Paper041. A 2-year-old is pale, mottled, with a spreading non-blanching rash. Action?A. Home paracetamol overnight, which is not the safest next step in NHS general practiceB. Oral penicillin only without transfer, which is not the safest next step in NHS general practiceC. Wait for CRP in 3 days, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Emergency 999 for possible meningococcal disease — red NG143Check
Paper042. A 4-month-old has a torn upper frenulum. Parents say he fell from a sofa. Most appropriate? Select TWO correct statements.Select all that apply.A. Most appropriate: Urgent safeguarding/paediatric assessment — torn frenulum in a non-mobile infant is a concerning injuryB. The following is not the most appropriate next step: Gum gel and discharge, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. Most appropriate: Wait for a confession, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Most appropriate: Accept sofa story without referral, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper043. A 7-month-old non-walker has a spiral femoral fracture. Action?A. Routine fracture clinic in 6 weeks without safeguarding, which is not the safest next step in NHS general practiceB. Immediate hospital safeguarding skeletal survey pathwayC. Home traction, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careD. Tell parents to use less force next time as the only stepCheck
Paper044. A 2-year-old treated for Kawasaki 2 weeks ago. What complication must follow-up look for?A. Coronary artery aneurysms (echo via paediatrics)B. Type 1 diabetes only, which is not the safest next step in NHS general practiceC. Sensorineural deafness as the main issue, which is not the safest next step in NHS general practiceD. No follow-up is needed, which is not the safest next step in NHS general practiceCheck
Paper045. A 8-week-old was given HPV vaccine in error instead of 6-in-1. Next step?A. Ignore and hope, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolB. Give a live yellow-fever vaccine to compensate, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolC. Start the adult HPV course, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolD. Treat as an immunisation incident: inform parents, incident report, immunisation coordinator/Green Book — give the correct 6-in-1 as advisedCheck
Paper046. A child had anaphylaxis to a previous 6-in-1. Further 6-in-1 in GP? The most appropriate action is: Swap for tetanus-only without advice, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careTRUE. TrueFALSE. FalseCheck
Paper047. A 4-week-old has projectile vomiting and a palpable pyloric olive. Action? The most appropriate action is: Reassure as reflux for 3 months, which is not the safest next step in NHS general practiceTRUE. TrueFALSE. FalseCheck
Paper048. A 1-year-old with egg allergy (urticaria only) is due MMR. Green Book?A. Give MMR in the routine setting — MMR is grown in chick-cell culture but egg allergy is not a contraindicationB. Withhold MMR for all egg allergy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. Give MMR only in ITU, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolD. Replace MMR with influenza LAIV, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck
Paper049. Parents of a 5-month-old with severe eczema ask about peanut. Advice?A. Delay all peanut until age 5 to prevent allergy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careB. Smear peanut oil on skin weekly as immunotherapy, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. Oral immunotherapy in GP today, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline care despite sounding plausible in a hospital protocolD. Early introduction of peanut as per SACN/BSACI-style guidance after allergy-service advice if very high risk — not delayed to age 3Check
Paper0410. After IM adrenaline a 7-year-old looks well. Next?A. Oral adrenaline, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careB. No referral, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careC. 999 transfer; observe for biphasic reaction; auto-injectors and allergy clinicD. Home after 5 minutes, which is not the safest next step in NHS general practice and this would delay appropriate UK-guideline careCheck