The practice health visitor informs you that a mother of a 6-month-old baby is coming to seek advice. The mother was diagnosed with Hepatitis B during pregnancy, and the baby received a vaccination before being discharged. What is the recommended Hepatitis B vaccine schedule for the baby?
A mother attends the surgery to ask about vaccination of her child who is coming up to six months old and due to start the primary schedule.
She recognises from the immunisation list what diseases most of the vaccines prevent but she doesn’t recognise ‘Hib’. She wants to talk about which diseases it can prevent.
Which of the following conditions is most likely to be prevented by Hib vaccination?
A three-month-old boy presents to the clinic with a scrotal mass that his mother has noticed. Upon examination, you observe a smooth, soft swelling on the right side of the scrotum. The testicle cannot be felt separately, and the lump is contained within the scrotum. You are able to palpate above the mass, and transillumination testing is positive. What is the most suitable course of action at this stage?
A mother has noticed that her 2-year-old daughter takes little interest in other children. She comes to clinic concerned the child may have autism.
Which of the following features is most suggestive of a diagnosis of autistic spectrum disorder in a child of this age?
A 9-month-old boy has a temperature of 38.5°C. You first saw the child two days ago and the child has been febrile since then. He now has a faint erythematous macular rash that blanches on pressure. The parents are anxious.
Which option would be MOST IMPORTANT in making the decision to admit the child to hospital?
A 4-year-old boy has developed a maculopapular rash. His mother wants to know what condition he has developed.
Which of the following features is most suggestive of a diagnosis of rubella rather than measles?
A 6-year-old child is brought to see you by his parents. They have noticed that he has developed a skin rash and bruising over last 24-36 hours.
The parents report that he has previously been a well child with no serious past medical problems or hospital admissions. The only time they have sought medical attention in the past has been for the occasional upper respiratory tract infection but these have been infrequent.
He last had a viral upper respiratory tract infection about 7-10 days ago. The parents managed this at home without the need for medical assessment as the symptoms were not severe.
On examination he appears well in himself with no temperature, and is interacting and playful. However there is marked superficial bruising and purpura over his trunk and legs. You also note four blood blisters on his tongue. There is no lymphadenopathy or hepatosplenomegaly and the remainder of the clinical examination is unremarkable with normal urine on dipstick testing.
What is the most likely diagnosis?
A newly pregnant, but otherwise healthy, patient asks about immunisations required during pregnancy.
Which of the following immunisations are specifically recommended from 20 weeks gestation – to be administered at any time of year?
A 12-year-old girl presents with complaints of right knee pain and a limp. Her parents report that over the last two to three days she has been experiencing pain in the right knee, which they thought would settle but as things have persisted, they wanted her to be reviewed. There is no history of trauma or injury. There is no current systemic unwellness and no recent illness is reported. Her past medical history includes asthma and left slipped upper femoral epiphysis (SUFE) which required operative fixation about 18 months ago. On examination, she is systemically well and there is no obvious swelling, erythema or heat affecting the right knee which has a full range of movement.
What is the most appropriate next step?
A 3-year-old child is brought to see you by his parents as they have noticed a squint affecting the right eye.
The child was born at full term via a normal vaginal delivery and had no antenatal or perinatal problems. He has been fit and well with no significant health concerns.
Which of the following is the most appropriate approach at this stage?