Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2019 RC 2018-2015 > 2018 MCQ > Flashcards

2018 MCQ Flashcards

1
Q

7 year old male with chronic GERD. He develops progressive dysphagia to solids. He has lost 2.3 kg as a result of his restrictive eating. Labs are normal. Best test for diagnosis:

  1. Hydrogen breath test
  2. H. Pylori serology
  3. Upper endoscopy and biopsy
  4. Upper GI series
A
  1. Upper Endoscopy and biopsy

Eosinophilic Esophagitis

Clinical:

  • Atopic male presenting in childhood or 4th decade, predominance in whites
  • Infants/toddlers: feeding difficulties
  • Children: vomiting or pain
  • A/w food allergy, eczema, chronic rhinitis, env allergies
  • ** Most common condition that presents as food impaction
  • Symptoms suggestive of GER that are unresponsive to antacids

Diagnosis

  • Symptoms related to esophageal dysfunction
  • Eosinophil-predominant inflammation on biopsy, >15 eos per hpf
  • Mucosal eosinophilia is isolated to esophagus and persists after ppi trial
  • Secondary causes of esophageal eosinophilia exluded
  • Response to tx (dietary elimination, topical corticosteroids) supports dx but is not required for dx
  • Biopsies are required

Treatment

  • Topical and systemic corticosteroids
  • First line therapy - multi-dose inhalers or aqueous nebs that are swallowed. Systemic prednisone works well but worse SE.
  • Dietary restrictions
  • Elimination diet, 6 food elimination diet, elemental diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Young girl with suspected sepsis. She is started on Ceftriaxone and gets better. Culture grows S. pneumo sensitive to Ampicillin. She is switched to ampicillin and shortly after taking it develops urticaria. Her blood pressure is low, HR 180 and RR 50. What is your next best step:

  1. IV diphenhydramine
  2. Restart Ceftriaxone
  3. 20 ml/kg normal saline
  4. Epi IV
A
  1. 20 ml/kg NS …and a variant of 4. Epi IV but not quite…

Sounds like anaphylaxis. Ideally : do IM to start. Stop Amp if still running. Give fluids for her hypotension. IV Epi is a consideration if ongoing hypotension - do this as an infusion, not a push.

CPS Emergency Tx of Anaphylaxis:

Epinephrine 1:1000 should be administered IM into the anterolateral thigh at a dose of 0.01 mg/kg (maximum total dose 0.5 mg), and can be repeated every 5 min to 15 min depending on the patient’s response to previous doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

1 year old has a seizure and is taken to the hospital. On examination, fundoscopy looks like this: (super vascular with poorly demarcated greyish area)

What is the underlying etiology:

  1. Tay Sach’s
  2. Retinopathy of prematurity
  3. Child abuse
  4. Toxoplasmosis
A

https://www.aao.org/topic-detail/retinopathy-of-prematurity–asia-pacific#figure18

This is an example of ROP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Teenage girl with exercised-induced syncope. She has been diagnosed with long QT syndrome. What is your next step in management:

  1. Calcium channel blocker with high intensity exercise restriction
  2. Beta Blocker with high intensity exercise restriction
  3. Calcium channel blocker without high intensity exercise restriction
  4. Beta blocker without high intensity exercise restriction
A
  1. Beta Blocker with high high intensity exercise restriction

This is a dumb question becaue exercise restriction is an area of huge debate. Exercise restriction depends on the genotype of LQTS - for LQT-1, swimming not recommended due to sudden cardiac death. For the others, so long as asymptomatic and avoid other exacerbating factors (over heading, drugs, dehydration) they can do competitive sports.

Since this is a new Dx - would avoid high intensity sports - make sure remains asymptomatic for a period of time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A child in grade 1 has a history of repaired TAPVR. He has been diagnosed with ADHD. After taking a thorough history and physical, your next step is:

  1. ECG
  2. ECHO
  3. Start a stimulant medication with no further investigation
  4. Stimulants are contraindicated
A
  1. Start on stimulant… ?

Do an ECG only if symptomatic… i think.

From the CPS Cardiac Risk Assessment

For ADHD patients with known heart disease who are followed by a cardiologist, the physician with expertise in ADHD likely remains the appropriate individual to evaluate benefit and risk, and make a recommendation for medication therapy, because there is little evidence that taking medication further increases the risk of sudden death. Discussion of treatment options with the cardiologist is appropriate, with ultimate treatment decisions being made by consensus. ‘In-person’ clinical review by the cardiologist specifically for ADHD risk assessment before starting treatment is generally unnecessary (class IIa, level C).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mom has husband who lived in Brazil up to 12 months ago, babe comes out looking well with a normal head circumference, weight and length. Normal physical exam. What testing do you do on the NEWBORN?

  1. Zikv PCR in blood and urine of babe and head u/s
  2. MRI babe
  3. ZIKV serologies
  4. Do nothing
A
  1. Do Nothing.

If there is possible exposure for mother - travel to endemic country while pregnant or sexual intercourse while pregnant with someone from endemic country in last 6 months and baby is NORMAL (normal HC and neuro exam)… then you can test mom first with ZIKV serology.

CPS ZIKA Statement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Microarray testing best able to detect

  1. 22q11
  2. Fragile X
  3. PWS
  4. Myotonic dystrophy
A
  1. 22q11

but you can also find PWS

Microarray compares the genome of patient to a control and looks for macro/micro deletions/duplications (smallest is 0.2 Mb).

Cannot find balanced translocations or inversions.

Cannot find single gene point mutations.

Fragile X - Direct PCR and Southern Blot analysis for copy number repeats

Prader Willi - 70% of individuals have deletion on one chromosome 15 involving bands 15q11.2-q13 - can be detected using FISH or chromosomal microarray… but this isn’t specific for PWS. DNA methylation analysis can detect the imprinting problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Girl comes to office over the summer, has hypopigmented patches over face and chest, with poorly-defined borders, fine white scale. History of asthma.

  1. Tinea versicolour
  2. Pityriasis alba
  3. Vitiligo
  4. ?
A
  1. Pityriasis alba

Pityriasis alba commonly affects children and is considered a component of the spectrum of atopic dermatitis. It is characterized by hypopigmented, mildly scaling patches common on sun-exposed areas. Often a Hx of eczema.

Tinea versicolor usually affects upper trunk, caused by malessezia.

Vitiligo - positive woods lamp, asymptomatic. Associated with autoimmune disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common sequale of NEC

  1. Malabsorption
  2. stricture
A
  1. Stricture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Parvob19 daycare restrictions (given picture of child with facial rash)

  1. Now
  2. As soon as the child is well enough to go
  3. After the rash resolves
  4. After fever and rash resolves
A
  1. As soon as the child is well enough to go.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Heavy pot user is incarcerated. Withdrawal symptoms?

  1. -none
  2. -distorted thinking
  3. -palpitations
  4. -abdominal pain
A
  1. Abdominal Pain

CWS is defined by experiencing at least two of five psychological symptoms:

  1. Irritability,
  2. anxiety,
  3. depressed mood,
  4. sleep disturbance,
  5. appetite changes

—and at least one of six physical symptoms—

  1. abdominal pain,
  2. shaking,
  3. fever,
  4. chills,
  5. headache,
  6. diaphoresis

—after cessation of heavy cannabis use.

Heavy cannabis use is defined as daily or near daily use for at least a few months.

Withdrawal symptoms commonly occur 24 h to 72 h after last use [32] and persist for 1 to 2 weeks.

Sleep disturbance is often reported for up to 1 month. CWS may impede cannabis cessation and precipitate relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Boy comes in from MVA. GCS 10, pupils unequal. Becomes hypertensive 180/100, HR 40. Next steps?

  1. mannitol
  2. hypertonic saline
  3. intubate and hyperventilate
  4. labetalol
A
  1. Mannitol

(get ready to intubate)

  • elevate head of bed to 30 degrees, keep head in midline
  • maintain normocapnia, normothermia, and normal O2 sats, treat hypotension
  • consult neurosurgery and PICU
  • IV mannitol 0.5- 1g/kg push or IV 3% saline 1-3ml/kg
  • consider hyperventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Baby born at 36 weeks by CS for FTT. Apgars 7/9. No infectious RF. Mom is GBS pending. Now requiring O2 to keep >92 with mild WOB. Cause?

  1. TTN
  2. RDS
  3. GBS sepsis
  4. VSD
A
  1. TTN

Could be TTN or RDS … Doesn’t tell timeframe well.

TTN - most common after term c-section. Tachypnea, mild wob and mild O2 requirements.

If quickly after delivery = RDS. RDS is more common in extreme <32 weekers but still see it in 15-30% of babies born 32-36weeks. Present with tachypnea, grunting, retractions, cyanosis.

RF: Csection, Cold Stress, GDM, Precipitious delivery,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Girl with periods from April 2-7 and 23-30. Menstrual cycle length?

  • 7
  • 14
  • 21
  • 28
A

21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Kid nephrotic syndrome. Most likely consequence?

  1. DVT
  2. Encephalopathy
  3. Acute renal failure
  4. Heart failure
A

?DVT

Most are steoid responsive- If NOT… then ARF…

Clinical Consequences of Nephrotic Syndrome (Nelsons)

  • Edema
  • Hyperlipidemia (increased cardiovascular risk)
  • Hypercoagulability (risk of DVT is 2-5%)
  • Infection (osteo, spontaneous bacterial peritonitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Female newborn with puffy hands/feet, low hairline. Most likely cardiac lesion

  1. Bicuspid aortic valve
  2. Pulmonic stenosis
  3. TOF
  4. TAPVD
A
  1. Bicuspid Ao Valve

Turner Syndrome = 45 XO

  • Short Stature, Short webbed neck, Low set Ears, Flat Nasal bridge, Epicanthal folds, Broad chest, wide spaced nipples.
  • Lymphedema of hands/feet
  • Short 4th MCP
  • Cardiac = CoArctation, Bicupsid Ao Valve, Increased risk of aortic root dilatation/dissection
  • Renal = horseshoe kidneys
  • Ovarian Dysgenesis
  • Hypothyroidism, Celiac, IBD, T1DM
  • Hearing Loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

18 month old who wakes up screaming, inconsolable, parents at loss of what to do. Does not recall events.

  1. Reassure
  2. EEG
  3. MRI
  4. Refer to psych
A
  1. Reassure - Probably night terrors… but 18 mos sounds young! Typically see in ages 2-7.

I would consider EEG if

  • definitely young (ie. questions isn’t wrong here)
  • more than once per night
  • short duration <5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most common reason for secondary adrenal insufficiency

  1. Long course of steroids
  2. Adrenoleukodystrophy
  3. Infection
  4. Head trauma
A
  1. Long course of steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

APGAR scores for a baby. 1 minute: HR 80, grimace with suction, blue, limp, irregular resps. 5 minute: still hypotonic, HR 140, no response to suction, acrocyanosis, irregular resps.

  • 4,4
  • 3,4
  • 3,5
A
  • 3, 4

APGAR (0-2)

Appearance (Blue Pale=0, Blue Extrem/Pink Body =1, Pink =2) =0, 1

Pulse (Absent =0, <100 = 1, >100 = 2) = 1 , 2

Grimace (Floppy =0, Minimally Responsive =1, Fully Responsive =2) = 1, 0

Activity (Absent = 0, Flexed =1, Active =2) =0 ,0

Respirations (Absent = 0, Slow Irregular =1, Cry =2) =1 ,1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A 5 year old boy has had fever and sore throat. Initially prescribed amox, defervesced. A few days later returns with brassy cough, high fever, toxic appearance. What is next in management?

  1. Nebulized epi
  2. Dexamethasone
  3. Call ENT
  4. Lateral neck xray
A
  1. Call ENT

This sounds like bacterial tracheitis. Get ENT - might need intubation. Needs ABx!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

8 yo male with CF, 6 weeks cough, congestion, NO fever.

+ weight loss (no mention of sputum). Most likely bug?

  1. Burkholderia Cepacia
  2. Mycoplasma
  3. Pseudomonas
  4. Stenotrophomonas
A
  1. Pseudomonas

Also a bad question - Pseudomonas is common but more so as the child ages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

12 yo F, menarche, multiple days of heavy bleeding, soaking through multiple pads. No FHx bleeding disorder. She is now having to change pads every 1 hour. Management?

  1. D&C
  2. High dose OCP
  3. Some other hormone related thing
  4. Tranexamic acid
A
  1. High dose OCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

4 yo F, brought in by CAS worker due to concerns about sexual abuse. Exam shows vulvar irritation and discharge. What to do?

  1. STI swabs and culture
  2. Avoid bubble baths
  3. Reassure
  4. Something else
A
  1. Avoid Bubble Baths

Step 1 - better hygeine.

If that fails - consider a swab.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Babe crying everytime she stools, mom has been to many doctors due to this. Thriving well

  1. Stop breastfeeding
  2. Reassure
  3. Hydrolzyed formula
A
  1. Reassure

Normal baby… but concerning that mom has visited many doctors?!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

13 yo F, with history of seasonal allergies. When she eats certain fruits (apples, peaches?) she develops tingling and swelling of her tongue and lips. She tolerates eating cooked fruits without these symptoms. What to do?

  1. SPT to pollens
  2. Avoid?
  3. Dx allergy?
  4. Oral food challenge
A

?? 1. SPT to pollens

As per UTD they recommend definitive testing, which would be for the fruit and the pollen.

This sounds like Oral Allergy Syndrome - probably has pollen allergy. Could argue to avoid the UNCOOKED foods.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The Mother of a 3.5 yo girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentences. She has associated facial twitches and blinking. What do you recommend?

a. Reassure
b. Follow up in 6 months
c. Refer to SLP

A

c. Refer to SLP

Because she has the facial twitches and tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

A 10 yr old girl presents with 10 days of fever and a migratory arthritis. On exam, she has a swollen left wrist. Her WBC is 18 and her ESR is 75. Diagnosis:

a. SLE
b. JRA
c. Rheumatic fever
d. Septic arthritis

A

Rheumatic Fever

JONES Criteria (2 major or 1 Major and 2 Minor)

MAJOR:

  • Arthritis
  • Carditis
  • Subcutaneous Nodules
  • Erythema Marginatum
  • Syndenham Chorea

MINOR:

  • Arthralgia
  • Fever
  • Lab: Elevated ESR or CRP
  • Prolonged PR

AND supportive evidence of GAS infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Baby first noted to have jaundice at 4 days of life. Now 1 week old, with total bilirubin 380, conjugated 150, presented with poor feeding, vomited once, and has temp 35. No vital signs mentioned. Most likely diagnosis?

  1. Sepsis
  2. Galactosemia
  3. Biliary atresia
  4. Neonatal hepatitis
A
  1. Sepsis but maybe Galactosemia??

The baby is hypothermic.

Conjugated is 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Baby with newborn screen screen positive for PKU, otherwise currently well, no family history. What do you do next?

  1. Repeat phenylalanine level
  2. Restrict phenylalanine
  3. Test for BH4 deficiency
A
  1. Repeat phenylalanine level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Sickle cell kid is going away - what is she at risk for

  • Typhoid fever
  • Hepatitis
A

Typhoid fever (salmonella is encapsulated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

15yo M with fever x 24 hours, one sided scrotal pain and swelling, with dysuria and pyuria. Urinalysis shows WBC- best management?

  1. Refer to urology
  2. Treat him with antibiotics
  3. Treat him and sexual partners with antibiotics
A

?3. Treat him and sexual partners with antibiotics

UTD: Among sexually active males, chlamydia is the most common microbial agent, followed by N. gonorrhea, E. coli, and viruses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Baby with petechiae. Plt 12. After transfusion, Plt are 16. Mom’s CBC normal. What is best management?

  1. PLA1 negative platelets
  2. IVIG
  3. Pooled donor platelets
  4. There was NOT a maternal washed option
A
  1. PLA1 negative platelets

Washed platelets from mom or PLA1

Alloimmune thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

MVA 10yo F reduced LOC, eye open to pain, withdrawal to pain and inappropriate words. GCS?

  • 6
  • 7
  • 8
  • 9
A

9

EVM (456)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Babe from primup at DOL 3 coming for check up. BW is 3.0kg, now is 2.693kg, breastfed only 9x/day with wet diapers 7x/day. Urinating well. What to do?

  • Follow up in 24 hours
  • Check a bili, creatinine, and electrolytes
  • Supplement with 15-30ml formula with each feed
  • Give the mom motilium/domperidone to improve breast milk production
A

Follow this up - baby is well, peeing lots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Antenatal hydronephrosis, postnatal ultrasound at 3w shows one sided mod-severe hydronephrosis, no mentioned urological abn. Baby looks well and peeing well. Next step?

  1. Urology consult before discharge
  2. VCUG
  3. DMSA
  4. ?reassure
A

According to Ham Review and the Canadian antenatal hydronephrosis guidelines…. you should refer to Urology (and they can decide on doing the VCUG).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

You are seeing a 4mo with a 24 hour history of poor feeding. He has just started solids. On examination, there is facial and limb weakness. Pupillary response is normal? DTR are absent.

  1. Botulism
  2. SMA
  3. Mytonic dystrophy
A
  1. botulinism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Teenage girl, previously with heavy use of marijuana. Now incarcerated. What symptom is most likely? (Cannibis withdrawal sx)

  1. Palpitations
  2. Abdominal pain
  3. No symptoms
  4. Distorted perceptions
A
  1. abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

You are seeing a newborn born to a Hepatitis B positive mother. What is the BEST management for the baby?

  1. Hep b Ig/hepb NOW
  2. Hepatiits B Vaccine within 12h and immunoglobulin within 7d
A
  1. Heb B Ig/Hep B now

We know mom is positive.

If mom is unknown then give the vaccine and test the mom. you have seven days to give the HBIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 year old fully-immunized girl fell on playground and has a deep arm laceration. After laceration has been cleaned and sutured, what further management?

  1. Tetanus toxoid (exact wording on exam - did not say tetanus toxoid vaccine)
  2. Tetanus toxoid and immune globulin
  3. Antibiotics
  4. Nothing
A
  1. NOthing

As long as you have 4 doses of dTap then you don’t have to proph.

From Canadian Immunization Guidelines: Any unimmunized (or incompletely immunized) individuals who sustain anything more than a minor, clean wound need swift treatment. Both TIg and tetanus toxoid-containing vaccine (as appropriate for age and immunization history) should be given, at different injection sites, using separate needles and syringes. The vaccine series should then be completed, unless contraindicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Girl with symptoms of DI (hypernatremia with high output low spec grav urine), improves with DDAVP (given improved Na, concentrated urine spec grav). MRI shows thickened pituitary stalk. What is the diagnosis

  1. Histiocytosis (just “histiocytosis”, not Langerhans histiocytosis)
  2. Craniopharyngioma
  3. Prolactinoma
  4. ??hypothalamic hamartoma
A

Craniopharyngioma

Pituitary Stalk thickening - common in LANGERHAN cell histiocytosis. So could be this?

Most common pituitary stalk lesion that will give you DI is craniopharyngioma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

12 year old girl with 3 weeks of fever, malaise, and polyarthralgias. No arthritis. Protein and blood in her urine, normal creatinine. Leukopenia, lymphopenia, normal platelets. ESR 75. What’s the most likely diagnosis?

  1. Systemic JIA
  2. SLE
  3. Rheumatic fever
  4. Post strep GN
A
  1. SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Kid with nephrotic syndrome started on steroids. Presents with abdominal pain, distended abdomen with dullness over the flanks bilaterally, peritoneal signs. Which test will give you the diagnosis?

  1. CT abdomen
  2. Paracentesis and culture
  3. Abdominal U/S
  4. Surgical exploration? Or ?laparotomy
A
  1. Paracentesis and Culture

?Spontaneous bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

6 month old, mother with hepatitis C (antibody positive, HCV RNA positive). Babe is well with normal liver enzymes and negative anti-HCV antibody. What do you do?

  1. Reassurance, no further testing needed
  2. Repeat HCV serology in 6 months
  3. Liver biopsy
  4. Measure HCV RNA
A
  1. Reassurance, no further testing needed

Technically you would test at 18 mo, not at 6 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

5 year old boy presents to the emergency department with 3 weeks of polyuria, polydipsia and blood glucose 28, normal gas, and is started on subcutaneous insulin and discharge home. In the next week, he has multiple hypoglycemic episodes. What is the likely reason for this?

  1. Wrong diagnosis
  2. Diabetes honeymoon period
  3. Non-compliant/ wrong dose of insulin
A
  1. Honeymoon period.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Teen with acute SOB and wheeze, three times in last few weeks, growing well, looks well, comes to ED - most likely test to give diagnosis

  1. PFT
  2. CXR
  3. CT Chest
A
  1. PFT

?Could be asthma or could be VCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

A 3-year-old male is brought to you because the mother has concerns about his language. He guides mom’s hand to things that he wants, has 18 single words, and can follow 2 step commands. His fine motor and gross motor development is normal. What is this most consistent with?

a) Expressive last ge delay
b) Receptive language delay
c) Normal variant
d) Autism Spectrum Disorder

A

d) Autism Spectrum Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

A 14-year-old male has idiopathic generalized tonic clonic epilepsy. He is on valproate. He is doing well and has been seizure free for 9 months. The family doctor did a valproate level as a part of his health supervision and it was 290 (normal 350-700). What do you do?

a) Increase valproate to therapeutic range
b) Discontinue valproate since he doesn’t need it
c) No change to his valproate dose

A

No change to his valproate dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A child at daycare bites another child and causes bleeding but it’s not a deep bite. Both are immunized but their hepatitis B status is unknown. The next best step is:

a. Do HBV serology on both
b. Give oral clavulin prophylaxis to the bitten child
c. Check both for HBV surface Antigen and antibodies
d. Give Hepatitis B vaccine to both

A

d. Give Hep B vaccine to both

Of all the blood born infections, risk is highest in Hep B. Bites are usually not that dirty and do not need antibiotics. In this question we are assuming they didnt have HBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

A 4 month old presents with a narrow elongated head and frontal bossing. What suture is most likely fused?

a) Metopic
b) Sagittal
c) Lambdoid
d) Coronal

A

Sagittal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Most common cardiac finding in turner

  1. MVP
  2. Bicuspid AV
  3. TOF
A
  1. bicuspid AV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Toddler with intussusception, seen before and had air enema reduction. Returns with similar symptoms, but now looks sick, tachycardic, hypotensive. What to do next?

  1. Nasogastric decompression
  2. Consult surgery
  3. Air enema
  4. Abdo ultrasound
A
  1. Consult surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Boy with 2 day history of mouth sores and rash. Preceded by 1 wk of fever and cough, given amox and acetaminophen. What is most likely cause ? (Give picture of rash - hands and lips looked similar to below)

a. HSV
b. amoxicillin
c. mycoplasma
d. acetaminophen

A

EM - most common cause is HSV but you can also get this with mycoplasma (especially with the pneumonia picture)

? Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

A child ingested his grandmother’s bottle of iron pills, developed nausea and hematemesis and was brought to the hospital. In the ER he was fluid resuscitated, deferoxamine was started and an abdominal radiograph demonstrates many iron pills still in his stomach. What is your next step in management?

a) Activated charcoal
b) Whole bowel irrigation
c) Endoscopic removal
d) Ipecac

A

b or c

charcoal is not effective for metal.

Many small pills -> irrigation. If lots in stomache then do gastric lavage first. If post pyloris do WBI.

Big impaction -> endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Teenager with fever and sore throat. Treated with amoxicillin and initially improved but now fever is back and having difficulty opening mouth due to pain, also has moderate anterior cervical lymphadenopathy bilaterally. What is the diagnosis?

  • Peritonsillar abscess
  • Retropharyngeal abscess
  • EBV
  • ?
A

Peritonsillar abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Child presents with brown urine. UA with hematuria and proteinuria. Hypertensive to sBP 160. C3 and C4 are both normal. What is likely diagnosis?

a) IgA nephropathy
b) MPGN
c) PSGN
d) SLE

A

IgA Nephropathy

Low all C3/C4 is SLE MPGN

Low C3 is PSGN

56
Q

You are seeing newborn. Mom is strictly vegan. She is planning to breastfeed exclusively until 6 months of life. Which vitamin is it most important to supplement the baby with?

  1. B12
  2. Iron
  3. Calcium
A
  1. B12
57
Q

A four year old comes into the emergency department and needs intubation. What size of endotracheal tube do you choose for him?

  • 3
  • 4
  • 5
  • 6
A

Size 5

ETT = age / 4 + 4

58
Q

You are called to see a 36 hour old term infant as a new rash has appeared. He is otherwise well, afebrile and in no distress. See photos. What is the diagnosis.

  • HSV
  • Miliaria
  • Neonatal pustular melanosis
  • Erythema toxicum
A

Miliaria

59
Q

Infant with history of recurrent otitis media infections, eczema and some bleeding symptoms. WBC 4.5, Hgb 120, Platelets 20. What is the diagnosis?

  • WAS
A

WAS

60
Q

3yo with gradually increasing oxygen requirement over the last 3 hours. He had a chest tube inserted for empyema, which drained 500mL, and continues to drain well. He is tachycardic, tachypneic, chest exam with decreased air entry on the side with the empyema. He is afebrile and well perfused. X-ray that shows a marked reduction in the size of the empyema. He has been given ceftriaxone, acetaminophen and ibuprofen. What is your next step in management?

  1. Clamp chest tube
  2. Add vancomycin
  3. Bolus 20ml/kg
  4. Give morphine
A
  1. Give morphine
61
Q

Baby born at term, doing well. Mother with chorioamnionitis, no other risk factor. Vitals stable.

What is your approach?

1) routine care
2) monitor vitals q3-4 hours and do CBC at 4 hours of life
3) do CBC now and monitor vitals q3-4 hours
4) do CBC now and start empiric antibiotics

A

2) monitor vitals q3-4 hours and do CBC at four hours

According to flow chart.

  • > If GBS negative or Unknown
  • >Mother has multiple risk factors OR chorio

THEN: At minimum observe 24 hours with vitals, consider a CBCd at 4 hours. Individualized treatment decision (ie. you might just treat).

62
Q

Father worried about size of penis of otherwise healthy 4kg newborn. Penis measure stretched out 3 cm. What do you do:

1) Dose 17-OH progesterone
2) CGH
3) Reassure

4)

Karyotype not in choice

A

3) Reassure

63
Q

12 yo girl with previously well-controlled asthma. Since 1 month has needed increased use of ventolin 4-5x/week. Is currently on low-dose CSI

1) montelukast
2) low CSI and add LABA
3) medium CSI
4) switch to an alternate CSI

A

2) Low CSI and add LABA

64
Q

Newborn from mother known with Hepatitis B. What is the best treatment.

1) Give hep B vaccine and Ig <12 hours
2) Give hep B vaccine <12 hours and Ig within 7 days
3) Give hep B vaccine now and within follow-up Ig at 1 month
4) Give hep B vaccine now and do serology in one month

A
  1. Give HepB vaccine and HBIG at <12 hours
65
Q

6 month old, breastfed, recently introduced solids. Comes in and you find him hypotonic (face and extremities), pupillary reflex normal, DTR absent. What is the diagnosis?

1) tetanus
2) botulism
3) myotonic dystrophy
4) congenital muscular dystrophy

A

2) Botulism

66
Q

Risperidone mechanism action for prolactinemia

A) Dopamine blockade

b) THR

A

a) Dopamine blockade

67
Q

Babe with stretched penile length of 3cm

  1. DSD
  2. reassure
A
  1. reassure
68
Q

Babe at 1 w, home delivery and bloody stool, tachycardia with low hgb

  • hemm disease of newborn
  • CMPA
  • Anal fissure
A

Hemmorrhagic Disease of Newborn

69
Q

Girl with diffuse goiter , TSH 30 - what most likely to find..

  1. anti TPO
  2. anti TSH
A
  1. Anti-TPO

Thyroid anti-peroxidase (anti-TPO) is common

Antithyroglobulin Antibodies in <50% in young children

Used together anti-TPO and anti-TRAbs positive in >95% of lymphocytic thyroiditis

70
Q

Conj bili in a 6 month old - 1 week of symptom onset? RUQ mass. Acholic stools

  1. choloductal cyst
  2. hepatoblastoma
  3. Alagille
  4. biliary atresia
A

?1. Choledocal cyst

?2. Hepatoblastoma

Only 1 or 2 should give you a mass… Hepatoblastoma presents initally as an asymptomatic abdominal mass -> fever, fatigue, anorexia, abdo pain, vomiting, etc.

71
Q

8 month old with quad CP. Can’t feed orally. Has been on bolus NG feeds for past few months. Improved interactions since starting. Has GERD, well controlled on ranitidine. What next?

  1. G tube
  2. J tube
  3. pH probe
  4. G tube with fundo
A
  1. Gtube
72
Q

2 year old girl with painless bright red blood per rectum. What test will best reveal diagnosis? Low hgb

  1. Colon
  2. Meckel scan
  3. Abdo U/S
A
  1. Meckel Scan
73
Q

Teen at a music festival. Hypertensive, combative, agitated. No nystagmus. How do you manage, mydriasis, flushed?

  1. Physical restraints
  2. Olanzapine
  3. Diazepam (not lorazepam, no route suggested)
  4. Flumazenil
A
  1. Diazepam

Sounds like a sympathomimetic intoxication. Manage ABCs. Dark Room. Cooling blanket. +/- benzos or haloperidol.

Flumazenil is an anitdote for benzo intoxication

74
Q

Patient with DKA. Given initial set of labs: pH 7.06, bicarb 7, lytes given Na 120s, Cl 100s, anion gap 20 (you must calculate AG yourself). Started on normal saline and 0.1 U/kg/hr of insulin.

Several hours later, patient looks better. Given second set of labs: pH 7.03, bicarb still 7 (?), but AG 8, Na 140s, Cl 130s. What is the cause of the acidosis?

  1. Lactic acidosis
  2. Hyperchloremia
  3. Inadequate insulin
  4. Hypoventilation
A
  1. Hyperchloremia

(Gap closed- can’t be lactic acidosis) - hyperchloremic metabolic acidosis is seen not that uncommonly when treating DKA

75
Q

SPO2 for oxygen application for RSV bronchiolitis?

  • <96
  • <94
  • <90
  • <88
A

<90

76
Q

What will give you a false negative Sweat Chloride test?

  1. Hypothyroid
  2. Edema
  3. Eczema
  4. Hypogammaglobulinemia
A
  1. Edema
77
Q

Term newborn baby in the nursery is found to be jittery, tachypneic with nasal flaring, with myoclonus. Normal glucose. Based on the most likely diagnosis, what is your next management?

a. Morphine

B. Benzos

C. Phenobarbitol? (I don’t think it was phenobarb, there wasn’t an appropriate neonatal seizure option…)

D. Amp/Gent

A

a. Morphine

Sounds like NAS

78
Q

kid with orbital cellulitis, started on ceftriaxone. Improves and things are getting better. 48h later left eye is swollen, and becomes lethargic. What is the next step?

a) MRI
b) Start vancomycin
c) Start dexamethasone
d) Consult for drainage of orbital abscess

A

?b) vanco

d) consult for drainage?

Sounds like a mass - guessing it’s the same eye

79
Q

3wk old, has straining and is fussy 15 minutes before passing stools, stools are non bloody and soft. After passing stools is well and not fussy. Gaining weight well, is breast fed and is otherwise healthy. Mom is ++ concerned and has already sought out 2 other consults with no answers. Best management?

a) Low dose lactulose
b) Abdo X ray
c) Reassure
d) Put mom on “bovine protein-restricted” diet

A

c) Reassure

INFANT DYSCHEZIA:

< 9 Months old

>10 minutes of straining and crying before successful passage of stool

Otherwise healthy

80
Q

12 year old kid comes in with rib pain and a few weeks of fever. White count is normal. Chest x ray shows mottled appearance of ninth rib with periosteal reaction and new bone formation. Most likely diagnosis?

a) Osteosarcoma
b) Ewings sarcoma
c) Osteoid osteoma
d) Osteomyelitis

A

b) Ewing Sarcoma

Lytic periosteal, onion skinning periosteal reaction.

Sites: axial and long bones.

81
Q

Baby with pneumonia on CXR, CBC shows eisonphilia - management?

  • Erythromycin
  • Ceftriaxone
  • Nothing
  • Ampicillin
A

Erythromycin

Chlamydia trachomatis - may have Hx of untreated mom, conjunctivitis, protracted illness, staccato cough, peripheral eosinophilia, bilateral interstitial infiltrates.

82
Q

Tx of baby with dysmorphic features (sounded like digeorge) with ical of 0.81. No mention of symptoms

  1. Vit d
  2. Ca suppl
  3. IV calcium
  4. calcitriol
A
  1. Ca Supplement

Give IV calcium if symptomatic (tetany, seizures). Extra vitamin D can be problematic and give them hypercalcemia

83
Q

15 yo with recurrent episodes of acute coughing and wheezing in the ED. SABA use does not help his symptoms. Otherwise well. Testing that will most likely reveal diagnosis?

  1. Pulmonary function testing
  2. CXR
  3. Laryngoscopy
A
  1. Laryngoscopy

Assuming VCD given age, episodic nature - though should be stridor. Laryngoscopy is gold standard - PFTs may show the blunted loop on inspiration.

84
Q

Teenage girl with irregular periods, hirsuitism, severe acne. Height and weight both at 50th %ile. Screening test?

  1. OGTT
  2. Dexamethasone suppression test
A
  1. OGTT

PCOS - increased risk of insulin resistance and T2DM, independent of tendency for patients to have elevated BMI

85
Q

You’re seeing an adolescent transgender female patient. What anticipatory guidance should be discussed?

  1. Sperm banking
  2. Eventual pap testing
  3. Breast self-exam
  4. Oocyte preservation
A
  1. Sperm banking

Trans female = male anatomy

86
Q

Female with autism. Best test to detect underlying diagnosis

  1. Microarray
  2. Fragile X testing
  3. ?
A
  1. Microarray
87
Q

Undescended testes at 8 month, what to do next

  1. Refer to surgery
  2. ultrasound
A
  1. Refer to Sx

Usually refer at 6-9 mos. Bring them down so we can examine them. HAM review said indication was fertility preservation.

Role of US - if you don’t think there are any present.

88
Q

8mo with 3cm umbilical hernia. No strangulation.

  1. Continue to monitor
  2. Refer at 2y if still persistent
  3. ?
A
  1. continue to monitor

Surgery is not advised unless the hernia persists to the age of 4-5 yr, causes symptoms, becomes strangulated, or becomes progressively larger after the age of 1-2 yr. Defects exceeding 2 cm are less likely to close spontaneously.

89
Q

You are working in a community practice and mom calls you about her kid who ingested a button battery. Kid <5yo, size of battery not given (although CR _ _ _ _ code given….)

  1. XRs after 10 days
  2. Urgent plain films
  3. Referral for emergent endoscopy
  4. Reassure because kids often swallow things
A
  1. Urgent plain films

If not in esophagus, no symptoms - then XR in a few days

If in stomach +symtoms - endoscopy

If in stomach -ve symptoms : then XR in a few days

90
Q

Kid with fever, swelling of face from ear to angle of the jaw. What is the treatment? (rpt)

  1. Supportive - pain control
  2. Antibiotics
A
  1. Supportive - pain control

(parotitis)

91
Q

What can be diagnosed on microarray?

  1. 22q11 deletion
  2. fragile x
  3. prader willi
  4. myotonic dystrophy
A
  1. 22q11 deletion
92
Q

Kid with Kawasaki disease. Got IVIG and high dose ASA. 24 later, has gross hematuria 3+blood and protein on urine dipstick. Elevated unconjugated bili , transaminases and LDH. (no mention of Hgb). What is the cause?

  1. hemolytic IVIG reaction
  2. renal vein thrombosis
  3. high dose asa causing bleeding
A
  1. Hemolytic IVIG reaction
93
Q

Girl with symptoms of DI (hypernatremia with high output low spec grav urine), improves with DDAVP (given improved Na, concentrated urine spec grav) (so central DI).. MRI shows thickened pituitary stalk. What is the diagnosis

  1. Histiocytosis
  2. Craniopharyngioma
  3. Prolactinoma
  4. ??hypothalamic hamartoma
A

?Histiocytosis (if meaning langerhans) - pituitary stalk is thickened in 70%

Craniopharyngioma - cystic calcified paracellar lesion

Prolacticinoma - pituitary mass

Hypothalamic hamartoma - nodule

94
Q

5 year old (think that was his age), has prepubertal testes, pubic hair tanner 3, enlarged penis. What investigation do you do next?

  1. brain MRI
  2. testicular ultrasound
  3. adrenal androgen levels
  4. LNRH antagonist
A
  1. adrenal androgen levels
95
Q

2yo year old asian boy presents with a history of URTI symptoms. He is pale. HR 130, Grade III/VI systolic murmur. Stable. WBC 6.?/Hgb 53/plt 585. MCV 58, elevated RDW (no number given). No retics given.

a) transfuse PRBCs
b) Start oral iron
c) parenteral iron

A

b) start oral iron

Weird q - RF for thal

96
Q

AOM 3 year old 39.1 degrees, red bulging tympanic membrane. Severe pain. Management plan

  1. Amox 75-90mg/kg BID x 5 days
  2. Amox 75-90mg/kg BID x 10 days
  3. Rx for above to be filled in 24 hours if still symptomatic of febrile
  4. Reassess in 24-48 hours.
A
  1. Amox 75-90 mg/kg div BID x 5 days
97
Q

5 year old with 2 episodes of vaginal bleeding. On the 97th and 99th%tile for weight and height. Found to have 3 cafe au lait spots, one large and irregular. What is the diagnosis?

  1. McCune Albright
  2. Neurofibromatosis
A
  1. McCune Albright

Get excess of all the hormones

98
Q

Hemangioma on left upper lip and jaw measuring 2-3cm^2. Other than regular surveillance of growth and development at regular appointments, what else to do?

  1. Ophtho
  2. MRI
  3. No additional testing
  4. Cbc in 6 months
A
  1. No additional testing

Not big enough for PHACES (needs 5 cm)

99
Q

Kid with hematuria - no mention of viral illness - C3 normal

  • Alports
  • MPGN
  • PIGN
A

Alports

MPGN + PIGN low C3

100
Q

Dm1 - with abdo pain, delayed puberty

?celiac vs hypothyroid

A

? Celiac

101
Q

Kid with varicella 3 days later presents with fever, blue indurated painful rash on leg. What’s the management?

  1. Pen and clinda
  2. Cloxacillin & Gentamicin
  3. Vanco & Ceftriaxone
A
  1. Pen and clinda

IGAS Guidelines

102
Q

What is the most common long term complication of NEC?

  1. GERD
  2. Malabsorption
  3. Intestinal stricture
A
  1. Intestinal stricture
103
Q

Sacral agenesis and even lumbar or thoracic

  1. IDM
  2. Trisomy 13
  3. FAS
A
  1. IDM

(FAS - Neural tube defects)

104
Q

Baby with G-tube that looks like this

a. Reassure
b. Silver nitrate cautery
c. Topic ABx
d. Fungal abx cream

A

b. silver nitrate cautery

(Can start with warm saline compress)

105
Q

Kid with campy + diarrhea and leg weakness/ GBS.

Treatment?

  1. Steriods
  2. Antibiotics
  3. IVIG
  4. NSAIDs
A

IVIG

106
Q

3 day baby with cyanosis, CXR shows large heart and decreased pulmonary markings.

Diagnosis?

  1. TGA
  2. Truncus
  3. TOF
  4. TAVPR
A
  1. TOF
107
Q

6mo kid with 1 week jaundice, total bili = 300 and conj bili = 180. You feel a mass in the RUQ. What is the most likely diagnosis?

  1. Biliary atresia
  2. Choledocal cyst
  3. Hepatoblastoma
  4. Alagille
A
  1. Choledochal cyst
108
Q

4 year old kid with fever, and swelling behind the ear with anterior displacement of ear. Which eye findings do you expect?

  1. Lack of lateral eye movement
  2. Lack of upward eye movement
  3. Lack of downward eye movement
  4. Lack of medial eye movement
A
  1. Lack of lateral eye movement (LR6)

Inward gaze

Gradenigo Syndrome - otorrhea, abducens palsy, unilateral periorbital pain (trigeminal)

109
Q

Below what systolic blood pressure would a 3yo be considered hypotensive?

  • 64
  • 70
  • 76
  • 84
A

76

110
Q

15 y.o. F approaches you to start contraception. Which of the following methods do you advise her is the most effective?

  • Transdermal patch
  • Progesterone containing IUD
  • Combined OCP
  • Progestin only pill
A

IUD

111
Q

Unimmunized kid with nasal discharge and low grade fever. Culture shows H. influenza. What do you do?

a) cephalosporin
b) Conservative
c) sinus x-ray
d) amoxicillin

A

b) Conservative mgmt

112
Q

You examine a 8 month old infant and find the right testicle is not palpable in the scrotum. What is the most important next step?

  • Reassess in 2 months
  • Refer to surgery
  • Order an ultrasound to locate the testicle
  • Refer to endocrinology
A

Refer to surgery

113
Q

Description of calcipenic rickets. Which lab value matches the diagnosis:

  1. Increased alk phos
  2. Decreased PTH
  3. Increased 1,25 vit d
A
  1. Alk Phos
114
Q

Toddler with episodes where she doesn’t get her way, cries/throws tantrum, then loses consciousness and sometimes turns blue. These episodes are increasing in frequency. What do you recommend?

a) Ignore the behaviour and put her in timeout after the episode
b) Refer for behavioural therapy
c) Put her in time-out before behaviour has a chance to escalate
d) Give in to what she wants

A

c) Put her in time-out before behaviour has a chance to escalate

? b) refer for behavioural therapy

115
Q

Adolescent transgender female. What do you provide as anticipatory guidance?

a) oocyte preservation
b) sperm banking
c) breast self-exams
d) eventual pap smears

A

b) sperm banking

116
Q

Teenager who had fainting episode after influenza immunization. Presents in ED with right arm stiffening and clonic movements of one limb for 5 minutes. Period of sleepiness after, but able to preserve protective reflexes. Normal neurologic exam. Kid doesn’t seem troubled by this.

a) Somatization
b) Post-concussion seizure
c) Conversion disorder

d)

A

c) conversion disorder

117
Q

Most specific indicator of seizure activity in neonate?

a) irregular respirations
b) tachycardia
c) eye movements

d)

A

c) eye movements

the best but this is really not specific either

118
Q

14 yo male with constitutional symptoms, weight loss, generalized lymphadenopathy including a right supraclavicular node. Low cell counts. Splenomegaly present. EBV testing negative. What is your initial investigation?

a. CXR
b. Abdominal CT
c. Bone marrow
d. Tb skin test

A

a. CXR

R = virchow’s now (chest LN drainage)

119
Q

14 yo male presents to ED with right sided arm movement, left sided leg twitches. Refuses to weight-bear. No focal findings on abdomen. Protecting reflexes. Patient himself is not concerned with findings. What is the diagnosis?

a. Somatization

B. Seizure

C. Conversion disorder

D. ??

A

c. conversion disorder

120
Q

Describes a child with TEF/EA and vertebral anomaly. What is the genetic inheritance of VACTERL?

a. Multifactorial

B. Dominant

C. sporadic

D. Recessive

A

a. Multifactorial

Has no genes - very random

121
Q

?10 year old boy refusing to eat solids since he had a bad gastroenteritis. Lost 6kg recently. Normal height/growth. Denies body image concerns. Now he is only drinking liquids and liquid nutritional supplements. (Question does not mention any coughing, gagging, dysphagia, or whether he attempts to eat any solids.)

A) Esophageal stricture

B) Anorexia nervosa

C) ARFID

D) Achalasia

A

c) ARFID

122
Q

9 year girl, parents divorced. How does she handle it?

A) Blames herself

B) ?

C) ?

D) Chooses one parent and takes their side

A

D) Choose a parent and takes their side

LIttle kids blame themselves becaue they are egocentric

Adolescents - move between homes

123
Q

Girl with itchy head. Upon closer inspection, you see live lice and eggs at the base of hairs. Mom asking when can she return to school?

A) Does not need to be restricted from returning to school.

B) Return when no more adult lice seen

C) Return after one application if pediculocide

D) Return when no more eggs/nits seen

A

A) Does not need to be restricted from returning to school

  • recommend that they treat and avoid head to head
124
Q

6yoF returned from to to Nova Scotia with family. Has erythematous rash with red centre and concentric ring around it. Also with fever, malaise, arthralgias. What is your management?

A) Start amoxicillin now

B) Start doxy now

C) Start amoxicillin if testing returns positive for Borrelia burgdorferi

D) Start doxy if testing if testing returns positive for Borrelia burgdorferi

A

A) start amoxicillin now

But in 2019 you can give doxy.

125
Q

6mo with depressed nasal bridge and elfin facies. Labs show elevated calcium level. What is the most common associated cardiac condition?

A) Endocardial cushion defect

B) ?

C) Supravalvar aortic stenosis

D) Tetralogy of fallot

A

c) Supravalvular aortic stenosis

75% Supravalvular Ao

25% Supravalvular pulm

(Think WIlliams - Looks like Mic Jagger… he’s SUPRAvalvular awesome)

126
Q

10 year old girl with Sickle Cell Disease and a history of stroke. Which treatment is most recommended given her history of stroke?

Hydroxyurea

Transfusion with PRBCs

Folic acid

A

Transfusions with PRBCs

(though they prefer exchange)

127
Q

Findings consistent with calcipenic rickets:

  • Low PTH
  • Low PO4
  • High Alk Phos
  • High 1,25 Vitamin D
A

High Alk Phos

Calcipenic ricket - related to Vitamin D

High PTH, Normal Phos, High Alk Phos, Low Vit D

128
Q

Girl with pancytopenia, HSM, febrile & unwell looking. Ulcerated tonsils on exam (repeat question). Most likely diagnosis?

  1. -Acute lymphoblastic leukemia
  2. -Lymphoma
    3.
A

Lymphoma

129
Q

Girl plays soccer. Heel pain worse with running and jumping, but not with swimming. Tender achilles on exam.

  1. Calcaneal apophysitis
  2. Calcaneal fracture
  3. Achilles tendinitis
  4. Plantar fasciitis
A
  1. calcaneal apophysitis

Sever’s Disease

130
Q

1y.o. With hypocalcemia/seizures, cleft lip, hypertelorism

Best management

  • Vit D
  • Calcitroil
  • Calcium suppl
  • IV calcium
A

IV Calcium

? Calcitriol

131
Q

Kid with fhx of uncles who died has 2/6 SEM worse with standing what do you need to do. Has heart palpitations.

    • Echo
    • Ecg
    • Holter
      4.
A

Screen = ECG

Diagnostic = ECHO

Send to cardiology!

132
Q

Diabetes with abdo distension and delayed puberty. Test

  • Anti tissue transglutaminase
  • LH FSH
  • TSH
A

Anti-tissue transglutaminase

133
Q

Kid with FTT bad eczema, 4months, breast feeding ?CMPA

  • Hydrolyzed formula
  • Mom elimination diet
A

Elimination Diet

But in reality probably Hydrolyzed formula - 2012 NASPGAN would say to do this if you had ++ symptoms in the interim then back to breast feeding (with the elimination diet)

+Calcium and Vitamin D for mom

134
Q

Seizures kid on Clobazam at home. Got one IN midaz what is next step.

  • Iv fospheny
  • Iv phenytoin
  • Iv midaz
  • IN midaz
A

IV MIdaz

135
Q

?10 year old male with arthralgias, intermittent fevers, hepatosplenomegaly and supraclavicular lymphadenopathy. Next step.

  • CXR
  • BMA
  • CT
A

CxR

136
Q

teenage girl with hirsuitism, pustular acne, and irregular periods. Weigh at the 97th percentile. What test would “help with diagnosis”??

  1. Dexamethasone suppression test
  2. OGTT
  3. Lipid profile
  4. Something else
A
  1. Dexamethasone Suppression Test?

But you really don’t need this test - use it if you’re unsure. So are they looking for OGTT?

2019 RC 2018-2015 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions