Understanding the Grassroots Movements Behind the AKP Recall
MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion…
MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion from his nose and coryzal signs, safe guard register checked and the family not known to social service. What is the best action to be done?
MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion from his nose and coryzal signs, safe guard register checked and the family not known to social service. What is the best action to be done?
Child: 3 years old, with two siblings (6 years and 6 months old)
Presentation:
Zygomatic bruising (2.5 cm) after hitting head on bed
Refused paracetamol
Yellow-brown nasal discharge and coryzal signs (suggestive of URTI)
History: Previous head trauma last year while climbing bed
Family: Not known to social services, safeguarding register checked
Concern: Recurrent injuries in a young child, facial bruising, and siblings present
Reasoning
Facial bruising in a young child — especially over the zygomatic area — is a red flag for possible non-accidental injury (NAI), particularly if the history is inconsistent or there are repeated injuries.
Recurrent trauma in a child under 5 should always raise suspicion, even if there is a plausible explanation.
Safeguarding principle: If there is any suspicion of abuse, the priority is to ensure the child’s safety and assess risk to siblings.
Guidelines:
Examine siblings for signs of injury.
Consider full safeguarding assessment.
Involve social services early.
Hospital admission may be needed for further investigation (skeletal survey, coagulation profile) if abuse is suspected.
Option Analysis
Option
Comment
A. Ask to examine other brothers
This is part of safeguarding, but on its own is insufficient — you must also escalate to social services.
B. Discharge to follow up in OPD
Unsafe — risk of harm if abuse is ongoing.
C. Discharge and plan for health visitor
Too low-level for the risk profile.
D. Admit, coagulation profile and skeletal survey
Appropriate if there is suspicion of NAI — allows thorough assessment and protection.
E. Refer to social services
Essential step in safeguarding — but in this acute setting, admission for investigation is also indicated.
Best Answer
✅ D. Admit, coagulation profile and skeletal survey
Why?
Admission ensures the child is in a safe environment while investigations are done.
Skeletal survey and coagulation profile help differentiate between inflicted injury and medical causes (e.g., bleeding disorders).
Social services referral will be part of the safeguarding process once admitted.
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MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion…
MRCPCH: These recall-based questions reflect the style, topics, and difficulty level seen in the actual paper. Whether you’re taking your first attempt or re-sitting, this insight into MRCPCH Part 2 real exam cases can help you focus on high-yield topics and common pitfalls.
