Archives: MRCGP AKT

AKT-0614

You are seeing a 4-year-old child who has been brought back to the clinic one afternoon having been seen by a colleague in the morning.

You review the notes from this morning’s consultation which show that the child presented with a fever and malaise and that a suspected viral infection was diagnosed and advice given accordingly. The mother reports that the child has become increasingly drowsy and hasn’t really drunk anything since being seen earlier. Despite regular paracetamol a fever has persisted.

You examine the child who is clearly lethargic. Tympanic temperature is 38.1°C. The child is undressed and you find several non-blanching spots on the lower legs.

The clinical record states that the child is allergic to penicillin; you ask the mother who says that when he was given it in the past for a sore throat he came out in a rash on his trunk which resolved when the antibiotics were stopped.

What is the most appropriate initial treatment to institute acutely in the community?

AKT-0599

You take a telephone call at the end of surgery from a childminder who is looking after a 5-year-old boy who she feels has suspicious injuries.

She says that when she commented on the injuries to his mother, when he was dropped off earlier in the morning, she gave an unconvincing account of what might have happened to him. She suspects non-accidental injury and from the history given, you do too, but are not sure. You arrange to see the child with his mother later that same day.

When should you make notes about this first consultation?

AKT-0600

Which statement about childhood vaccination is accurate?

AKT-0581

A child of 6 years is suspected to have Giardiasis.

Which one of the following drugs is the most appropriate treatment?

AKT-0582

A 25-year-old backpacker returns from a year of travelling in a remote part of South America. She has had diarrhoea for three weeks and the lab confirms that she has giardiasis.

What is the incubation period of giardiasis?

AKT-0583

You are contacted about an otherwise well 9-year-old child who is a patient of yours. His primary school has flagged to you that he is often absent from class, appears withdrawn and is keen to cover up areas of his limbs, which he says is due to eczema, when he is doing sport.

The school nurse has contacted you because he has extensive bruising to his buttocks with evidence of grip marks. You are concerned about non-accidental injury.

What is first line recommended management?

AKT-0584

A toddler boy is now 2 years old, having been born at 34 weeks’ gestation. You see his mother during a follow-up appointment and she expresses concerns about potential complications of prematurity during early childhood.
Which of these problems is MOST LIKELY to be a complication of preterm (premature) birth during early childhood?

AKT-0585

A 6-year-old girl presents with a rash and joint pain. The rash has developed over the past few days, with the joint pain starting today. She also reports intermittent abdominal pain that has been occurring since before the rash appeared. On examination, she is afebrile with a blood pressure of 110/70 mmHg. There is a symmetrical purpuric rash over the extensor surfaces of her arms and legs and over her buttocks, while her trunk is unaffected. The child complains of pain in her knees and ankles, which appear slightly swollen. Her abdomen is soft with mild periumbilical tenderness on palpation. Which test would be most helpful in guiding further management of this patient?

AKT-0586

A 6-year-old boy complaining of acute abdominal pain is brought to see you by his mother. His mother tells you that he has been having bouts of abdominal pain for the last few days that she thought would settle with time. In addition, she tells you that he has also developed a rash on his legs and has been complaining that his knees and ankles are sore. He is opening his bowels normally and passing urine normally. Prior to the last few days he has been entirely well. He has no significant past medical history and is not on any regular medications.

You examine him and he is afebrile and alert. His blood pressure is 118/82 mmHg. There is no significant lymphadenopathy. His abdomen is soft with no masses. He has some mild tenderness on deep palpation around the umbilicus and lower abdomen. There is an obvious purpuric rash over the extensor surfaces of his legs and buttocks. You also notice a few similar lesions on the extensor surfaces of his arms. His trunk is unaffected by the rash.

He has full range of movements in his joints which are not inflamed, however there is discomfort when manipulating his knees and ankles and his ankles appear slightly puffy.

Which of the following tests is most useful in guiding further management of this patient?

AKT-0587

A 9-year-old boy comes to see you with his father; they have returned from a holiday to Egypt and the father is very concerned as his son is lethargic, tired and has most recently become jaundiced, with dark urine. He is nauseated all the time and hardly able to eat.

On examination he is pyrexial 38.2°C, with jaundice and evidence of scratch marks on his skin.

Investigations show:

Haemoglobin 118 g/L (135 – 180)

WCC 8.2 ×109/L (4 – 10)

Platelets 190 ×109/L (150 – 400)

Sodium 140 mmol/L (134 – 143)

Potassium 4.7 mmol/L (3.5 – 5.0)

Creatinine 105 µmol/L (60 – 120)

Bili 142 (<26) ALT 680 (<36) Which one of the following is true of his condition?