BC Peds (general bootcamp) Flashcards
Less than 5-year-old child presents with an enlarged submandibular node that is 5 cm in diameter, nontender, and not fluctuant. The node has been enlarged for 3 weeks and there are no constitutional symptoms. CBC is normal. ESR, monospot, CMV and toxo screen are pending. TST with 5 tuberculin units of PPD shows 8 mm of induration. A course of antibiotics covering staph and strep shows no improvement. What is the most likely diagnosis?
A. tuberculous lymphadenitis atypical mycobacteria lymphadenitis acute pyogenic lymphadenitis D. acute lymphoblastic leukemia E. cat-scratch fever
Atypical mycobacteria lymphadenitis
History of painless submandibular lymph node
Mantoux testing positive >5mm
A full term baby, delivered by vaginal delivery, is noted to have a large cephalohematoma. His birth weight is 4800 g. Which one of the following maternal factors is most likely to have contributed to the baby’s clinical condition?
Maternal substance use Maternal age and obesity Preeclampsia diabetes mellitus Graves disease
Diabetes Mellitus
Haemophilus influenzae Type B vaccine has been recommended for which one of the following groups?
Any child with impaired cell and humoral immunity.
All children at age 2 months.
All children after the age of 18 months
All children at one year old
All children between 4 to 6 years
All children at age 2 months
What do you give at 2 months of age (Pentacel; diphtheria, pertussis, inactivated polio etc)
Why hIB to prevent meningitis
A 2-week-old male is brought to the Emergency Room by his 16-year-old mother with a 12 hour history of inconsolable crying, vomiting and a tender mass in the right groin. Which one of the following is the most likely diagnosis?
incarcerated hernia acute hydrocele child abuse testicular torsion infantile colic
Incarcerated Hernia
13-year-old boy states that he is growing painful breasts. He has been growing taller this past year. On physical examination you note some acne on his face, his testes are appropriate for age, and has fine sparse pubic hair. Which one of the following is the most likely diagnosis?
Klinefelter's syndrome pituitary tumor Adrenal tumor normal puberty gonadal tumor
normal puberty
Exposure ‘to lead in a 4 year old can cause all of the following, EXCEPT
paresis. Microcytic anemia constipation abdominal pain cirrhosis of the liver.
cirrhosis of Liver
After treatment of a FIRST urinary tract infection in a 3-year-old female child, further investigation should include
renal ultrasound only. voiding cystogram only intravenous pyelogram only. voiding cystogram and intravenous pyelogram voiding cystogram and renal ultrasound
Renal US only
7 days of age infant with bilateral purulent conjunctive discharge, erythema and swelling at the medial aspect of the eyes. What is the most likely diagnosis?
nasolacrimal duct inflammation due to Staphylococcus aureus
chemical irritation from eye ointment received at delivery
Neisseria gonorrhoeae infection
herpes simplex infection
Chlamydia trachomatis
Neisseria gonorrhea (gram -ve diplococci
Conjunctivitis in a Child
First 24h is drugs (med induced) – erythromycin ointment
3d – 7d; Gonorrhea (purulent dc) (gram –ve diplococci)
7d – 6wk; chlamydia (no gram stain) (avg 2 – 3wk)
Tx with ceftriaxone
A 6-year-old boy is seen for a generalized edema of 2 weeks’ duration initially noted around the eyes and lower extremities. Idiopathic nephrotic syndrome is confirm by all of the following, EXCEPT
1) serum cholesterol and triglyceride levels are elevated.
2) fat globules are seen in the urine.
3) serum C3 (complement) level is low.
4) serum albumin level is less than 20 g/L.
5) protein excretion exceeds 2 g/24 hours.
Serum complement is low
Nephrotic Syndrome (PALE) Proteinurie; Need 50mg/kg Albumin; hypoalbuminemia Lipids; Fatty oval casts in urine Edema
8-month-old girl presents with recurrent pulmonary infections, steatorrhea, and failure to thrive. Measurement of which substance is most appropriate in this patient?
serum beta-lipoprotein erythrocyte glucose-6-phosphate dehydrogenase serum phenylalanine sweat chloride serum ceruloplasmin
sweat chloride
10-year-old is referred to you for evaluation of hypertension. He has a history of recurrent urinary tract infections. Which one of the following is the most likely diagnosis?
1) horseshoe kidney
2) vesico-ureteral reflux
3) dominant polycystic disease
4) post-streptococcal
5) glomerulonephritis
6) juvenile diabetes mellitus
Vesico ureteral reflux
The disappearance of a ventricular septal defect (VSD) murmur in a patient known to have a large left-to-right shunt is most likely due to
1) closure of ventricular septal defect (VSD).
2) development of aortic stenosis.
3) development of pulmonary stenosis.
4) development of significant pulmonary arterial hypertension.
5) increase in the left-to-right shunt.
?
Streptococcus pyogenes is virulent to humans, causing pharyngitis and a variety of other infections. Which one of the following is the likely virulent factor?
the specific group A polysaccharide penicillin resistance the M and T type of streptococci the presence of pili the M protein
the M protein
On physical examination of a 3-month-old child you detect a thrill and a machinery-type murmur at the left upper sternal border. A widened systemic pulse pressure and bounding peripheral pulses are also noted. Based on these findings, which one of the following is the most likely diagnosis?
patent ductus arteriosus familial hypercholesterolemia Marfan's syndrome aortic stenosis tetralogy of Fallot
PDA
For the past day, a 16-year-old girl has had fever, vomiting, and watery diarrhea. She also complains of intermittent abdominal pain and generalized myalgia. On physical examination she is noted to be slightly lethargic. Temperature is 39.7oC, pulse is 154 beats/minute, and blood pressure is 80/46 mmHg. Her conjunctivae and pharynx are hyperemic, and she has a generalized erythematous maculopapular rash that spares her wrists. Which one of the following is the most likely diagnosis?
Kawasaki's disease Rocky Mountain spotted fever toxic shock syndrome scarlet fever ruptured appendix
Toxic Shock Syndrome
2 year-old boy presents with generalized edema shortly after recovery from an upper respiratory infection. Labs showed marked albuminuria, hypoalbuminemia and hyperlipidemia. Which one of the following is the most likely diagnosis?
minimal change disease rapidly progressive glomerulonephritis membranous glomerulonephritis focal and segmental glomerulosclerosis poststreptococcal glomerulonephritis
Minimal change disease
Cyanosis in the newborn is typical of:
patent ductus arteriosis. transposition of the great vessels. coarctation of the aorta. aortic stenosis. left-to-right cardiac shunt
transposition of great vessels
A couple bring their 34-month-old infant son to their pediatrician because he has not learned to speak, does not interact or play with other children, does not display eye contact and repeatedly flaps his hands. Physical examination is normal. Which one of the following is the most likely diagnosis?
attention deficit disorder - inattentive type pervasive developmental delay (autism) deafness Down syndrome oppositional defiant disorder
Autism
4-year-old girl has had occasional urinary discomfort. A urine culture grew Escherichia coli. Diagnosis of pyelonephritis is most likely if associated with
- fever of greater than 38°C.
- urinalysis (urine microscopy) of greater than 15 white blood cells per high-power field.
- urinalysis (urine microscopy) with 10 to 15 red blood cells per high-power field.
- family history of urinary tract infection.
- significant proteinuria.
Fever of greater than 38
A full-term male is born by vaginal delivery. At one minute his heart rate is 80/min, he takes a gasp, grimaces to stimulation, and his limbs are limp at rest. He is centrally pink and has cyanosed fingers and toes. Which one of the following is the 1-minute Apgar score for this infant?
4 7 5 3 6
4
APGAR Appearance 1 Pulse 1 Grimace 1 Activity 0 Respiration 1
Coryza in 22 days-old infant may lead to upper airway obstruction when the baby sleeps, but not when awake and crying because
- the extrathoracic trachea is floppy and collapses easily on quiet inspiration.
- the tonsils become enlarged and obstruct the airflow in and out of the larynx.
- an infant is an obligate nose-breather.
- there is inflammation and edema of the larynx and trachea.
- the tongue falls back into the posterior oropharynx.
obligate nasal breathers
4 year-old with a history of asthma is brought to the Emergency Department in acute respiratory distress. His mother relates that she stopped his twice daily sodium cromoglycate 7 days ago. Physical examination reveals a distressed child with a harsh cough. On auscultation of the chest, there are areas of reduced air entry and diffuse expiratory wheezes. Which one of the following is the most appropriate initial management?
aerosolized sodium cromoglycate by nebulization
aerosolized ipratropium bromide by nebulization
subcutaneous epinephrine, 1:1000 dilution
aerosolized salbutamol by nebulization
aerosolized budesonide
Aerosolized salbutamol (ventolin)
A 24 hour old full-term infant has become jaundiced and breast-feeding well. The initial step in management is to
- obtain an abdominal ultrasound.
- review birth history and physical examination.
- order a septic work-up.
- discontinue breast-feeding.
- begin phototherapy.
Review history of physical exam
4 year-old girl is referred to a cardiologist because of a murmur heard during a routine examination. Which one of the following clinical characteristics is consistent with an innocent murmur?
audible throughout systole associated with a precordial heave attenuated with change in body position audible only in diastole radiates from apex to the axilla
attenuated with change in body position
3-year-old girl presents with rapidly progressing respiratory distress, high fever, muffled voice, and drooling. Which one of the following measures is most appropriate in the initial management of this problem?
Bronchodilators endotracheal intubation racemic epinephrine aerosol ribavirin aerosol high doses of intravenous steroids
endotracheal intubation
2 and half -year-old boy presents to the emergency room following a 40 second generalized tonic-clonic seizure. He has been ill with a high fever for 24 hours. His history is unremarkable, and physical examination is normal, CBC and urinalysis are normal. Which one of the following would be the best initial step?
- Carry out blood cultures.
- Arrange to have an EEG performed urgently.
- Reassure the mother and recommend close observation.
- Admit to hospital for an immediate CT scan of the head.
- Perform a lumbar puncture.
Reassure
common 6mo 6yr
14 yo year-old boy presents with a history of repeated fire setting. He collects lighters and enjoys watching fires in the neighborhood. his temper is explosive and he is known to fight, lie and steal. he is argumentative and disobedient. Which one of the following diagnoses is most likely?
- oppositional defiant disorder
- pyromania
- intermittent explosive disorder
- conduct disorder
- attention deficit hyperactivity disorder (ADHD)
Conduct Disorder
What is the rate of recurrence of a febrile seizure
33%
What is the chance a kid will develop epilepsy after a febrile seizure
same as regular population (2%)
5-year-old girl presents with areas of bluish discoloration of the lower extremities, buttocks and upper trunk. She has a low-grade fever .The complete blood count reveals the following results: hemoglobin, 120 g/L; white blood cell, 8.2x109/L and platelets 170 x109/L. Which one of the following is the most likely diagnosis?
hemophilia A henoch-Schönlein purpura idiopathic thrombocytopenic purpura Meningococcemia acute leukemia
HSP
9-year-old boy comes with headaches and stomach aches each morning before school and has missed most of the last 2 weeks of school. He has no history of vomiting, change in stool patterns, weight loss or visual disturbances. His physical examination is normal The most appropriate course of action is
- referral back to school with reassurance to parents.
- computed tomography scan of the head.
- propranolol prophylaxis for migraines.
- suggest withdrawal of privileges to deal with truancy.
- Maalox® before meals.
referral back to school with reassurance to parents.
5 yo old boy has a history of easy bruising, nosebleeds, and a similar history among male and female family members. Labs show normal INR and prolonged APTT. Which one of the following is the most likely cause of this boy’s tendency?
Christmas disease hemophilia A von Willebrand's disease factor XIII deficiency familial platelet function disorder
Von Willebrands
Christmas Disease AKA hemophilia B; only males
Hemophilia A; only males
Factor XIII deficiency;
Vit K deficiency if no Vit K at birth
4 yo-old boy presents with a swelling in the right scrotum. the swelling is irreducible, it is possible to get above it and it is translucent. Which one of the following is the most likely diagnosis?
torsion of the testis acute epididymo-orchitis indirect inguinal hernia primary hydrocele varicosity of testicular veins
Primary Hydrocele
Only two things that transilluminate are hydrocele and spermatocele
7 month-old girl comes with vomiting and diarrhea of acute onset. Her systolic blood pressure is 40 mm Hg, pulse is 160/minute, she has poor peripheral circulation and is very lethargic. Her serum sodium concentration is 158 mmol/L. Which one of the following is the best initial management?
-intravenous 5% dextrose in water at 80 mL/kg/24 hours
septic workup
-oral solution containing 50 mmol sodium per liter
- hydrocortisone 200 mg intravenously
-intravenous 5% dextrose in 0.9% saline, 20 mL/kg over 60 minutes
Septic Workup
12 year-old boy is brought to the hospital with a history of having fallen from his bike. He fainted and is now complaining of abdominal pain and thirst. There is general abdominal tenderness and rebound tenderness. Approximately 3.8 hours after the accident, the white blood count is 20 x 109/L and the hemoglobin is 80 g/L. What is the most likely diagnosis?
acute pancreatitis renal contusion retroperitoneal hematoma ruptured spleen ruptured bowel
ruptured spleen
A infant girl presents with a webbed neck, shield chest, coarctation of the aorta, and edema of the hands and feet . Which one of the following conditions is she likely to manifest?
Deafness renal failure Cataracts kyphoscoliosis amenorrhea
amenorrhea
You see a cyanotic 1-day-old baby boy, born by difficult delivery at 37 weeks’ gestation. After administration of 100% oxygen, there is no significant change in the arterial PaO2. Based on this finding, the most likely primary diagnosis is
pulmonary disorder. central nervous system damage. sepsis. congenital heart disease. metabolic disorder.
congenital heart disease
A 14-year-old girl is being assessed for weight loss. Which one of the following features from the history would suggest an organic cause for the patient’s problem?
- She is unconcerned about her weight loss.
- She is on the school athletic team.
- She complains of constant fatigue.
- Her mother and sister have been treated for depression.
- Her dentist had to fit two crowns because of dental erosion.
Fatigue
A student in a university residence has been diagnosed with meningococcal meningitis. Which one of the following is the most effective prophylaxis for individuals exposed to this patient?
erythromycin tetracycline penicillin G Ethambutol rifampin
Rifampin
A 3-year-old boy, diagnosed as having a hemolytic uremic syndrome 4 months ago, would likely presents with which one of the following laboratory findings (finger prick):
potassium 9 mmol/L urea nitrogen 7.3 mmol/L chloride 106 mmol/L creatinine 60 mmol/L sodium 135 mmol/L
Expect K to be high in setting of hemolysis
A newborn infant has excessive drooling along with coughing and choking with feeding. Cyanosis is present and is unrelieved by crying. Bilateral pulmonary rales are present. There is abdominal distention with tympany on percussion. Which one of the following is the most likely diagnosis?
respiratory distress syndrome tracheoesophageal fistula duodenal atresia Zenker's diverticulum choanal atresia
choanal atresia
A 9-year old boy who had been suffering from a gait disturbance for several weeks was found to have a posterior fossa mass on CT scan. Which of the following is the most likely cause for these findings?
astrocytoma a berry aneurysm Oligodendroglioma Medulloblastoma pseudotumor cerebri
Medullo blastoma
Astrocytoma not common in kids
A 3 year old girl is admitted to hospital because of generalized petechiae. The blood count shows anemia and neutropenia. The best initial diagnostic step is to order
A reticulocyte count A bone marrow biopsy anti-platelet antibodies Antinuclear antibodies An osmotic fragility test.
Bone marrow for leukaemia
After stepping on a rusty nail, a 5 year old comes to the emergency room. History reveals that he had his DPTP vaccination at 2, 4, 6 months and 18 months of age and booster Dtap vaccination one year ago. Which of the following would you recommend?
Vaccination with tetanus and diphtheria toxoids Recombinant human anti tetanus toxin No further immunizations are required Intramuscular immunoglobin Metronidazole
no further
if dirty wound, depth >1cm, animal bite, burn then need tetanus every 5y
use immunoglobulin if haven’t had 3 vaccines every and wound is dirty
Passive immunization is most often used to prevent
Rabies Diphtheria Meningococcal menigitis Typhoid Tuberculosis
rabies
An 8 year old boy is admitted with a diagnosis of acute renal failure. The serum potassium level is 7.5 mmol/L. Which one of the following is most likely to be observed on the electrocardiogram? Increase T wave amplitude Increased P wave amplitude Absent Q waves Increase R wave ST segment elevation
increased T wave amplitude
next step = calcium gluconate
17 year old boy with abrupt onset of hematuria and proteinuria, accompanied by azotemia and salt and water retention, most likely has which one of the following? Multiple myeloma Nephrotic sysdrome Nephrolithiasis Diabetic nephropathy Acute glomerulonephritis
acute glomerulonephritis
In a 5 year old girl with leg edema and apparent congestive heart failure, which one of the following would be most effective in inducing rapid therapeutic diuresis? Furosemide mannitol Thiazides Digoxin Spironolactone
furosemide
A 7 year old boy with occasional nose bleeds is referred to you for investigations. Which one of the following conditions is the most common cause of recurrent epistaxis? Digital trauma (nose-picking) Idiopathic thrombocytopenic purpura(ITP) Von Willebrand’s disease Nasal angiofibroma Allergic rhinitis
digital trauma
A 4 year old girl has a 6 day history of high fever, unresponsive to penicillin. She has a conjunctival injection, red cracked lips, marked cervical adenopathy, and a macular exanthem which involves the palms and soles. The most lilkely diagnosis is
Scarlet fever
Mononucleosis
Mucocutaneous lymph node (Kawaski) syndrome
Measles
Stevens- Johnson syndrome
Kawasakis
age <5y
fever >5d
A 13 year old boy complains of having six loose bowel movement with blood associated with abdominal cramps on a daily basis for the past 3 months. He has one bowel movement during the night. Which one of the following is the most likely diagnosis?
Salmonella gastroenteritis Campylobacter gastroenteritis Colonic polyp Ulcerative colitis Giardiasis
UC
A 4 year old girl presents with a 2 day history of low grade fever and headahCes, followed by an onset of erythematous facial flushing, most prominent on her cheeks. Examination reveals a macular rash on her face ( particular cheeks), trunks and extremities and arthritis of wrist joints. Which of the following is the most likely cause of the infection? Adenovirus Echovirus Parvovirus B19 Coxsackie virus Measles
Parvovirus B19
Slapcheek
Incubation period 4 - 14d
best thing to prevent = hygiene
IgM +ve = acute infection (in pregnant women need to monitor baby with US as they can develop hydrous fetalis
A 2 year old child, who was previously well, presents with sudden onset of cough, respiratory distress and wheeze. Examination reveals that he is afebrile with diminished air entry and wheezing on the right side. Which one of the following is the most likely diagnosis? Acute pneumothorax bronchitis Congenital lung cyst Acute asthma Foreign body inhalation
FB
A 6 year old boy with hypochromic, microcytic anemia is unresponsive to iron supplements prescribed by his family doctor. The doctor investigates further by requesting hemoglobin electrophoresis, which shows elevated hemoglobin A2 and explanation for the persistent anemia? Sideroblastic anemia Beta thalassemia trait Sickle cell trait Lead poisioning Hereditary spherocytosis
beta thalassemia
A term new born infant is noted to have abdominal distention and failure to pass meconium at 48 hours of age. Abdominal x ray show dialted loops with sir fluid levels and a granular “ground glass” material. A gastrografin enema is administered with good effect, as the infant passes meconium. Which one of the following investigation is indicated in the following investigations is indicated in the follow up management of this infant? Sweat chloride test Small bowel biopsy Fluid deprivation test Glucose tolerance test Gastrointestinal motility test
Sweat chloride test
A 2 year old child presents with fever, prostration, and nuchal rigidity. He has received his primary immunizations but not the pneumococcal conjugate vaccine 7. The cerebrospinal fluid(CSF) is cloudy, and microscopic examination reveals innumerable neutrophils. The CSF protein is increased, and glucose is decreased. Which on of the following is the most likely etiologic agent?
- Haemophilius influenza
- Streptococcus pneumoniae
- Niesseria meningitides
- E coli
- Staphylococcus aureus
Strep Pneumo
age over 3 months = strep pneumo
A 24 hour old newborn is observed to have a red conjunctival irritation with a clear discharge after an uneventful delivery. Which one of the following is the most likely diagnosis?
- Chlamydial conjunctivitis
- Lacrimal duct obstruction
- Staphylococcus aureus conjunctivitis
- Drug-induced conjunctivitis
- Gonococcal ophthalmia
Drug Induced (most likely in <24h)
Gonococcal (3-5d incubation period therefore 3 - 7d)
Chlamydia (presents around 2 - 3 wk r/t incubation period)
A mother express concerns that her 2 year old son doesn’t seem to want to cuddle with his parents and often doesn’t respond to their voices. The child doesn’t smile, laugh or play with his parents, and his language development is behind that of other children his age. He has been growing well physically. Which one of the following is the most likely diagnosis?
- Mental retardation
- Mixed receptive-expressive language disorder
- Pervasive developmental disorder
- Deafness
PDD
