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2019 RC 2018-2015 > 2017 Exam > Flashcards

2017 Exam Flashcards

1
Q

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
A

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
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2
Q

11 y.o. with separation anxiety and OCD. What do you start:

  • benzo
  • family tx
  • fluoxetine
  • gradual exposure therapy
A

Gradual exposure therapy (part of CBT)

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3
Q

T or F: 500ug + of INH steroid risk of adrenal insuff

A

True

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4
Q

T or F: stool alpha anti-trypsin is reliable and simple test for protein losing eneteropathy

A

True.

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5
Q

Describe the ottawa ankle rules

A

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

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6
Q

Best way to people with disabilities from suffering from sexual abuse:

  • less autonomy
  • putting them in day facility with more supervision
  • better sexual education
A

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

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7
Q

Most common tonsillectomy complications?

A

Halitosis
White shaggy eschar (x 3-4 weeks)
Uncommon: Infection
Rare: hyponatremia (from fluid in OR + SIADH)

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8
Q

T or F: Pre puberty should grow 4-5 cm/year. Peak to 8cm/year in F Tanner Stage.

A

True

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9
Q

What are ARFID criteria

A
  • *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

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10
Q 
Divorce. How do his of different ages react?
< 3
4-5
school age
teens?
A

< 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

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11
Q

Neo with mydriasis and irritable. Hard delivery. Likely sarnat?

A

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.

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12
Q

Achondroplasia. Should screen for?

A

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.

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13
Q

Best advice for teen starting vegan diet:

  • take B12 sup
  • take zinc sup
  • take vit d supp
  • see dietician
A

See dietician

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14
Q

When you refer what may be developmental disfluency to SLP?

A

Stuttering (2 or more repetition)
Tension
Pause

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15
Q

T or F: there are contraindications for nicotine replacement in youth.

A

False. None.

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16
Q

Truncus arteriosus. What is most likely to develop over the first week of life?

  • pul edema
  • severe cyanosis
  • shock
  • pul hypertension
A

Pulmonary Edema

  • usually MILD cyanosis.
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17
Q

What is the minimum height requirement to sit in a car with a seatbelt and no car seat?

A

145 cm

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18
Q

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
A

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

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19
Q

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
A

X linked Adrenoleukodystrophy

= Ataxia, ADHD, Early Death

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20
Q

7 day old with prune belly syndrome. What is most likely cause of abdo mass?

  • hydronephrosis
  • multi cystic kidney
  • polycystic kidney
  • wilms tumour
A

Hydronephrosis

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21
Q

T or F: for long QT syndrome you should start beta blocker and restrict vigorous activity.

A

True

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22
Q

At what sat do you apply O2 for bronchiolitis?

A

< 90%

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23
Q

What is fecal calprotectin most helpful in:

  • functional abdo disorder vs. IBD
  • IBS vs. IBD
  • severity of IBD
  • dx post infectious IBD
A

IBS vs. IBD

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24
Q

List three traits that make a teen more likely to quit smoking:

A
  • Male
  • Older teen
  • Parenthood
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25
Q

T orF: chronic illness is a factor for a teen to NOT quit smoking.

A

True.

26
Q

Blister on newborn hand. Term. Normal everything.

  • Reassure
  • Abx
  • Acyclovir
A

Reassure; sucking blister from in utero.

27
Q

T or F: you should think of gambling problems if teen has new secretive history, money missing, strange charges on credit card.

A

True.

28
Q

5 y.o. has 1 week hx of fever & cough. Started on amox. Develop rash (look like EM) Likely aetiology?

  • amox
  • mycoplasma
  • HSV
A

Mycoplasma

29
Q

Four P/E signs of infratentorial tumour.

A

Most common: astrocytoma, medulloblastoma

  • *- Papilledema
  • *- Diplopia
  • Facial asymmetry
  • CN dysfunction
  • Horner
  • *- Nystagmus
  • torticollis
  • *- Ataxia
30
Q

What are two pharmacological measures you give if 1 dose of adenosine already given?

A
  1. Higher dose adenosine (0.2 mg/kg)
  2. Amiodarone
  3. Flecanamide
31
Q

5 reasons for neonatal low plt

A 
AI (ITP, SLE)
Alloimmune (NAIT)
Sepsis
TORCH (CMV, rubella)
IUGR
Kasabach-Merrit
Thrombosis
Aplastic Anemia (Fanconi anemia), TAR (absent radii)
32
Q

What is the concern with toxic stress and poor outcome in adulthood?

A
    • Direct graded dose response

- i.e. alcoholism, substance abuse, depression, ischemic heart dx, work performance, STI, risk of violence etc.

33
Q

What are two key factors of AN:

A

Restricted intake (leading to weight loss)

Fear of gaining weight

Disturbance in weight/shape

34
Q

Consent for sexual activity rules:

A

“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

35
Q

Three investigations for assess effect of HTN:

A

Echo: LVH, cardiomyopathy
Albumin: Cr ratio
Retinal examination

36
Q

Panic Dx Criteria:

A

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”

37
Q

Iron deficiency anemia. How much supplementation and for how long?

A

4-6 mg/kg/day of elemental iron

x 3 month with F/U in 1 month.

38
Q

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:

A

Hep B:
Hep B IG and vac @ birth, 1 mon, 6 month

HIV
6 week IV zidovudine +/- lamivudine, nevirapine

39
Q

Reducing SIDS via:

A
  • 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
40
Q

How to treat migraine in ED:

A
  1. IVF + bolus
  2. Maxeran
  3. Ketoralac
  4. Sumatriptan
  5. Dihydroergotamine (DHE)
41
Q

5 common conditions linked with Turner:

A
  • *- gonadal dysgenesis
  • HTN
  • horseshoe kidney
  • *- short stature
  • strabismus
  • *- hypothyroidism
  • *- celiac disease
  • LD
42
Q

4 dietary intervention to decrease risk of further stone in boy with calcium oxalate stone.

A

Increase fluid intake
less salt
Normal Ca2+ diet
oral citrate with meals

43
Q

Screening with DM:

A

at 12 y.o. OR 5 years with dx

  • diabetic nephropathy (Urine Alb: Cr)
  • hyperlipidemia

at 15 y.o.
- diabetic retinopathy

44
Q

Three reasons to refer a child with nephrotic syndrome to nephrologist?

A
  • Steroid unresponsive
  • Relapsing
  • Gross hematuria or persistent HTN
  • age < 12 month or > 1 0 y.o.
  • low C3
45
Q

Three questions to guide P/E if child says abuse.

A
  1. Bruising, bleeding
  2. When it happened; STI symptom or known STI with father
  3. Any other injuries to R/O type of abuse.
46
Q

5 genetically inherited syndromes linked with leukaemia:

A 
T21 if translocation
Fanconi Anemia
Shwachman-Diamond
Ataxia Telangiectasia
Bloom Syndrome
47
Q

5 recommendations for sleep onset association

A
  1. Environment (dim lights)
  2. Move routine up so drinking bottle away
  3. Put down drowsy
  4. Full extinction or gradual
  5. Consider more appropriate association (old enough like toy or positive reinforcement)
48
Q

Back pain in gymnast. Likley dx? investigations? two ways to tx?

A

Spondylosis
XR spine
Rest, PT, +/- back brace

49
Q

Most common reason for hypothyroidism in neo? Two recommendation to ensure absorption? Repeat when?

A

Thyroid dysgensis.
Diet: no soy formula, don’t take with ca2+ or iron
Repeat within 2 week.

50
Q

3 investigation as part of routine monitoring for risperidone?

A

Fasting BG
Lipid profile
+/- AST, ALT if overweight
+/- prolactin if symptom.

51
Q

Most common reason for HTN in child with NF1?

A

Renal artery stenosis from NF1.

Acutely can use : labetalol, hydrazine, nitroprusside, nicardipine

52
Q

Who do you manage abscess with concern for MRSA (after being on 7d of keflex)

A

Septra + Keflex

53
Q

Way to treat serum sickness like syndrome?

A

Remove offending agent

Supportive: antihistamine, +/- NSAID, +/- corticosteroids if severe.

54
Q

Vulvar pruritus. White, shiny, thin with scattered petecahise seen. Dx? Tx? Other reason for itching?

A

Lichen Sclerosis.

Tx: topical steroid.

Other: vulvovaginitis (irritant or GAS), FB

55
Q

When do you refer kid with nasolacrimal duct obstruction to ophtho?

A

12 month

Consider Sx/probe.

56
Q

Long term complications of JIA:

A

Uveitis
Joint contracture
Leg length discrepancy
Growth retardation or osteo (due to steroid)

57
Q

Two RF that predict increased risk of uveitis in JIA

A

ANA (+)

Oligoarthritis

58
Q

Dx asthma in preschooler

A
  1. Documented obstruction (i.e. wheeze, AE)
  2. Documented reversibility (i.e. SABA)
  3. Alternate dx ruled out.
59
Q

Weird Q: two P/E on resp auscultation that suggest viral versus bacterial causes?

A

Bacterial: focal consolidation, resp failure, dull to percussion, bronchial breath sounds.

Viral: diffuse crackle, transmitted upper airway sounds, stridor.

60
Q

13 y.o. with recurrent jaundice. All pathology ruled out. LIKley cause and trigger. Management?

A

Gilbert syndrome
Trigger: stress, infection
Tx: reassurance.

2019 RC 2018-2015 (6 decks)

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