2017 Exam Flashcards
When are you concerned for a sacral dimple:
- slate gray nevus over dimple
- located 2cm from anal verge
- 3mm in diameter
- located above gluteal cleft
Located above gluteal cleft
Review of red flags:
- associated with cutaneous hemangioma, or hairy tuft
- abN p/e exam (R/O neuro)
- multiple
- diameter > 5 mm
- dimple 25mm above anus (“remember 5 and 25”)
- dimple outside of sacrococcygeal region
11 y.o. with separation anxiety and OCD. What do you start:
- benzo
- family tx
- fluoxetine
- gradual exposure therapy
Gradual exposure therapy (part of CBT)
T or F: 500ug + of INH steroid risk of adrenal insuff
True
T or F: stool alpha anti-trypsin is reliable and simple test for protein losing eneteropathy
True.
Describe the ottawa ankle rules
Bony tendernes at POSTERIOR tip of medical or lateral malleolus. OR can’t weight bear BOTH immediately and in ED.
Ottawa foot rules: tender at 5th metatarsal, tender at navicular, can’t weight heart BOTH immediately and in ED
Best way to people with disabilities from suffering from sexual abuse:
- less autonomy
- putting them in day facility with more supervision
- better sexual education
Better sexual education
CPS:
> institution: screen and monitor employee and volunteer, chaperone physical exam, have supervised outings, have culture that promotes privacy, and be alert and report abuse
> person: get sexual education
> HCP: respect privacy in this pt pop’n
Most common tonsillectomy complications?
Halitosis
White shaggy eschar (x 3-4 weeks)
Uncommon: Infection
Rare: hyponatremia (from fluid in OR + SIADH)
T or F: Pre puberty should grow 4-5 cm/year. Peak to 8cm/year in F Tanner Stage.
True
What are ARFID criteria
- *Eating or feeding disturbance** w/ failure to meet nutrition and ONE of:
- *> wt loss
- *> nutritional deficiency
- *> enteral feed dependence
- *> impair f’n
** Not better explained by neglect or culture
**No body shape or fear of gaining weight
Divorce. How do his of different ages react? < 3 4-5 school age teens?
< 3= reflect caregiver grief (irritable, poor sleep, anxiety, developmental regression)
4-5= blame themselves, clingy, fear abandonment
school age= strong sense of fair; prone loyalty and take sides
teens= eager to be accepted; want to make everyone happy
Neo with mydriasis and irritable. Hard delivery. Likely sarnat?
1
1= hyperalert, normal activity + tone, weak suck but strong moro, pupils BIG
2= lethargic, poor tone, weak moro and small pupil. *SZ
3= stupor, no activity, absent reflects. Non reactive pupils.
Achondroplasia. Should screen for?
MRI
Every infant= neuro hx, p/e, neuroimaging and polysomnography.
Risk of central apnea from compression of vessels of foramen magnum leading to unexpected death in infants.
Best advice for teen starting vegan diet:
- take B12 sup
- take zinc sup
- take vit d supp
- see dietician
See dietician
When you refer what may be developmental disfluency to SLP?
Stuttering (2 or more repetition)
Tension
Pause
T or F: there are contraindications for nicotine replacement in youth.
False. None.
Truncus arteriosus. What is most likely to develop over the first week of life?
- pul edema
- severe cyanosis
- shock
- pul hypertension
Pulmonary Edema
- usually MILD cyanosis.
What is the minimum height requirement to sit in a car with a seatbelt and no car seat?
145 cm
Swallows 8mm coin battery. 2hr ago. Stable on XR. In stomach. What do you do?
- endoscopy removal
- wait 48 h; follow serial XR
- wait 10 d; follow serial XR
- reassess if does not appear in stool
Wait 10d and follow serial XR.
Stomach: Any age battery < 2 cm= XR 10-14 and serial XR.
If < 5 y.o. and > 2 cm= remove!
If > 5 y.o. and > 2cm= repeat XR In 48h
7 y.o. with recent hyperactivity and inattention. One exam ataxia. Maternal uncle died at age 10 with similar symptoms. What does he have?
- Friedrich adrenoleukodystrophy
- X linked adrenoleukodystrophy
- DMD
- Ataxia telangiectasia
X linked Adrenoleukodystrophy
= Ataxia, ADHD, Early Death
7 day old with prune belly syndrome. What is most likely cause of abdo mass?
- hydronephrosis
- multi cystic kidney
- polycystic kidney
- wilms tumour
Hydronephrosis
T or F: for long QT syndrome you should start beta blocker and restrict vigorous activity.
True
At what sat do you apply O2 for bronchiolitis?
< 90%
What is fecal calprotectin most helpful in:
- functional abdo disorder vs. IBD
- IBS vs. IBD
- severity of IBD
- dx post infectious IBD
IBS vs. IBD
List three traits that make a teen more likely to quit smoking:
- Male
- Older teen
- Parenthood
T orF: chronic illness is a factor for a teen to NOT quit smoking.
True.
Blister on newborn hand. Term. Normal everything.
- Reassure
- Abx
- Acyclovir
Reassure; sucking blister from in utero.
T or F: you should think of gambling problems if teen has new secretive history, money missing, strange charges on credit card.
True.
5 y.o. has 1 week hx of fever & cough. Started on amox. Develop rash (look like EM) Likely aetiology?
- amox
- mycoplasma
- HSV
Mycoplasma
Four P/E signs of infratentorial tumour.
Most common: astrocytoma, medulloblastoma
- *- Papilledema
- *- Diplopia
- Facial asymmetry
- CN dysfunction
- Horner
- *- Nystagmus
- torticollis
- *- Ataxia
What are two pharmacological measures you give if 1 dose of adenosine already given?
- Higher dose adenosine (0.2 mg/kg)
- Amiodarone
- Flecanamide
5 reasons for neonatal low plt
AI (ITP, SLE) Alloimmune (NAIT) Sepsis TORCH (CMV, rubella) IUGR Kasabach-Merrit Thrombosis Aplastic Anemia (Fanconi anemia), TAR (absent radii)
What is the concern with toxic stress and poor outcome in adulthood?
- Direct graded dose response
- i.e. alcoholism, substance abuse, depression, ischemic heart dx, work performance, STI, risk of violence etc.
What are two key factors of AN:
Restricted intake (leading to weight loss)
Fear of gaining weight
Disturbance in weight/shape
Consent for sexual activity rules:
“2 in 2 and 5 in 5”
min. 16= all good except person of authority or exploitative
14-15= within 5 year
12-13= within 2 year
Three investigations for assess effect of HTN:
Echo: LVH, cardiomyopathy
Albumin: Cr ratio
Retinal examination
Panic Dx Criteria:
Recurrent and > 1 mon.
Worry about the attack
OR change behaviour related to attack (i.e. avoid unfamiliar situation)
NOTE: attack is = 4 of “STUDENTS FEAR the 3 C’s”
Iron deficiency anemia. How much supplementation and for how long?
4-6 mg/kg/day of elemental iron
x 3 month with F/U in 1 month.
Two infection for F with no prenatal care and hx of IVDU. Two infection with vertical infection and how you would treat to prevent transmission:
Hep B:
Hep B IG and vac @ birth, 1 mon, 6 month
HIV
6 week IV zidovudine +/- lamivudine, nevirapine
Reducing SIDS via:
- back to sleep
- no co sleeping
- sleep in same room
- no cig smoke exposure
- BF
- pacifier
- firm sleep surface with no heavy blanket or soft bedding
- immunization
- don’t let BB get too hot
How to treat migraine in ED:
- IVF + bolus
- Maxeran
- Ketoralac
- Sumatriptan
- Dihydroergotamine (DHE)
5 common conditions linked with Turner:
- *- gonadal dysgenesis
- HTN
- horseshoe kidney
- *- short stature
- strabismus
- *- hypothyroidism
- *- celiac disease
- LD
4 dietary intervention to decrease risk of further stone in boy with calcium oxalate stone.
Increase fluid intake
less salt
Normal Ca2+ diet
oral citrate with meals
Screening with DM:
at 12 y.o. OR 5 years with dx
- diabetic nephropathy (Urine Alb: Cr)
- hyperlipidemia
at 15 y.o.
- diabetic retinopathy
Three reasons to refer a child with nephrotic syndrome to nephrologist?
- Steroid unresponsive
- Relapsing
- Gross hematuria or persistent HTN
- age < 12 month or > 1 0 y.o.
- low C3
Three questions to guide P/E if child says abuse.
- Bruising, bleeding
- When it happened; STI symptom or known STI with father
- Any other injuries to R/O type of abuse.
5 genetically inherited syndromes linked with leukaemia:
T21 if translocation Fanconi Anemia Shwachman-Diamond Ataxia Telangiectasia Bloom Syndrome
5 recommendations for sleep onset association
- Environment (dim lights)
- Move routine up so drinking bottle away
- Put down drowsy
- Full extinction or gradual
- Consider more appropriate association (old enough like toy or positive reinforcement)
Back pain in gymnast. Likley dx? investigations? two ways to tx?
Spondylosis
XR spine
Rest, PT, +/- back brace
Most common reason for hypothyroidism in neo? Two recommendation to ensure absorption? Repeat when?
Thyroid dysgensis.
Diet: no soy formula, don’t take with ca2+ or iron
Repeat within 2 week.
3 investigation as part of routine monitoring for risperidone?
Fasting BG
Lipid profile
+/- AST, ALT if overweight
+/- prolactin if symptom.
Most common reason for HTN in child with NF1?
Renal artery stenosis from NF1.
Acutely can use : labetalol, hydrazine, nitroprusside, nicardipine
Who do you manage abscess with concern for MRSA (after being on 7d of keflex)
Septra + Keflex
Way to treat serum sickness like syndrome?
Remove offending agent
Supportive: antihistamine, +/- NSAID, +/- corticosteroids if severe.
Vulvar pruritus. White, shiny, thin with scattered petecahise seen. Dx? Tx? Other reason for itching?
Lichen Sclerosis.
Tx: topical steroid.
Other: vulvovaginitis (irritant or GAS), FB
When do you refer kid with nasolacrimal duct obstruction to ophtho?
12 month
Consider Sx/probe.
Long term complications of JIA:
Uveitis
Joint contracture
Leg length discrepancy
Growth retardation or osteo (due to steroid)
Two RF that predict increased risk of uveitis in JIA
ANA (+)
Oligoarthritis
Dx asthma in preschooler
- Documented obstruction (i.e. wheeze, AE)
- Documented reversibility (i.e. SABA)
- Alternate dx ruled out.
Weird Q: two P/E on resp auscultation that suggest viral versus bacterial causes?
Bacterial: focal consolidation, resp failure, dull to percussion, bronchial breath sounds.
Viral: diffuse crackle, transmitted upper airway sounds, stridor.
13 y.o. with recurrent jaundice. All pathology ruled out. LIKley cause and trigger. Management?
Gilbert syndrome
Trigger: stress, infection
Tx: reassurance.
