KFP – Child and youth health (Paediatrics)

Jasmine Al-Mansour, aged 14 months, is brought to your suburban general practice clinic by her mother, Amira. Amira is concerned that Jasmine has not started walking yet, whereas her older sibling walked by 11 months. Jasmine is not saying any recognisable words but babbles and gestures to indicate wants. She sits independently, crawls, and pulls to stand. She has recently started cruising along furniture. She has a good pincer grasp and feeds herself finger foods. Amira reports that Jasmine is otherwise well, with no history of seizures, chronic illness, or hospitalisations.

Medications: None

Allergies: Nil known

Past history: Born at term by spontaneous vaginal delivery. Birth weight 3.3 kg. No complications in pregnancy or delivery. Neonatal hearing screen normal.

Family history: An older brother diagnosed with global developmental delay and attending early intervention services. No known genetic syndromes.

Social history: Parents are non-consanguineous. Father works full time. Mother is primary carer. No exposure to alcohol, drugs, or tobacco. Up to date with immunisations.

Examination findings: Jasmine is alert and interactive. Length and weight are on the 50th percentile. Head circumference is on the 75th percentile. She has normal tone and reflexes. Cranial nerves are intact. No dysmorphic features noted.

What are the most appropriate next steps in management? Select three (3) from the following list:

Riley Thompson, aged 7 years, is brought to your general practice clinic by his father due to frequent headaches over the past two months. The headaches occur around three times per week, mostly in the afternoon or evening. Riley describes the pain as ‘pounding’ and points to the front of his head. He often lies down in a dark room and avoids noise when he has a headache. Occasionally, he has nausea but no vomiting. There is no photophobia. The headaches sometimes improve with paracetamol.

Medications: None

Allergies: Nil known

Past history: Unremarkable. Normal birth and developmental history.

Family history: Father has a history of migraine with onset in adolescence.

Social history: Lives with both parents. No recent stressors. Riley is in Year 2 and enjoys school. He has been sleeping poorly and tends to skip breakfast.

Examination findings: Riley is well-appearing and alert. Vital signs are normal. Height and weight are on the 50th percentile. Neurological examination is normal. No signs of raised intracranial pressure. Fundoscopy is normal. No neck stiffness.

What are the most appropriate next steps in management? Select three (3) from the following list:

Isla Nguyen, aged 2 years, is brought to your general practice clinic by her mother after developing a fever and rash. Isla became unwell two days ago with a fever (up to 39.5°C) and irritability. Today, a widespread rash appeared on her trunk and limbs. Her mother reports that Isla had a runny nose, mild cough, and red eyes prior to the onset of the rash. She is drinking small amounts and has had fewer wet nappies. Isla is normally fit and well.

Medications: Nil

Allergies: Nil known

Past history: No significant medical history. Full-term normal vaginal delivery. Reached developmental milestones appropriately.

Immunisations: Has not received MMR vaccine due to parental concerns. All other immunisations up to date.

Examination findings: Isla is febrile (38.9°C), irritable but alert. A maculopapular rash is noted, starting on the face and now widespread across the body. She has non-purulent conjunctivitis and small white spots on the buccal mucosa near her molars. No neck stiffness. No focal neurological signs. Throat is mildly erythematous. Lungs are clear. Abdomen soft, no organomegaly.

What are the most appropriate next steps in management? Select three (3) from the following list:

Leo Bennett, a 4-year-old boy, is brought to your regional general practice by his mother due to concerns about frequent urination and increased thirst. She reports that over the past two weeks, Leo has been waking at night to urinate and has recently wet the bed, which had not happened for over a year. He has also been drinking water constantly and seems more tired than usual. He has had no fever, vomiting, cough, or diarrhoea. His appetite has reduced over the last few days.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Paternal uncle diagnosed with type 1 diabetes at age 12

Examination findings: Leo is alert but appears tired. He is afebrile, heart rate 110 bpm, respiratory rate 22, BP 94/58 mmHg. Weight is on the 50th percentile. No abdominal tenderness. Mildly dry mucous membranes. Chest clear. No signs of respiratory distress. Capillary blood glucose in clinic is 16.8 mmol/L.

What are the most appropriate next steps in management? Select three (3) from the following list:

Matilda Rowe, a 3-year-old girl, is brought to your general practice by her parents due to persistent wheeze. Over the past six months, she has had at least four episodes of wheeze, typically triggered by viral infections. Her parents report noisy breathing, coughing at night, and shortness of breath when active. Each episode has responded to salbutamol inhalers prescribed during an emergency department visit. Between episodes, Matilda appears well. She has no history of eczema or food allergies. Her growth and development are normal.

Medications: Salbutamol as needed (via spacer)

Allergies: Nil known

Past history: No hospital admissions

Family history: Father has asthma; mother has allergic rhinitis

Social history: Attends day care. No exposure to tobacco smoke. Up-to-date with immunisations.

Examination findings: Matilda is well and playful. Respiratory rate 24/min, oxygen saturation 98% on room air. Chest clear with no wheeze at time of review. No digital clubbing. No eczema or rash.

What are the most appropriate next steps in management? Select three (3) from the following list:

Liam Farrow, a 9-year-old boy, is brought to your general practice by his mother due to worsening abdominal pain over the past 24 hours. The pain started as vague discomfort around the umbilicus but has now localised to the right lower quadrant. He has had a poor appetite, nausea, and one episode of vomiting. There has been no diarrhoea. Liam has no significant past medical history and is generally well. His immunisations are up to date.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Nil relevant

Social history: Lives with parents and two siblings. No recent travel. Attends school regularly.

Examination findings: Liam is alert but uncomfortable. Temperature 38.2°C. Heart rate 100 bpm. Abdomen is tender in the right iliac fossa with rebound tenderness and guarding. Rovsing’s sign is positive. Bowel sounds are present. No masses or organomegaly.

What are the most appropriate next steps in management? Select three (3) from the following list:

Ava Henderson, a 6-year-old girl, is brought to your metropolitan general practice by her mother with concerns about Ava’s difficulty focusing at school and frequent disruptive behaviour. Her teacher reports that she often leaves her seat during class, talks excessively, and struggles to complete tasks. At home, Ava has trouble settling for bed and frequently loses belongings. Her mother says Ava is bright but constantly ‘on the go’ and impulsive. There is no history of trauma or sleep apnoea. Ava has no history of seizures or head injury.

Medications: Nil

Allergies: Nil known

Past history: Normal development; no chronic illness

Family history: Maternal uncle diagnosed with ADHD

Social history: Lives with both parents. No family violence or child protection concerns. Stable home. No substance exposure. Attends Year 1 at local primary school.

Examination findings: Ava is cooperative but fidgety. Growth parameters are within normal limits. Neurological exam is normal. No dysmorphic features. No signs of neglect or malnutrition.

What are the most appropriate next steps in management? Select three (3) from the following list:

James Holloway, a 15-year-old boy, presents to your general practice accompanied by his mother. He has developed pain and swelling in his right knee over the past 48 hours. He denies trauma. He also complains of morning stiffness lasting around an hour and feeling unusually fatigued at school. On questioning, he recalls intermittent wrist and ankle pain over the past few months, which resolved spontaneously. There is no history of fever, rash, or weight loss.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Maternal aunt has rheumatoid arthritis

Social history: Lives with parents and younger brother. Plays soccer but has not participated recently due to knee pain. Non-smoker, no alcohol use reported.

Examination findings: Afebrile. Right knee is swollen with visible effusion, warm to touch, and has reduced range of motion due to pain. No overlying erythema. No other joints appear swollen. Systemic examination is unremarkable. Weight and height are at the 60th percentile.

What are the most appropriate next steps in management? Select three (3) from the following list:

Ella Namatjira, a 10-year-old Aboriginal girl, is brought to your remote general practice clinic by her grandmother with a three-day history of painful ears and reduced hearing. Her grandmother reports that Ella has had frequent ear infections since early childhood, and recently there has been persistent discharge from her right ear. She occasionally complains of itchiness and trouble hearing the teacher in school. She is otherwise well with no systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Multiple documented episodes of acute otitis media and previous grommet insertion at age 5. No history of surgery since.

Social history: Lives in a remote community with extended family. Overcrowded housing and limited access to clean running water. Attends school irregularly. Up to date with immunisations including pneumococcal vaccines.

Examination findings: Afebrile, cooperative. Otoscopy reveals thick mucoid discharge and a large central tympanic membrane perforation in the right ear. The left ear appears normal. No mastoid tenderness. No lymphadenopathy. Weber test lateralises to the right, Rinne test negative on the right.

What are the most appropriate next steps in management? Select three (3) from the following list:

Imran Chowdhury, a 13-year-old boy, presents to your suburban general practice with a 4-month history of weight loss, fatigue, and intermittent abdominal pain. His parents are concerned that he is falling behind in school and appears pale and withdrawn. He has also had loose stools up to four times a day, sometimes with mucus. There is no blood in the stool. He denies vomiting. He is not currently taking any medications.

Medications: Nil

Allergies: Nil known

Past history: Previously well. Normal growth and development until this year.

Family history: Father has coeliac disease. No family history of inflammatory bowel disease.

Social history: Imran is in Year 7. Lives with both parents and younger siblings. No recent travel. No known infections in household. Diet is mixed, including bread and cereals.

Examination findings: Height and weight are below the 10th percentile. Pallor noted. Abdomen soft, with mild diffuse tenderness. No hepatosplenomegaly. No perianal abnormalities. No oral ulcers. No joint swelling or rash.

What are the most appropriate next steps in management? Select three (3) from the following list:

Olivia Marks, an 8-year-old girl, is brought to your general practice by her mother due to concerns about daytime urinary incontinence. Her mother reports that Olivia has been wetting her pants at school several times a week over the past three months. There is no nocturnal enuresis. Olivia has been toilet trained since the age of 3. She denies dysuria, urgency, frequency, or abdominal pain. Her bowel habits are irregular, with hard stools every 3–4 days. She feels embarrassed and has stopped attending after-school activities.

Medications: Nil

Allergies: Nil known

Past history: No history of urinary tract infections. Developmental history is normal. Immunisations are up to date.

Social history: Lives with both parents. School performance is good. No psychosocial stressors identified.

Examination findings: Height and weight are on the 50th percentile. Abdomen is soft but mildly distended. No palpable bladder. No spinal or neurological abnormalities noted. Perineal examination normal. Urinalysis is normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Maya Singh, a 5-week-old infant, is brought to your general practice by her parents due to vomiting after feeds for the past 10 days. Initially, the vomiting was occasional and non-bilious, but it has become more forceful and occurs after most feeds. Maya remains hungry after vomiting. Her parents report fewer wet nappies and no bowel movements in the past two days. She was born at term via spontaneous vaginal delivery and has been exclusively formula-fed since birth.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Nil relevant

Social history: Lives with both parents. No recent travel. Non-smokers. Good access to health care.

Examination findings: Weight has dropped from the 50th to 15th percentile since birth. She is alert but appears mildly dehydrated. Abdomen is soft, non-tender, with no distension. A small, palpable, firm olive-shaped mass is noted in the right upper quadrant. No hepatosplenomegaly. Bowel sounds present.

What are the most appropriate next steps in management? Select three (3) from the following list:

Samuel Adebayo, a 12-year-old boy, presents to your general practice with his mother due to shortness of breath and a persistent dry cough, particularly at night and after exercise. His symptoms have been gradually worsening over the past few months. He occasionally experiences chest tightness, especially in the early mornings. There is no history of fever, weight loss, or recent infections.

Medications: Salbutamol inhaler used intermittently (borrowed from cousin)

Allergies: Nil known

Past history: Mild eczema in early childhood

Family history: Father has asthma and allergic rhinitis

Social history: Lives with parents and two siblings. Attends school regularly. No exposure to tobacco smoke. Keeps a pet cat at home.

Examination findings: Vital signs are normal. Chest is clear on auscultation. No wheeze at rest. Growth parameters are within normal range. No digital clubbing. No signs of acute distress.

Investigations: Spirometry shows FEV1/FVC ratio of 0.72 with a 15% improvement in FEV1 post-salbutamol.

What are the most appropriate next steps in management? Select three (3) from the following list:

Aria D’Souza, a 3-year-old girl, is brought to your general practice by her father due to a two-day history of lethargy, reduced appetite, and fever. He reports that Aria has been increasingly irritable and sleeping more than usual. Today, he noticed a red-purple non-blanching rash on her legs. Aria has had no recent illness, has completed all her immunisations, and attends day care. There is no history of trauma or travel. She has had no vomiting or diarrhoea.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable birth and development history

Family history: Nil significant

Social history: Lives with both parents. No smokers in the home. Attends day care 3 days per week.

Examination findings: Temperature 39.4°C, HR 138 bpm, RR 28, BP 92/60. Aria is drowsy but rousable, with delayed capillary refill (3–4 seconds). A purpuric rash is noted on both lower limbs, particularly around the ankles and thighs. Neck stiffness is present. No focal neurological deficits. No signs of dehydration or respiratory distress.

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Elwood, a 16-year-old boy, presents to your general practice complaining of a painless lump in his left testicle that he noticed about three weeks ago. He describes it as firm but not tender. There is no associated trauma, urinary symptoms, or systemic symptoms such as fever, weight loss, or night sweats. He has no prior history of testicular issues and has been otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Father had testicular cancer in his late twenties

Social history: Year 11 student. Non-smoker. Plays competitive soccer. No alcohol or drug use reported. No recent travel or high-risk sexual activity.

Examination findings: Left testis is enlarged with a firm, non-tender mass. No transillumination. Right testis is normal. No scrotal erythema or swelling. No inguinal lymphadenopathy. No gynaecomastia. Abdominal exam is unremarkable.

What are the most appropriate next steps in management? Select three (3) from the following list:

Zahra Al-Rashid, a 6-year-old girl, is brought to your general practice by her mother due to concerns about Zahra’s ongoing picky eating and poor weight gain. Her mother reports that Zahra eats a limited variety of foods, mostly white carbohydrates, and refuses fruits, vegetables, and meats. She often gags or becomes distressed when offered new foods. Meals are prolonged, with significant family stress. Zahra has always been small for her age and has recently fallen from the 25th to below the 5th percentile for weight. She has no gastrointestinal symptoms, fatigue, or developmental concerns.

Medications: Nil

Allergies: Nil known

Past history: Full-term birth, normal development, no chronic illnesses

Family history: Mother has a history of disordered eating in adolescence

Social history: Lives with both parents. No food insecurity. Attends school regularly. Family meals are often tense.

Examination findings: Zahra is alert, cooperative, and developmentally appropriate. Weight is below the 5th percentile, height is at the 25th percentile. No signs of micronutrient deficiency. Teeth, skin, and nails are normal. No organomegaly or abdominal tenderness.

What are the most appropriate next steps in management? Select three (3) from the following list:

Lucas Zhang, a 14-year-old boy, presents to your general practice with a three-day history of fever, sore throat, and difficulty swallowing. His parents report that he has been lethargic and is refusing food. Lucas has no cough or runny nose. He has no known allergies and is otherwise healthy. He completed the full childhood immunisation schedule, including the meningococcal ACWY vaccine.

Medications: Nil

Allergies: Nil known

Past history: No significant medical history

Family history: Non-contributory

Social history: Year 9 student. No recent travel. No known exposure to unwell contacts. Plays basketball regularly.

Examination findings: Temperature 39.2°C, heart rate 104 bpm. Lucas appears unwell and is speaking softly with a muffled voice. He has tender anterior cervical lymphadenopathy and trismus. Oropharyngeal examination reveals asymmetric tonsillar swelling and uvular deviation to the left. No rash. Chest and abdominal exams are unremarkable.

What are the most appropriate next steps in management? Select three (3) from the following list:

Nicholas Petrou, a 7-year-old boy, is brought to your general practice by his parents due to recurrent episodes of abdominal pain for the past 3 months. The pain is periumbilical, crampy in nature, and typically occurs in the mornings before school. It often resolves spontaneously and does not wake him from sleep. There are no associated vomiting, diarrhoea, or weight loss. His appetite is normal and he is growing along the 50th percentile for weight and height. His parents have noted he becomes more anxious on school days and recently mentioned being bullied at school.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has a history of irritable bowel syndrome

Social history: Lives with both parents and attends Year 2 at a local primary school. No recent travel. Immunisations up to date.

Examination findings: Nicholas appears well. Vital signs are normal. Abdomen is soft and non-tender with no organomegaly or masses. Growth is appropriate. No skin changes or joint abnormalities.

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily George, a 2-year-old girl, is brought to your general practice by her parents with concerns about an acute rash. Her parents report that she developed a fever yesterday, followed by the appearance of red spots that quickly became fluid-filled blisters. The rash started on her torso and has spread to her face and limbs. The blisters are itchy, and some have started to crust over. She is otherwise eating and drinking well and has no respiratory symptoms.

Medications: Nil

Allergies: Nil known

Past history: Healthy and developmentally normal

Immunisation history: All immunisations up to date for age; varicella vaccine not yet given (scheduled at 18 months)

Family history: Non-contributory

Social history: Attends day care. No known recent exposures, but a child in her class was recently off sick with a rash.

Examination findings: Afebrile today (was 38.2°C yesterday). Multiple vesicular lesions on an erythematous base, some crusting, noted over torso, scalp, and extremities. No signs of secondary bacterial infection. Normal ENT, respiratory, and abdominal examinations.

What are the most appropriate next steps in management? Select three (3) from the following list:

Isaac Toleafoa, a 9-year-old boy, is brought to your general practice by his aunt due to ongoing fatigue, difficulty concentrating at school, and pale skin noticed over the past several weeks. He has no fever or weight loss. His appetite is reduced, and he sometimes complains of headaches. He is up to date with his immunisations and has not had any recent illnesses.

Medications: Nil

Allergies: Nil known

Past history: No significant illness. Normal growth and development.

Family history: Aunt reports that several relatives have had ‘low blood’ and needed iron tablets in the past.

Social history: Lives with aunt and cousins. Limited intake of meat. Occasional constipation. No recent travel. Attends school regularly.

Examination findings: Pale conjunctivae and skin. Vital signs within normal limits. No hepatosplenomegaly. No lymphadenopathy. Growth charts show weight and height tracking along the 25th percentile. No murmurs. Abdomen soft, non-tender.

What are the most appropriate next steps in management? Select three (3) from the following list:

Amelia Tran, a 6-year-old girl, is brought to your general practice by her mother due to a new-onset limp for the past two days. Amelia has no history of trauma, and her mother reports that she was well until earlier this week when she had a low-grade fever and mild upper respiratory symptoms. The limp is worse in the morning and improves throughout the day. Amelia has been reluctant to bear weight on her right leg but remains otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable. Up to date with immunisations.

Family history: Non-contributory

Social history: Lives with both parents. Attends Year 1 at a local school. No recent travel.

Examination findings: Afebrile, well-appearing. Antalgic gait favouring the right leg. Right hip shows reduced range of motion, especially in internal rotation. No erythema, warmth, or swelling of joints. No lymphadenopathy. Abdomen soft, no organomegaly. Neurological exam normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Layla Morrison, a 4-year-old girl, is brought to your general practice by her mother with a 24-hour history of fever, decreased appetite, and a new rash. Layla has been irritable and is drooling more than usual. She recently started kindergarten. Her mother reports that some children in her class have been off sick with fevers and rashes. Layla is fully immunised and previously well.

Medications: Nil

Allergies: Nil known

Past history: Normal development and no chronic illnesses

Family history: Non-contributory

Social history: Lives with parents and younger sibling. Attends kindergarten 3 days per week.

Examination findings: Temp 38.4°C. Mildly irritable but alert and interactive. Vesicular lesions noted on the palms, soles, and around the mouth. Several small ulcers are visible on the buccal mucosa and tongue. No cervical lymphadenopathy. Lungs clear. Abdomen soft. No neck stiffness or photophobia.

What are the most appropriate next steps in management? Select three (3) from the following list:

Charlie Devlin, a 13-year-old boy, presents to your general practice with his mother complaining of persistent nasal congestion, sneezing, and itchy eyes for the past 2 months. Symptoms are worse in the morning and during springtime. Charlie has difficulty sleeping due to nasal obstruction and has noticed trouble concentrating at school. He has no fever, cough, or sore throat. He has a known history of mild asthma, well-controlled with occasional salbutamol use.

Medications: Salbutamol as needed

Allergies: Nil known

Past history: Mild asthma. No prior ENT surgery.

Family history: Mother has allergic rhinitis and eczema

Social history: Lives with parents and siblings. Non-smoker household. No pets. No recent travel. Attends school regularly.

Examination findings: Afebrile. Pale, boggy nasal mucosa with clear rhinorrhoea. No purulent discharge. Nasal turbinates swollen. No nasal polyps. Throat mildly erythematous. Lungs clear. No wheeze. Growth parameters normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Jackson Kelly, a 5-year-old boy, is brought to your general practice by his parents due to sudden onset of a limp and left leg pain. He was playing normally yesterday but woke up this morning refusing to bear weight on the left leg. He has no fever and is otherwise well. There is no history of trauma. His parents report no previous episodes like this. Jackson is fully immunised and has been otherwise healthy.

Medications: Nil

Allergies: Nil known

Past history: Normal development. No prior joint issues.

Family history: Non-contributory

Social history: Lives with both parents. Attends preschool. No recent travel.

Examination findings: Afebrile. Alert and interactive. Antalgic gait with refusal to fully weight bear on left leg. Mild limitation of internal rotation of the left hip. No swelling or warmth over joints. No lymphadenopathy or skin changes. Normal abdominal and neurological examination.

What are the most appropriate next steps in management? Select three (3) from the following list:

Olive Harris, a 15-year-old girl, presents to your general practice with her mother due to ongoing fatigue and irregular, heavy menstrual periods since menarche at age 13. She reports needing to change pads every 1–2 hours during her period and has missed school due to tiredness. Her periods last 7–10 days. There is no family history of bleeding disorders. She denies easy bruising or bleeding from other sites. She is otherwise well and not sexually active.

Medications: Nil

Allergies: Nil known

Past history: Normal development. Menarche at age 13. No chronic illness.

Family history: No known bleeding disorders. Mother had heavy periods as a teen but resolved after starting the pill.

Social history: Lives with mother and two siblings. Year 10 student. Eats a varied diet. No smoking or substance use.

Examination findings: Pale conjunctivae, normal vital signs. Abdomen soft, non-tender. No bruising or petechiae. BMI at 50th percentile. No hirsutism or acne.

What are the most appropriate next steps in management? Select three (3) from the following list:

Benji Saunders, a 10-year-old boy, presents to your general practice with his father due to concerns about frequent sneezing, itchy eyes, and nasal congestion that has worsened over the past year. Symptoms are perennial but seem worse in the morning and at night. Benji has no cough, wheeze, or skin rashes. He sleeps poorly due to nasal obstruction. He has a pet dog and often plays on the carpet. His school performance is starting to be affected by tiredness.

Medications: Nil

Allergies: Not known

Past history: Unremarkable. No history of asthma or eczema.

Family history: Mother has hay fever

Social history: Lives with both parents. Non-smoking household. No recent travel.

Examination findings: Pale, swollen nasal turbinates with clear rhinorrhoea. No nasal polyps. No purulent discharge. Mouth breathing observed. Lungs clear. No rashes.

What are the most appropriate next steps in management? Select three (3) from the following list:

Sophia Ibrahim, an 11-year-old girl, is brought to your general practice by her father due to concerns about frequent abdominal pain and bloating. The symptoms have been present for the past 6 months and occur several times per week. The pain is crampy, periumbilical, and often relieved by passing stool. She has occasional episodes of loose stools but no blood or mucus. There has been no weight loss, fever, or nocturnal symptoms. Her appetite is good and growth is on the 50th percentile for weight and height.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Mother has irritable bowel syndrome (IBS)

Social history: Lives with parents and two siblings. Attends school regularly. No recent travel or known exposure to gastrointestinal illness.

Examination findings: Well-appearing child. Abdomen soft, non-tender, no masses or organomegaly. No perianal abnormalities. Growth charts within normal limits.

What are the most appropriate next steps in management? Select three (3) from the following list:

Harper Wallace, a 7-year-old girl, is brought to your general practice by her mother due to concerns about Harper’s increasing clumsiness and frequent falls over the past 6 months. Her teacher has also noticed she struggles with tasks requiring fine motor coordination, such as writing and using scissors. Harper has no history of seizures or head trauma. There are no behavioural or learning concerns. Her mother has recently noticed Harper occasionally walks on her toes.

Medications: Nil

Allergies: Nil known

Past history: Uncomplicated pregnancy and normal developmental milestones until age 6

Family history: An uncle (maternal side) had a ‘muscle problem’ diagnosed in his teens

Social history: Lives with both parents and two younger siblings. Attends Year 2. No recent travel.

Examination findings: Alert and cooperative. Gower’s sign positive. Calf pseudohypertrophy noted. Mild lumbar lordosis. Normal cranial nerves. Reflexes diminished in lower limbs. No sensory deficits.

What are the most appropriate next steps in management? Select three (3) from the following list:

Levi Anderson, a 12-year-old boy, is brought to your general practice by his father due to frequent headaches over the past three months. The headaches occur approximately three times per week, often after school. They are described as a tight band-like pressure across the forehead and temples. They usually resolve with rest or paracetamol. He does not have associated nausea, photophobia, or visual changes. He is otherwise well and performing well academically.

Medications: Occasional paracetamol

Allergies: Nil known

Past history: Nil significant

Family history: Father has migraines

Social history: Lives with both parents. Year 7 student. Good sleep habits. No recent travel. Drinks minimal water and skips lunch occasionally. Spends 3–4 hours per day on screens after school.

Examination findings: Normal vital signs. Neurological examination unremarkable. No focal deficits. Fundoscopy normal. Growth charts within normal limits.

What are the most appropriate next steps in management? Select three (3) from the following list:

Aaliyah Thomas, a 17-year-old girl, presents to your general practice with a two-month history of irregular vaginal bleeding and pelvic discomfort. She reports light bleeding that occurs unpredictably, sometimes after intercourse. Her last normal period was three months ago. She has no dysuria or fever but has experienced increased vaginal discharge. She is sexually active with one male partner and uses condoms inconsistently. She has not had a cervical screening test or STI check before.

Medications: Nil

Allergies: Nil known

Past history: No chronic illnesses. Menarche at age 12. Previously regular cycles.

Family history: Non-contributory

Social history: Lives with mother and attends Year 12. No smoking or alcohol use. Not currently on any contraception.

Examination findings: Aaliyah is afebrile and well-appearing. Abdominal examination is normal. Speculum examination reveals mucopurulent cervical discharge and contact bleeding. Bimanual examination reveals mild cervical motion tenderness but no adnexal masses.

What are the most appropriate next steps in management? Select three (3) from the following list:

Matilda Brooks, a 4-month-old infant, is brought to your general practice by her parents due to episodes of back-arching, crying, and frequent regurgitation after feeds. The symptoms have been present for the past six weeks. She is formula-fed and feeds every 3–4 hours. Her parents report that she sometimes refuses to feed and often cries inconsolably after feeding. There is no blood in the vomit, no projectile vomiting, and no signs of respiratory distress. She is otherwise alert and gaining weight along the 25th percentile.

Medications: Nil

Allergies: Nil known

Past history: Term birth, no complications. Immunisations up to date.

Family history: Father has a history of reflux disease

Social history: Lives with both parents. No smoking or pets. No recent illness in the household.

Examination findings: Well-appearing infant. Vital signs normal. Abdomen soft and non-tender. No signs of dehydration. No palpable mass. Normal tone and neurological examination. No eczema or signs of allergy.

What are the most appropriate next steps in management? Select three (3) from the following list:

Lachlan Reid, a 3-year-old boy, is brought to your general practice by his parents due to concerns about speech delay. They report that Lachlan uses fewer than 20 words and does not form two-word phrases. He can follow simple commands, such as ‘bring your shoes’, and points to objects of interest. His hearing was tested at birth and was normal. He is otherwise healthy, sleeps well, and has no behavioural concerns. He attends day care three days a week.

Medications: Nil

Allergies: Nil known

Past history: Full-term birth, normal development aside from language

Family history: Paternal uncle had delayed speech in early childhood

Social history: Lives with both parents. English is the primary language at home. No known psychosocial concerns.

Examination findings: Cooperative child. Engages well with clinician. Normal tone and gait. Good eye contact. No dysmorphic features. ENT examination normal. Growth tracking along the 50th percentile.

What are the most appropriate next steps in management? Select three (3) from the following list:

Isla Nguyen, a 13-year-old girl, presents to your general practice with her mother complaining of episodes of light-headedness and palpitations over the past few weeks. These occur mostly when she stands up quickly or after long periods of sitting in class. She sometimes feels nauseous or tired, especially after sport. There is no chest pain, shortness of breath, or loss of consciousness. Her periods started at age 12 and are regular. She has no known medical conditions and is not on any medication.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has hypothyroidism. No history of cardiac disease.

Social history: Lives with her parents and younger brother. Attends high school. Balanced diet but drinks minimal water. No caffeine or alcohol use. Plays netball weekly.

Examination findings: Height and weight in 50th percentile. Alert and oriented. Cardiovascular and respiratory exams normal. Supine BP 110/70 mmHg, HR 78 bpm. Standing BP 98/64 mmHg, HR 104 bpm after 3 minutes. No murmurs. ECG normal sinus rhythm.

What are the most appropriate next steps in management? Select three (3) from the following list:

Aaron Sadiq, a 2-year-old boy, is brought to your general practice with a 24-hour history of barking cough and hoarse voice. His parents report he woke during the night with noisy breathing and seemed distressed, but settled after sitting in a steamy bathroom. He has had a low-grade fever and mild runny nose for two days. He is drinking fluids and has normal urine output. No previous similar episodes.

Medications: Nil

Allergies: Nil known

Past history: Normal growth and development

Family history: Non-contributory

Social history: Lives with parents and older sister. Attends day care 3 days a week. No smokers in the household.

Examination findings: Temp 37.8°C. Mild inspiratory stridor at rest, hoarse voice, and barking cough. Mild intercostal recession. Oxygen saturation 97% on room air. Alert and interactive. No drooling or cyanosis. Chest clear on auscultation.

What are the most appropriate next steps in management? Select three (3) from the following list:

Eva McKenzie, a 16-year-old girl, presents to your general practice with concerns about irregular periods and recent onset of facial acne and hirsutism. She reports having had only four periods in the past year. Her menarche was at age 13. She has also noticed weight gain over the past year. She denies sexual activity. There is no significant past medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has type 2 diabetes

Social history: Lives with parents. Non-smoker. Balanced diet. Sedentary lifestyle. No disordered eating behaviours reported.

Examination findings: BMI 31 kg/m². Moderate facial acne. Hirsutism on upper lip and lower abdomen. No galactorrhoea. Acanthosis nigricans on neck. Normal blood pressure. Pelvic exam not performed.

What are the most appropriate next steps in management? Select three (3) from the following list:

Ruby Ellis, a 6-week-old infant, is brought to your general practice by her parents due to concerns about persistent crying and difficulty settling. Ruby cries for several hours a day, mostly in the late afternoon and evening. She pulls her knees up to her chest and appears to be in discomfort, but settles briefly when held. She is feeding well and has normal wet nappies. Her weight gain is appropriate, and there are no vomiting or diarrhoea symptoms. Her parents are first-time parents and appear tired and anxious.

Medications: Nil

Allergies: Nil known

Past history: Term delivery, normal neonatal screening and examination

Family history: Non-contributory

Social history: Lives with both parents. No social supports nearby. No pets. Non-smoker household. Breastfeeding exclusively.

Examination findings: Well-appearing infant. Normal vital signs. Alert, with normal tone and reflexes. Abdomen soft and non-distended. No signs of illness or distress on examination.

What are the most appropriate next steps in management? Select three (3) from the following list:

Hugo Palmer, a 5-year-old boy, is brought to your general practice by his mother due to increased daytime tiredness and loud snoring at night. She reports that Hugo has restless sleep, frequently wakes during the night, and has started wetting the bed again after being dry for over a year. During the day, he is often irritable and struggles to concentrate at preschool. He has no history of seizures or chronic illness.

Medications: Nil

Allergies: Nil known

Past history: Term birth. Normal developmental milestones. Immunisations up to date.

Family history: Father has allergic rhinitis and asthma

Social history: Lives with parents and younger sibling. Non-smoking household. Attends preschool 4 days per week.

Examination findings: Weight and height on the 75th percentile. Adenoidal facies. Enlarged tonsils touching midline. No wheeze or signs of asthma. No neurological abnormalities. ENT exam otherwise unremarkable.

What are the most appropriate next steps in management? Select three (3) from the following list:

Zane Crawford, a 9-year-old boy, is brought to your general practice by his mother due to increasing difficulty with concentration and disruptive behaviour at school. His teacher reports that Zane often leaves his seat, talks excessively, and struggles to complete tasks. His academic performance is below expected level. At home, his mother describes him as ‘always on the go’ and easily distracted. There is no history of trauma, seizures, or chronic illness. Sleep is normal. No concerns about appetite or mood.

Medications: Nil

Allergies: Nil known

Past history: Term birth. Normal development. No prior psychiatric history.

Family history: Father diagnosed with ADHD as a child

Social history: Lives with both parents. Year 4 student. No known psychosocial concerns. Screen use exceeds 3 hours/day after school.

Examination findings: Engages well but fidgety during consultation. Growth parameters within normal range. Neurological and physical examinations unremarkable. No signs of anxiety or mood disorder.

What are the most appropriate next steps in management? Select three (3) from the following list:

Maya Singh, a 15-year-old girl, presents to your general practice with a 2-month history of fatigue and feeling ‘down’. She reports losing interest in her usual hobbies and withdrawing from her friends. She denies suicidal ideation but feels unmotivated and struggles to sleep. She reports difficulty concentrating in class and declining school performance. There is no history of drug or alcohol use. Her periods are regular. She is not sexually active.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has a history of depression

Social history: Lives with parents and younger brother. Year 10 student. Non-smoker. Balanced diet. Good school attendance until recently.

Examination findings: Quiet but cooperative. Appears tired. Normal vital signs. No psychomotor agitation or retardation. Neurological exam normal. No weight loss or signs of self-harm.

What are the most appropriate next steps in management? Select three (3) from the following list:

Aliyah Rahman, a 3-year-old girl, is brought to your general practice by her parents with a 2-day history of painful urination and fever. She has been more irritable than usual, and her appetite is reduced. There is no vomiting or diarrhoea. Her immunisations are up to date. This is her first episode of urinary symptoms. She has been toilet training for several months but still wears nappies at night.

Medications: Nil

Allergies: Nil known

Past history: Normal development. No chronic conditions.

Family history: Non-contributory

Social history: Lives with parents and older brother. Attends day care 4 days/week.

Examination findings: Temp 38.5°C. Alert but irritable. Abdomen soft, mild suprapubic tenderness. No costovertebral angle tenderness. Hydrated. ENT and chest exams normal. Growth parameters normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Jonah Edwards, a 14-year-old boy, presents to your general practice with left knee pain that has been gradually worsening over the past 3 weeks. He is physically active and plays basketball four times a week. The pain is worse after activity and improves with rest. There is no history of trauma, swelling, locking, or instability. He denies any fever or systemic symptoms. He has no other joint pain.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Non-contributory

Social history: Year 9 student. Non-smoker. Lives with parents and younger sister.

Examination findings: Healthy adolescent. Tenderness over the tibial tuberosity of the left knee. No joint effusion or instability. Full range of motion. No erythema. Gait normal. No other joint abnormalities noted.

What are the most appropriate next steps in management? Select three (3) from the following list:

Zara Ali, a 13-year-old girl, presents to your general practice with a 4-month history of itchy, red patches on the backs of her knees and elbows. The rash worsens during hot weather and sometimes keeps her awake at night. She has a history of asthma and seasonal allergies. Her mother reports that she had similar skin problems as a child. Zara has been using a fragranced moisturiser, which provides minimal relief. No other family members are affected.

Medications: Salbutamol as needed

Allergies: Nil known

Past history: Asthma, allergic rhinitis

Family history: Mother has atopic dermatitis

Social history: Lives with parents and two siblings. Non-smoker household. Attends school regularly.

Examination findings: Erythematous, lichenified plaques with excoriations noted in bilateral antecubital and popliteal fossae. No signs of secondary infection. No weeping or crusting. Skin elsewhere is dry. Growth and development normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Leo Matthews, a 12-year-old boy, presents to your general practice with a 3-week history of limping and intermittent left hip pain. He denies trauma. The pain is described as dull and occasionally radiates to the thigh or knee. His parents have noticed that he’s walking with his left foot turned out. He has no fever or systemic symptoms. Leo is overweight for his age.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Non-contributory

Social history: Lives with both parents and two siblings. Active but recently stopped participating in sports due to hip pain.

Examination findings: Height at 50th percentile, weight at 95th percentile. Antalgic gait with left foot externally rotated. Limited internal rotation and abduction of left hip. No swelling, erythema, or signs of infection. Neurovascular status of lower limbs intact.

What are the most appropriate next steps in management? Select three (3) from the following list:

Samuel Jin, a 6-year-old boy, presents to your general practice with his mother due to persistent coughing that has lasted for more than 3 weeks. The cough is worse at night and with exercise, and sometimes wakes him from sleep. He has had no fevers, chest pain, or weight loss. His appetite is normal and he is otherwise well. His mother mentions a history of eczema and that he occasionally wheezes during colds.

Medications: Nil

Allergies: Nil known

Past history: Eczema in early childhood. No hospitalisations for respiratory illness.

Family history: Father has asthma

Social history: Lives with both parents. Non-smoker household. Attends primary school. No recent travel.

Examination findings: Well-appearing, afebrile. Chest clear to auscultation with normal breath sounds. No wheeze. Oxygen saturation 98% on room air. Growth tracking along 50th percentile.

What are the most appropriate next steps in management? Select three (3) from the following list:

Isabelle Taylor, a 7-year-old girl, is brought to your general practice by her mother due to persistent episodes of abdominal pain and loose stools for the past 3 months. The pain is crampy, mostly occurs after eating, and is relieved by defecation. The stools are loose but not watery, occurring 2–3 times per day. There is no blood in the stool, no weight loss, and no fever. Her appetite is normal, and she is growing well. Her mother is concerned about possible food intolerances, as Isabelle avoids dairy due to stomach discomfort.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has irritable bowel syndrome

Social history: Lives with parents and older brother. Balanced diet. Attends Year 2 at school. No recent travel.

Examination findings: Well-appearing. Growth chart tracking along 60th percentile for height and weight. Abdomen soft, mild tenderness in the lower quadrants with no guarding or masses. Bowel sounds normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Elijah Foster, a 3-year-old boy, is brought to your general practice by his father due to concerns about wheezing and coughing. The symptoms began during a recent viral illness and have occurred a few times over the past six months, especially during colds and at night. Elijah has required two presentations to the emergency department for nebulised salbutamol but has never been admitted. His father has asthma and eczema.

Medications: Nil currently

Allergies: Nil known

Past history: Term birth. Up-to-date immunisations. Normal development.

Family history: Father has asthma and eczema

Social history: Lives with both parents. No exposure to tobacco smoke. Attends day care. No pets.

Examination findings: Well-appearing. No respiratory distress. Chest clear. Normal oxygen saturation and respiratory rate. Growth within normal limits. No eczema currently.

What are the most appropriate next steps in management? Select three (3) from the following list:

Lila Baxter, a 4-year-old girl, presents to your general practice with her mother due to frequent sneezing, watery eyes, and nasal congestion that worsens during springtime and when playing outside. The symptoms have been ongoing for two years and are affecting her sleep and concentration at preschool. She has no history of asthma or eczema but has dry skin. Her mother reports that over-the-counter antihistamines only provide partial relief.

Medications: Occasional cetirizine

Allergies: Nil known

Past history: Nil significant

Family history: Mother has hay fever and eczema

Social history: Lives with parents and older sister. Non-smoker household. Attends preschool. No pets. No recent travel.

Examination findings: Well-appearing. Pale, boggy nasal mucosa with clear discharge. No nasal polyps or purulent discharge. Throat mildly erythematous. No wheeze. Chest and skin examination normal.

What are the most appropriate next steps in management? Select three (3) from the following list:

Grace Thompson, a 6-month-old infant, is brought to your general practice by her parents for concerns about a flat area at the back of her head. They noticed the flattening when she was around 3 months old, and it seems to have become more noticeable over time. Grace is otherwise happy, alert, and meeting her developmental milestones. She has good head control and is rolling from front to back. She sleeps on her back and spends time in a baby rocker during the day. There are no concerns with feeding or growth.

Medications: Nil

Allergies: Nil known

Past history: Uncomplicated term birth

Family history: Non-contributory

Social history: Lives with both parents. No smoking exposure. Attends local playgroup.

Examination findings: Growth within normal range. Flattening noted on the right occiput. No cranial ridges or suture abnormalities. No facial asymmetry. Normal tone and motor development. Anterior fontanelle open and soft. Neck range of motion full with no torticollis.

What are the most appropriate next steps in management? Select three (3) from the following list:

Owen McLeod, a 10-year-old boy, presents to your general practice with a 4-day history of fever, sore throat, and difficulty swallowing. He complains of headache and abdominal pain. His parents report that he has been very tired and has missed school. There is no cough or nasal congestion. He has no known sick contacts. This is his first significant illness this year.

Medications: Nil

Allergies: Nil known

Past history: Nil significant. Immunisations up to date.

Family history: Non-contributory

Social history: Lives with both parents. Attends Year 5. No travel history. No pets.

Examination findings: Temperature 38.9°C. Enlarged, erythematous tonsils with white exudate. Palpable, tender anterior cervical lymph nodes. Mild splenomegaly. No rash. No cough or wheeze. Abdominal tenderness in left upper quadrant without guarding.

What are the most appropriate next steps in management? Select three (3) from the following list:

Amara Yusuf, a 13-year-old girl, presents to your general practice with a 6-month history of increasing tiredness, headaches, and reduced school performance. She has also noticed paleness and has begun craving ice. Her periods began at age 12 and are regular but heavy, lasting 7–8 days. She has no dietary restrictions but admits to skipping meals occasionally. There is no history of bleeding from other sites, bruising, or recent illness.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable

Family history: Mother had anaemia as a teenager

Social history: Lives with mother and younger brother. Year 8 student. No smoking or alcohol use. Diet low in red meat.

Examination findings: Conjunctival pallor noted. No jaundice, lymphadenopathy, or hepatosplenomegaly. Cardiovascular and respiratory exams normal. BMI at 60th percentile. No neurological deficits.

What are the most appropriate next steps in management? Select three (3) from the following list: