2019 - MCQ Flashcards
(Photo of EKG showing wide complex tachycardia)
Patient in ED waiting area with poor pulses, not responsive, first line therapy?
a. Adenosine
b. Sync cardiovert
c. CPR
d. Amiodarone
Sync cardiovert
15 year old female with 5 prior episodes of syncope. Each one is associated with light headedness, going dark in field of vision. On one episode her father kept her upright and she had brief GTC activity with urinary incontinence. What is your initial investigation?
a. EEG
b. ECG
c. blood pressure lying and standing
d. Echo
ECG
Term newborn, uncomplicated pregnancy, discharge physical exam is normal. There is a II/VI systolic murmur at the left sternal border. What is your next step: a - ECG b - CXR c - Routine care d - Echo
Routine Care
CPS says that you would do both CXR and ECG with 4 limb BPs if you fail CCHD - without this, one would assume routine care
3 year old kid with multiple recurrent sinopulmonary infections. One pneumonia with lung abscess cultured Strep pneumo. Previous episode of stomatitis with secondary facial cellulitis. History of recurrent oral ulcers. Concern with what part of the immune system
a. T cell
b. B cell
c. Granulocytes
d. complements
B cell
8 year old boy presents with itchy mouth and angioedema of lips and tongue after eating an apple. He is otherwise well. What do you do?
- Recommend avoiding raw apples.
- Recommend avoiding raw apples and prescribe EpiPen autoinjector.
- Recommend avoiding raw and cooked apples.
- Recommend avoiding all raw fruit.
Recommend avoiding raw apples and prescribe EpiPen autoinjector.
Picture of abdomen (with herald patch)
a. Nummular eczema
b. Tinea
c. Pityriasis rosea
Pityriasis rosea
1 week old infant presents with an umbilical granuloma. What is the treatment?
- Excise
- Silver nitrate
- Observe/reassure
Silver nitrate
6 year old boy with varicella infection presents with progressive skin lesion on his limb - red with blue hue, increasingly large and now exquisitely painful. Which antibiotics should you treat him with? Clinda/gent Pen/clinda Piptazo ceftriaxone/vanco
Pen/clinda
3 yo F with eczema presents with several days of rash seen in image. She is also febrile. How would you treat? Image shows large yellow crusts on erythematous base, on the eyelid, over the mouth (more yellow and crusty than above, some people said they saw lesions on the tongue) IV Acyclovir IV Cefazolin PO Acyclovir PO Cephalexin
PO Cephalexin
if patient unwell - IV cefazolin
2 year-old previously healthy boy with a recent history of malaise and cough, and the new onset of rash, which predominantly involves his distal extremities (picture provided - whole body, confluent erythematous rash with bullae involving mucous membranes). He was started on amoxicillin 7 days ago in the context of his respiratory illness. Nikolsky sign is positive only in areas of involved skin. What is the most likely diagnosis? Staphylococcal scalded skin Toxic epidermal necrolysis Bullous pemphigoid Scarlet fever
??
SSSS versus TEN
Teen female with blackheads on her forehead. She first noted these lesions 2 months ago, and has not previously sought medical attention. Which would be the MOST appropriate INITIAL treatment?
a. Benzoyl peroxide
b. Wash face frequently
c. Topical retinoid
d. Topical antibiotic
Benzoyl peroxide and topical retinoid both correct
7 year old girl discloses sexual abuse by her 15 year old stepbrother for the past couple of years. On examination, there is a complete cleft in the posterior hymen. This is:
a. diagnostic of sexual abuse
b. a normal variant
c. a congenital abnormality
d. diagnostic of previous hymenal injury
diagnostic of previous hymenal injury
9 month old has a left humeral midshaft fracture, no provided history. Normal development, previously healthy. Skeletal survey does not show any other fractures. Dilated fundoscopy exam is normal. Bloodwork is normal including CBC, extended electrolytes (Ca, Phos, Mg), ALP, urinalysis, liver enzymes (AST, ALT). Most appropriate management:
a. Abdominal ultrasound
b. Genetics referral
c. Repeat skeletal survey in 2 weeks
d. Repeat Ophtho exam in 2 weeks
Repeat skeletal survey in 2 weeks
2 yr old with stuttering. Speaks in 3-4 word sentences. What would make you most concerned?
- Pauses between words
- Repeats full words
- Repeats part of words
- Tension in face
- Tension in face
At what age are most children sure of their gender identity? 1- 4 2- 6 3- 8 4- 10
4
A 10 year old boy with ADHD and is stable on stimulants for 2 years. He presents with increased aggressive behavior and difficulty following limits. His sleep and appetite are otherwise normal. After ruling out psychological stressors. Which of the following is the most appropriate action: 1- Increase his stimulant dose 2- Use benzo PRN 3- Add atypical antipsychotic 4- Add an SSRI
Increase his stimulant dose
School aged child, difficulty making friends, doesn’t get invited to birthday parties. Doing well academically. Has a very organized desk and gets upset with people when they touch it. Does not make eye contact with classmates. 1- OCD 2 - ASD 3- Social anxiety 4 - ?
ASD
21 month old female presents with right sided breast swelling. SMR 2 on the left and SMR 3 on the right. She is 75th for height and weight. No secondary sexual characteristics. What is the next investigation?
a. Reassurance
b. Breast ultrasound
c. LHRH stim test
d. Abdominal ultrasound
Reassurance
14 years old teenage girl. Gaining ++ weight over last couple of years and now obese. Menarche at 12, still irregular in menses. Mild acne. LH, FSH, 17OHP normal. Hypertensive. Has marked purple striae on exam and central obesity. What is most likely?
PCOS
Cushing Syndrome
Hypothyroid
Cushing Syndrome
15 year old gymnast presents with menstrual cycles once every 2-3 months. She had initial menarche at 11 years old. She has consistently been at the 25% for BMI. She has grade 3 acne and very mild facial hair growth. She has mildly elevated LH and testosterone. Her FSH, DHEAS, prolactin, and 17-OHP are normal. What is the most likely diagnosis? Physiologic anovulation CAH PCOS Adrenal tumour
PCOS
A 9 year old boy has a BMI of 95%. His weight has been steadily increasing since 5 years of age. He watches TV 5 hours a day and has a sedentary lifestyle. His father died (or had) an MI at the age of 32. His blood work showed a high total cholesterol, high LDL, normal HDL, and normal TG. His TSH is on the upper limit on normal. What is the most likely diagnosis: 1- Familial hypercholesterolemia 2- Obesity related dyslipidemia 3- Familial combined dyslipidemia 4- Subclinical hypothyroidism
Familial hypercholesterolemia
After discontinuing sources of vitamin D and Ca, what is your initial management of hypercalcemia?
a. Calcitonin
b. IVF
c. Furosemide
d. Pamidronate
IVF
8 year old presents with bilateral conjunctivitis received topical antibiotics with no improvement. Does not describe pain but a sandpaper feeling and associated photophobia and tearing. On exam he has pseudomembrane keratoconjunctivis What is the most likely diagnosis? 1. allergic conjunctivitis 2. Uveitis 3. Bacterial conjunctivitis 4. Adenovirus keratoconjunctivitis
Adenovirus keratoconjunctivitis
Infant presents with seizures. On assessment, still hypotonic and lethargic. Fundoscopy shown (can’t find exact photo; dot and blot hemorrhages that extend to periphery). Most likely diagnosis? Tay Sachs Toxoplasmosis NAI ?
NAI
16y sexually active male referred for scrotal mass/swelling: associated dull ache, on exam there is an irregular mass palpable in the left scrotum that increases when standing (no vitals given). The left testis is of normal size. diagnosis:
a. Spermatocele
b. Inguinal hernia
c. Epididymitis
d. varicocele
varicocele
A 17 month old boy is going for elective orchidopexy today. When he shows up he has a fever of 38.2 and copious yellow nasal discharge. He has an intermittent cough but otherwise appears well. Can he have his surgery?
Yes
Yes, but he needs to be observed overnight
No, wait until his symptoms resolve
No, wait until 6 weeks after his symptoms resolve
No, wait until 6 weeks after his symptoms resolve
A 4-month-old presents with a narrow elongated head, dolichocephaly, and frontal bossing. What suture is most fused?
a. Lambdoid
b. Sagittal
c. Coronal
d. Metopic
Sagittal
A 9-week old baby is lying on his back in a stroller. Mother hears the baby cough, after which becomes stiff and red, followed by limp and pale. The episode lasts less than 30 seconds, after which baby returns to normal. What is the MOST likely diagnosis: Seizure GERD Breath-holding spell Bronchiolitis
GERD
28 week gestation mom lives with her husband and 2 and 5 year old kids. How best to protect future baby for first 6 months of its life?
Vaccinate everyone except the mother
Vaccinate mother with inactivated vaccine
Vaccinate father with inactivated vaccine and children with live vaccine
Vaccinate mother with inactivated vaccine
3yo previously healthy kid with ear pain for one day. One exam, T 37.8C and erythematous, bulging tympanic membrane. Best management?
Reassess in 24-48 hours
Amoxicillin 45-60 mg/kg/day divided BID x 5 days
Amoxicillin 75-90 mg/kg/day divided BID x 5 days
Amoxicillin 75-90 mg/kg/day divided BID x 10 days
Reassess in 24-48 hours
Ex-28 week premature baby in the NICU, now 8 weeks old. He is working up on feeds and gradually weaning oxygen, expected discharge in 2-3 weeks. When should he receive rotavirus vaccine?
Now
This baby is not eligible for Rotavirus vaccine (or something like that… maybe contraindicated?)
At time of discharge from NICU
At 2 months corrected gestational age
At time of discharge from NICU
4mo old with eruption of 2 new teeth, what do you do? Brush with water only Brush with fluoride toothpaste Send to dentist now and every 6 months Discontinue night time feed
Brush with water only
What is the most appropriate treatment for headlice when there is known resistance?
- Dimeticone solution
- Permethrin (Nix)
- Pyrethrin (R&C shampoo)
- Isopropyl-myristate/Cyclomethicone (Resultz)
Isopropyl-myristate/Cyclomethicone (Resultz)
What are the current recommendations for HPV Vaccine for 15 year old boy
- 2 doses; now and 6 months later
- 3 doses; now, then at 1, and 6 months
- No vaccine
- Wait until he’s sexually active
3 doses; now, then at 1, and 6 months
You are seeing a 2 month old in your clinic being seen due to concerns with poor weight gain. Brith weight approx 3kg, currently weighs 4 kg. She is drinking 60mL of regular formula every 3 hours. What is her daily caloric intake? 60 kcal/kg/day 80 kcal/kg/day 100 kcal/kg/day 120 kcal/kg/day
80 kcal/kg/day
28 week prem now 8 weeks. On low flow O2. Will be admitted for another 2-3 weeks. When do you give rotavirus vaccine?
a. Not indicated
b. Now
c. In 2-3 weeks at discharge
d. At 8 week corrected
In 2-3 weeks at discharge
4 day old female baby with jaundice, Bili 420. Both parents well. Mom O-, baby B+. Coomb’s negative. Of Northern European ancestry. What is most likely cause of jaundice?
a. Rh incompatibility
b. ABO incompatibility
c. Hereditary spherocytosis
d. G6PD deficiency
ABO incompatibility