2017 - MCQ Flashcards
A 6 year old boy is brought into the ER by ambulance after a high speed MVA. He is moaning and not responsive, extends his arms and legs to pain. His respiratory rate is 18, BP is 120/60, HR is 130. His pupils are 4mm bilaterally and reactive. What is your next step of management?
a) RSI
b) Mannitol
c) CT head
d) NS bolus
RSI
A 10 year old child twists his ankle playing soccer. He presents to the ER, where he is able to bear some weight but with ++ pain. What findings on physical exam would prompt you to order an x-ray?
a) If he has pain on palpation anterior to the medial malleolus
b) If he was unable to walk immediately after the injury
c) If he has pain on palpation posterior to medial malleolus
d) If there is swelling
If he has pain on palpation posterior to medial malleolus
A child presents to ER with bruising on face and her response to pain is withdrawal on one side only. Vitals revealed hypotension. What is your next management step:
a. CT head
b. Give NS bolus bolus via intraosseous
c. Hydrocortisone IV
Give NS bolus via IO
6 month old child presents to the emergency department with significant facial swelling and bruising (r/o NAI??) Given vital signs, tachycardia and hypotension with BP 60/40s. SpO2 99%. Respiratory rate is normal, pupils are equal and reactive. Most appropriate next steps?
a. CT head
b. Insert IO and give bolus of normal saline
c. Give mannitol
d. Intubate
Insert IO and give bolus of normal saline
2 year old swallows a 8 mm coin battery 2 hours ago. Stable. On x-ray, it is found in the stomach. What is the next step in management?
a. Consult for endoscopic removal
b. Wait for 48 hours, follow serially with x-rays
c. Wait for 10 days, follow serially with x-rays
d. Reassess if it does not appear in the stool
Wait for 10 days, follow serially with x-rays
8 year old anxious kid. No issues with body image or fear of gaining weight. He has become more selective with his eating and now only eats chocolate pudding. His weight has decreased from 50th%ile to 10th%il.e. What is the diagnosis?
a) Picky eater
b) Avoidant/Restrictive food intake disorder
c) Anorexia nervosa
d) Bulimia
ARFID
At what age should screening begin with PAP smear?
a. 21 years
b. 18 years
c. After sexual intercourse
21
Adolescent girl with bulimia who smokes 1.5 packs/day wants to quit, and is interested in nicotine replacement. Which of the following is a contraindication?
a. There is no contraindication
b. That she still smokes a few cigarettes once in a while
c. That she is <18 years old
d. Her eating disorder
No contraindication
Teen female with type 1 diabetes presents with decreasing weight, falling off the growth curve. Weight was previously at the 50th percentile and now is below the 10th. Doing well in school and gets all A’s in her classes. HbA1C 7.5%. What is the most likely cause?
a. Eating disorder
b. Diabetic ketoacidosis
c. Celiac disease
Eating Disorder
15 year old girl who has undergone puberty, with a normal exam, who is in your office and shares that she feels that she has always identified more as a boy. She is very distressed by her breast growth and menstruation. Most appropriate plan:
a. Listen attentively and referral for gender dysphoria
b. LH, FSH, estrogen levels
c. Listen attentively and reassure that this is part of normal development
Listen attentively and referral for gender dysphoria
A 15 year old otherwise healthy female is sexually active and comes in for a annual health check. According to the Greig health record, which of the following should she get:
- Chlamydia, gonorrhea testing
- Chlamydia, gonorrhea and HIV testing
- Chlamydia, gonorrhea, HIV testing and Pap smear
Chlamydia, gonorrhea and HIV testing
Child is admitted with strep pneumo bacteremia and started on ampicillin. Shortly after receiving antibiotics has decreased LOC and urticaria. Tachycardic and hypotensive. What would you do?
IV epinephrine (**it really said IV, not IM!)
2. IV benadryl
3. Normal saline bolus
4. Oral cetirazine
Normal saline bolus
Picture with white papule
a. HSV
b. Neonatal erythema toxicum
c. Pustular melanosis
d. Miliaria
Miliaria
Teenage boy with acne, currently on topical antibiotic and BP in the AM, and topical retinoids in the PM. No symptomatic improvement. What is your next step in management?
- Minocyclin
- Clindamycin
- Isotretintoin
- Cefazolin (I think)
Minocycline
5 year old with exercise intolerance. On examination he has a slight heave at the left lower sternal border. His first heart sound is normal, the second heart sound is split and quieter. He has a Harsh ejection systolic murmur loudest at the left upper sternal border. What is the most likely cause?
a. Mitral stenosis
b. Mitral valve prolapse
c. Aortic stenosis
d. Pulmonary stenosis
pulmonary stenosis
16 year old girl complains of feeling dizzy and palpitations – it occurs within 5 minutes of standing upright. Her supine blood pressure is 118/70 and her supine heart rate is 84bpm. When she stands up, her blood pressure is 116/68 and her heart rate is 120bpm. What is the diagnosis?
A. Orthostatic hypotension
B. Long QT
C. Postural orthostatic tachycardia syndrome (TB)
POTS
A teenager has long QT syndrome. He also has been having syncopal episodes while participating in sport. What is the best course of management:
a. Start CCB and restrict vigorous activity
b. Start CCB and do not restrict activity
c. Start beta blocker and restrict vigorous activity
d. Start beta blocker and do not restrict activity
Start beta blocker and restrict vigorous activity
What is important to know in order to determine if BP is within normal range?
a) Weight
b) Ethnicity
c) Height
d) Age
age, for screening purposes
height, sex
You are seeing a 1 day old newborn, with truncus arteriosus. What are they most likely to develop over the first week of life?
- pulmonary edema
- severe cyanosis
- shock
- pulmonary hypertension
pulmonary edema
What is the best way to prevent people with disabilities from suffering sexual abuse.
a) Less autonomy
b) Putting them in day facilities with more supervision
c) Better sexual education
Better sexual education
7 year-old girl discloses that her 14 yo step brother has been sexually abusing her. On exam you find a complete cleft in the posterior hymen. This is:
- Diagnostic of sexual abuse
- Diagnostic of previous hymenal injury
- Normal variant
- Congenital abnormality
Diagnostic of previous hymenal injury
9 year old whose parents are getting a divorce and they ask what type of behavior she will exhibit:
a. Developmental regression
b. Pick sides (mother vs. father) and blame the other parent
c. Try to make everyone happy
d. Blame herself for the divorce
Pick sides (mother vs. father) and blame the other parent
Mother of a 3 yo girl is concerned about her speech. She said her first words at 11 months. There are no concerns with development. She has had difficult speaking: will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speaking in the middle of sentences. This is associated with facial twitches and blinking. What do you recommend?
a. Audiology
b. Developmental assessment
c. Reassure
d. Refer to SLP
Refer to SLP
Description of a 2 month old baby with colic. Tolerating breastfeeding well, normal exam. What is the best management?
a) Encourage mom to continue breast feeding
b) Add cows milk based formula in diet
c) Add soy based formula in diet
d) Simethicone
Encourage mom to continue breast feeding
An 18 year old boy has asthma, for which he is on inhaled salbutamol and fluoxetine, 250ucg INH bid. He has 3-4 exacerbations per month, for which he doubles the dose. He was last on oral prednisone a few weeks ago. He now presents to the ED with 1-2 days of illness, decreased PO intake and vomiting, dizziness and feeling unwell. His glucose is found to be 1.8. What is the etiology?
a) X-linked adrenoleukodystrophy
b) Ketotic hypoglycemia
c) Adrenal insufficiency
d) Addison’s disease
Adrenal insufficiency
An 8 day old infant presents with Na 164, K 4.7. What is the most likely etiology?
a) Munchausen by proxy
b) Inadequate breastfeeding
c) CAH
d) RTA
Inadequate breastfeeding
For adolescent girls, which would be the most concerning in terms of height velocity
a. Tanner stage 2, growing 6cm/year
b. Tanner stage 3, growing 4cm/year
c. Tanner stage 4, growing 5cm/year
d. Tanner stage 5, growing 1cm/year
Tanner stage 3, growing 4cm/year
Which of the following growth velocities is most concerning in a female?
a. SMR 1 and growing at 6cm/year
b. SMR 2 and growing at 4cm/year
c. SMR 3 and growing at 8cm/year
d. SMR 5 and growing at 1cm/year
SMR 2 and growing at 4cm/year
Which of the following is most consistent with a boy who is tanner 3?
a. Increased axillary hair
b. Voice deepening
c. Pubic hair is becoming curly
Pubic hair is becoming curly
10 year old girl with an enlarged thyroid, diffuse nontender. T4 6.6 TSH >50, thyroid antibodies positive. What is your next step in management?
a) Start methimazole
b) Order thyroid ultrasound
c) Order radionuclide scan
d) Start levothyroxine
Start levothyroxine