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2019 RC 2018-2015 > 2015 Exam > Flashcards

2015 Exam Flashcards

1
Q

Boy with lupus. Most likely test consistent with lupus:

  • ANCA (+)
  • HIGH plt
  • HLA B27 (+)
  • (+) RPR
A

(+) RPR

SLE: Thrombocytopenia typically (high much less common), ANA, anti-dsDNA antibodies, anti-Sm, False (+) RPR (syphilis test)

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2
Q

Absent reflexes. Fasciculation in 6 wk old with poor feed and hypotonia. What is next most diagnostic test?

  • MRI
  • thyroid function
  • metabolic screen
  • genetic testing
A

Genetics!

SMA= absent reflexes +/- tongue fasciculation
= SMN1 gene testing

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3
Q

3 y.o. with CP with pneumonia. Consolidation with effusion. best tx:

  • cipro
  • clinda + gent
  • cefuroxime + azithro
  • amp+ gent
A

Clinda + gent

CLIN= anaerobes, staph, strep
Gent= gram (-) bacilli and pseudomonas
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4
Q

Post tonsillectomy. Na 121 with serum osmolality 260. most consistent with:

  • urine osmolality > serum
  • serum osmolality> urine
  • Urine Na < 0
  • high U/O
A

Urine osmolality > serum.

Two factors:

  • excessive hypotonic fluid in Sx
  • SIADH due to non osmotic causes post-op (pain, low fluid etc.)

SIAD= low UO= urine osm > serum

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5
Q

2 y.o. with 2 wk proximal muscle weakness:

  • congenital myopathy
  • neuromuscular
  • peripheral neuropathy
  • SC injury
A

Congenital Myopathy

Central= HIE= DTR up, muscle bulk and power normal/low

Anterior Horn Cell= PROXIMAL; DTR low or absent
i.e. SMA= hypotonia, proximal, fasciculation, areflexia. SMN1 gene testing!

Peripheral= DISTAL.
i.e. Charcot Marie Tooth= teens, slow DISTAL weakness, tripping, foot drop, inverted champagne of lower leg, high arch, hammer tone, flat feet
W/U: nerve conduction study, EMG +/- genetic testing

Neuromuscular: muscle bulk and power normal but fluctuate.
i.e. Myasthenia Gravis= Ptosis, EOM weak, normal pupil, feeding issue, symmetric progressive distal limb with rapid fatigue. EMG!

Muscular Dystrophy=
i.e. DMD= distal= calf hypertrophy, muscle bx.

Myotonic Dystrophy = tent mouth, low DTR

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6
Q

When is the live flu vaccine contraindicated?

A

< 2

severe asthma (active wheeze, PO or high dose ICS, medically attended wheezing in last 7d)

immunocompromised

pregnancy

on ASA

<48h after antiviral agent against flu given

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7
Q

AOM with myringotomy tubes. Purulent drainage. Afebrile.

  • Cx and wait
  • Topical Abx and corticosteroid drop
  • High dose amox
  • Standard dose amox
A

Topical Abx and Corticosteroid Drop

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8
Q

Lots of pRBC. ECG complication?

A

Peaked T waves= high K

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9
Q

Acute rheumatic fever ECG finding?

A

Prolonged PR interval.

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10
Q

HTN, high temp. tachycardia. Due to?

  • cocaine
  • LSD
  • marijauna
A

Cocaine= Sympathomimetic

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11
Q

Describe APGAR:

A

0-1-2

Appear= Blue, Acro, Pink
Grimace= None, grimace w/ stimulated, vs. 2 is sneezing, coughing or pulling away with stimulation
Pulse= None, < 100, > 100
Activity/Tone= 0, some flexion, full
Resp= None, Irregular, Full
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12
Q

Best test for nutritional vitamin D deficiency?

  • Ca
  • 1, 25 (OH)D
  • 25-Vitamin D
  • PTH
A

25 Vitamin D

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13
Q

BB screen comes back (+) for Carnitine palmitoyltransferase 2 deficiency. Best course until confirmed:

  • start PO carnitine
  • feed frequent (q3h)
  • a.a. formula
  • hyper caloric formula
A

= F.a. Oxidation Defect

= Avoid fasting!

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14
Q

What tumour is beck with Wiedemann at higher risk for?

A

Wilm’s Tumour
Hepatoblastoma
Neuroblastoma
Adrenocortical carcinoma

Reminder: macrosomia, macrogloassia, omphalocele, HSM, ear pit, hypoglycaemia due to hyperinsulinemia, hemihyperplasia

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15
Q

Why do we irradiate blood given to prem?

  • less CMV
  • less GVHD
  • sterilize RBC
  • less hemolytic rxn
A

Less GVHD

Goal= prevent transfusion associated graft-versus host disease

Indication: infant, immunosuppressed or dficienct, bone marrow/stem cell transplant, intrauterine transfusion

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16
Q

Hemoglobin electrophoresis patterns:

A 
HbAS (sickle trait)= ++ A + S
Hb SS (sickle dx)= ++ S; no A
Beta thal minor= A + variable F
Beta thal major= +++ F. No A
Alpha major= ++ A; HbH
HbBart= ++ HbH; no A.
17
Q

8 y.o. with T1DM with abdo pain. Lost wt. Pruritic bulls lesions on extensor surface of arms + trunk. Likely dx?

  • celiac dx
  • IBD
  • eosinophilic gsatroenteropathy
  • eosinophilic gastroenteropathy
  • parasitic infection
A

Celiac Dx

Dermatitis herpetiformis

18
Q

What glomerular dx has low C3?

A

Post infectious
Membranoproliferazive
AI and Vasculitis (SLE)
Subacute bacterial endocarditis

Versus Normal
= IgA, anti-GBM, HSP, alport, polyarteritis nodosa

19
Q

Leukocoria. Name 3 DX?

A 
Retinoblastoma
Cataracts
Advanced ROP
Coats Dx
Toxocariasis
20
Q

What do you do for SIADH

A

Fluid restrict

21
Q

Most imp and two other organism for splenic pt?

A

Streptococcus pneumoniae

Other: Salmonella, Neisseria meningitidis, Haemophilus influenzae

22
Q

Contractility vs. Peripheral vascular resistance. Describe the pattern for:

  • Dopamine
  • high dose epi
  • low dose epi
  • dobutamine
A

Dopamine: Up both
High dose: Up both
Low dose Epi: Contractibility up but no change to PVR
Dobutamine: Same as low dose epi

23
Q

What are two investigations or dermatomyositis?

A

CK, AST, LD
EMG
+/- Muscle Bx

Reminder clinical dx:
= Classic Rash (heliotrope of eye lid + grotton) + min. 3 of
> weakness (symmetrical proximal)
> muscle enzyme (CK, AST, LDH)
> EMG change (Short small motor unit, fibrillation, (+) sharp wave)
> Muscle bx (necrosis, inflammation)

24
Q

Short gut syndrome sequelae. Other than malnutrition and malabsorption:

A

➢ Dehydration
➢ Vitamin deficiency
➢ Malnutrition (i.e. Vitmain B12, folate, fat soluble vitamins, zinc, copper)
➢ ** Bacterial Overgrowth
➢ High rate of sepsis and cholestasis since may depend on TPN for long time
o ** Catheter infections
o **** Cholestasis
➢ Central line infection, liver failure w/ long TPN use
o ** *Sepsis

25
Q

Describe good control asthma:

A

< 4 daytime /week;
no nightly;
activity normal
no missed school

Moderate= daily daytime but no weekly night
Severe= weekly night use
26
Q

Describe 4 organs other than MSK involved with DMD and their effect:

A

Cardiac: Cardiomyopathy
Resp: Hypoventilation
GI: constipation

OTHER: GI: obesity
OTHER: Steriod affect= osteopenia
CNS: intellectual impairment
MSK: intoning, calf hypertrophy, scoliosis, mobility down

27
Q

Methanol long term complication

A

Blindness

28
Q

Methanol treatment

A

ABC
Fomepizole
Give ethanol to stop methanol metabolism
+/- Na bicarb, folate, hemodialysis

29
Q

4 features of atypical febrile seizure

A

More than 1 in 24 hour
Seizure > 15 minute
Focal symptom

+/- age < 6 or > 6 y.o.?

30
Q

5 absolute contraindications for OCP int teen?

A 
Migraine with aura
Severe cirrhosis
Severe uncontrolled HTN
History of Stroke
History of VTE or DVT
Current breast cancer
31
Q

Name 3 RF for refeeding syndrome?

A

Weight < 80% of ideal weight for age, height and sex.
Not eating > 10 days.
Other: fast re-feeding

32
Q

4 High risk groups for sever influenzae?

A

Pregnancy
< 5 year old (Neonates and Infants) (6-59 months)
Aboriginal, Inuit and First Nation.
Children with chronic disease. (i.e. CVS, liver, renal dx, neuro, anemia, CA etc.)
On Chronic ASA therapy
Elderly

33
Q

FEV1 drop in CF. 5 reasons?

A 
Infection: Pseudomonas
Infection: Stenotrophomonas
Infection: Burkholderia cepacia
Viral LRTI
ABPA
Smoking
Natural progression= Worsening bronchiectasis (progression of dx)
Non adherence to treatment (although they said she is)
34
Q

Neonatal lupus. Two most common antibodies?

A

Anti-Ro

Anti-Lau

35
Q

Three signs of neonatal lupus aside from congenital heart block:

A

Discoid rash
Hepatitis
Thrombocytopenia/ cytopenia

2019 RC 2018-2015 (6 decks)

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