1. The Sick Child AKT practice questions

2. Q1 A 7-year-old boy presents with a three week history of a flu-like illness, which progressed after a week to paroxysms of coughing. He was previously well and he thinks he had all the recommended childhood immunisations. On examination he is afebrile and his chest sounds clear. You suspect pertussis infection. What is the single most appropriate investigation to confirm the diagnosis? The recommended tests are: Pernasal swab culture for Bordetella pertussis Pernasal swab culture for Bordetella pertussis CXR CXR FBC FBC PCR PCR serology for anti-pertussis IgG serology for anti-pertussis IgG

3. Q2 A 5-year-old girl who has been unwell over the preceding two months is brought in by her mother. The mother tells you that recently the child has been overly tired and complaining of generalised aches and pains. She has been brought in today with a sore throat. Looking at her record she has been back and forth with recurrent episodes of sore throat. On examination, the child looks pale and has enlarged lymph nodes in the neck. You also note a few small petechiae on the child's abdomen. What is the most appropriate next step in managing this patient? FBC FBC urine dip urine dip penicillin V penicillin V symptomatic advice symptomatic advice throat swab throat swab

4. Q3 A 4-year-old boy is brought to see you with a rash and joint pain. The rash has developed over the last few days, with the joint pain coming on today. On further questioning he has also has some intermittent abdominal pain that has been occurring since before the rash appeared. On examination, he is afebrile with a blood pressure of 114/80 mmHg. There is a symmetrical purpuric rash over the extensor surfaces of his arms and legs and over his buttocks; his trunk is spared. The child complains of pain in his knees and ankles which do look slightly puffy. His abdomen is soft with slight periumbilical discomfort on palpation. Which of the following tests is most useful in guiding further management of this patient? Blood film Blood film LP LP Platelet count Platelet count throat swab throat swab urine dipstick urine dipstick

5. Q4 You are working an out-of-hours session one evening when a mother brings her 6-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 has been sounding wheezy. The mother has brought the child this evening because a cough has developed and the child's feeding has been reduced because of breathlessness. On examination, the child has a sharp cough and is tachypnoeic. Auscultation of the chest reveals widespread high pitched wheezes and diffuse fine crackles. What is the most likely diagnosis? A Asthma B Bronchiolitis C Cardiac failure D Croup E Pneumonia A Asthma B Bronchiolitis C Cardiac failure D Croup E Pneumonia

6. Q5 A 4-year-old boy is brought to your surgery having rapidly developed a fever and vomiting. The child is moribund and has a non- blanching, purpuric rash, which has developed over the past 30 minutes. You make a diagnosis of meningiococcal disease and decide to administer benzylpenicillin injection via the IM route (you cannot access the venous route). What dose (in mg) would you give? What dose (in mg) would you give?

7. Q6 During baby clinic a 15 month old baby develops a severe anaphylactic reaction to one of the vaccines. What dose (in ml) of 1 in 1000 adrenaline (1mg/ml) would you administer via the intramuscular route? What dose (in ml) of 1 in 1000 adrenaline (1mg/ml) would you administer via the intramuscular route?

8. Q7 You see a four-year-old girl one evening when doing an out of hours shift. She has become very unwell quite suddenly, with high fever, sore throat and difficulty breathing. You see a four-year-old girl one evening when doing an out of hours shift. She has become very unwell quite suddenly, with high fever, sore throat and difficulty breathing. When you see her, she is sitting upright with her mouth open, and you notice that saliva is drooling down her chin. She has a soft stridor audible at rest. When you see her, she is sitting upright with her mouth open, and you notice that saliva is drooling down her chin. She has a soft stridor audible at rest. What is the most likely diagnosis? What is the most likely diagnosis? Acute asthma Acute asthma Acute epiglottitis Acute epiglottitis Acute laryngotracheobronchitis Acute laryngotracheobronchitis Angio-oedema Angio-oedema Acute tonsillitis Acute tonsillitis

9. Q8 A two-year-old boy is brought to see you late one evening when you are working an out of hours shift. The history from the parents is that he has not been himself over the last couple of days and tonight he has developed a barking cough. They have also noticed that his breathing is noisy. You examine the child. There is audible stridor at rest and you note the very prominent barking cough. His chest is clear and there are no other signs of respiratory distress. What is the most appropriate management plan? Give nebulised adrenaline and send to hospital in an ambulance Give nebulised adrenaline and send to hospital in an ambulance Give nebulised budesonide and oral dexamethasone and advise the parents to monitor the child and return if he deteriorates Give nebulised budesonide and oral dexamethasone and advise the parents to monitor the child and return if he deteriorates Give oral dexamethasone and advise the parents to monitor the child and return if he deteriorates Give oral dexamethasone and advise the parents to monitor the child and return if he deteriorates Reassure the parents and advise them to try a warm, humid environment, or steam inhalation to ease symptoms Reassure the parents and advise them to try a warm, humid environment, or steam inhalation to ease symptoms Refer for paediatric assessment Refer for paediatric assessment