of undescended testicles and there are no other health concerns.

On examination, she appears well and seems to have normal sexual development other than bilateral undescended testicles.

How would you manage this case?

AKT-0610

A 3-month-old boy presents with a runny nose, cough and a temperature of 38.5°C. On auscultation, he has widespread, fine inspiratory crackles and a faint wheeze. He is not tachypnoeic, he remains alert and is taking most feeds. There is slight intercostal and subcostal recession.
What is the most appropriate management option?

AKT-0611

A 10-month-old child presents with difficulty opening its bowels. The child is having to strain to pass hard stools and is only going once a week. On reviewing the history, the child was born at full term with no perinatal complications. The baby passed meconium within 24 hours of birth and has had no previous issues with constipation. Examination shows a normal abdomen, perianal area, legs, and spine with no focal neurological signs. What is the best initial management approach?

AKT-0612

A 5-year-old child presents with a six month history of soiling his underpants. His parents report that his appetite is good, he goes to the toilet to open his bowels only about three times a week and his stools are hard.

On examination his height and weight are on the 50th centile. His abdomen is soft, non-tender and non-distended.

What is the next step in your management of this child?

AKT-0613

A 6-year-old boy is brought to see you by his mother due to concerns about his hearing. The school has raised concerns about his lack of attention in class and his speech and language development. The mother reports that at home, she has noticed her son sitting close to the television and frequently having to repeat herself when speaking to him.

Upon reviewing the medical records, it is noted that the child has had recurrent episodes of acute otitis media affecting both ears over the past 18 months. He was last seen by a colleague at the practice three months ago and was treated for right-sided acute otitis media with a course of oral amoxicillin.

On examination, the child appears to be in good health, but both tympanic membranes are intact and have a grey color with absent light reflexes.

What is the most appropriate initial management strategy for this child?