BC Peds (general bootcamp) Flashcards
1
Q
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
A
Atypical mycobacteria lymphadenitis
History of painless submandibular lymph node
Mantoux testing positive >5mm
2
Q
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
A
Diabetes Mellitus
3
Q
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
A
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
4
Q
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
A
Incarcerated Hernia
5
Q
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
A
normal puberty
6
Q
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.
A
cirrhosis of Liver
7
Q
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
A
Renal US only
8
Q
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
A
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
9
Q
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.
A
Serum complement is low
Nephrotic Syndrome (PALE) Proteinurie; Need 50mg/kg Albumin; hypoalbuminemia Lipids; Fatty oval casts in urine Edema
10
Q
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
A
sweat chloride
11
Q
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
A
Vesico ureteral reflux
12
Q
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.
A
?
13
Q
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
A
the M protein
14
Q
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
A
PDA
15
Q
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
A
Toxic Shock Syndrome
16
Q
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
A
Minimal change disease
17
Q
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
A
transposition of great vessels
18
Q
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
A
Autism
19
Q
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.
A
Fever of greater than 38
20
Q
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
A
4
APGAR Appearance 1 Pulse 1 Grimace 1 Activity 0 Respiration 1
21
Q
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.
A
obligate nasal breathers
22
Q
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
A
Aerosolized salbutamol (ventolin)
23
Q
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.
A
Review history of physical exam
24
Q
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
A
attenuated with change in body position
25
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
26
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
27
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
28
What is the rate of recurrence of a febrile seizure
33%
29
What is the chance a kid will develop epilepsy after a febrile seizure
same as regular population (2%)
30
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
31
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.
32
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
33
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
34
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
35
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
36
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
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
Passive immunization is most often used to prevent
```
Rabies
Diphtheria
Meningococcal menigitis
Typhoid
Tuberculosis
```
rabies
46
```
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
47
```
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
48
```
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
49
```
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
50
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
51
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
52
```
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
53
```
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
54
```
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
55
```
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
56
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
57
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)
58
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
59
8 year old girl hospitalized for a tonsillectomy awakens and cries out in fright that a “ big bear” is in her room. She is relieved when a nurse, responding to her cry, enters the room and turns on the light, revealing the bear to be an armchair cover with a coat. This experience would be an example of
- A hallucination
- Dissociative reaction
- An illusion
- A delusion
- Déjà vu
illusion
60
A chest x ray in a 4 year old shows a posterior mediastinum mass. Which of one the following is the most probable diagnosis?
- Lymphoma
- bronchogenic
- Thymic hyperplasia
- Neuroblastoma
- Teratoma
Neuroblastoma
61
Which one of the following conditions is most often co-morbid with ADHD in childhood?
- Conduct disorder
- Tic disorder
- Major depressive disorder
- Oppositional defiant disorder
- Separation anxiety disorder
ODD (both ODD and conduct is associated with ADHD
62
A 10 year old boy has never had corrective surgery for congenital dislocation of the hips. Which of the following would best describe his gait?
- Circumducting
- Staggering
- Wadding
- Steppage or equine
- Shuffling
Wadding
63
6 year old child is brought to you because his parents find him overactive easily distracted, restless, disorganized in his play and often in conflict with other children his age. Which one of the following medications is the most appropriate?
- Phenytoin
- Lithium carbonate
- Methylphenidate
- Cimetidine
- Diazepam
Methylphenidate (sympathomimetics)
SE Of methylphenidate know
Toxidromes*
64
```
Social smiling by an infant is elicited by the face or voice of the caretaker at which on the following age ranges?
4 to 8 weeks
3 to 4 months
8 to 12 weeks
More than 4 months
1 to 4 weeks
```
4 - 8wk
65
Dark brown spots in the lips and palate are noted in a 5 yo old girl. You suspect Peutz-Jeghers syndrome. Investigation for which of the following conditions is indicated?
- Addison’s disease
- Malignant melanoma
- Lead poisoning
- Gastric ulcers
- Intestinal polyposis
Intestinal Polyposis
*know causes of intestinal polyposis
important because you need to screen earlier
66
The parents of a 2 year old girl bring her to the emergency room. They state that she has been suffering from a cold for five days. They became concerned when she developed a barking cough and noisy breathing. Examination reveals a listless child with a mild fever, inspiratory stridor and diminished breath sounds. Which one of the following is the most likely pathogen?
- Parainfluenza virus
- Haemophilus influenzae
- Respiratory syncytial viru
- Streptococcus pneuminiae
- Bordetella pertusis
parainfluenza
67
A mother brings her 10 year old son to your office because he lost consciousness the day before while running. She says that he had similar episodes in the past, but has never been seen by a doctor. She also states that he does not seem to be able to play as long as most of his friends. On physical examination you detect a systolic ejection murmur and find that the apical impulse is lateral to the mid calvicular line. Which one of the following is the most likely diagnosis?
- Mitral valve stenosis
- Coarctation of the aorta
- Aortic insufficiency
- Aortic stenosis
- Patent ductus arteriosus
aortic stenosis
68
An 8 year old boy has had the following symptoms for the last 3 months profuse watery rhinorrhea, nasal obstruction, itching tearing of the eyes, and mouth breathing. Which one of the following is the most probable diagnosis?
- Tonsillitis
- Nasal polyposis
- Sinusitis
- Hypertrophy of adenoids
- Allergic rhinitis
Allergic rhinitis
Initial medication; antihistamines (non sedating)
69
A 5 yo old patient has axillary freckling, several firm subcutaneous masses on both arms and seven light brown macules on his trunk which are grater than 1.5 cm. which one of the following is the most likely diagnosis?
- Sturge –Weber syndrome
- Tuberous sclerosis
- Albright’s disease
- Peutz-Jeghers syndrome
- neurofibromatosis
Neurofibromatosis
Neurocutaneous (skin/nervous system) syndromes;
Neurofibromatosis Type I (pheo, opticglioma)
Neurofibromatosis Type II
(acoustic neuroma)
Important to know to assess tumour in CNS with skin sx
Sturge Weber; Also affects skin and CNS, need to know port wine stain (trigeminal nerve, V1/V2 distribution) see leptomeningealgioma? tumour is ipsilateral to the port wine stain
70
A 5 year old boy is admitted with a provisional diagnosis of acute renal failure. The laboratory calls you to report that his serum potassium level is 7.5 mmol/l. which one of the following should be your next investigation?
- Serum creatinine
- Serum bicabonate
- White cell count
- Electrocardiogram
- Serum sodium
ECG
71
A 5 day old baby is seen in the emergency department one evening because of lethargy and poor feeding. His skin is cold and mottled, and his temperature is 36.8 C. after stabilization, which one of the following is the most appropriate investigation?
- Blood gases
- Cranial ultrasound
- Chest x ray
- Lumber puncture
- Serum electrolytes
serum lytes
72
5 days old female infant is brought to the pediatrician’s office for a weight check. The mother is concerned about the infant’s breast and vagina. The infant has a normal physical examination. Which of the following findings is not consistent with physiologic withdrawal of maternal hormones?
- Vaginal discharge
- Breast engorgement
- Vaginal bleeding
- Labial ecchymoses
- Nipple discharge
labial ecchymosis
73
6 year old boy presents to your office complaining of right ear pain. Upon examination of the ear, pain is elicited with traction of the tragus, the tympanic membrane is not visualized well, and some periauricular lymph nodes are plapable. What is the most likely diagnosis?
- Acute otitis externa
- Acute viral conjunctivitis
- Mastoiditis
- Acute otitis media
- A blocked eustachian tube
Acute otitis externa
pain on tragus - more likely externa
Otitis Externa; abx drops and topical steroids ( ciprodex)
Pseudomonas aeurginosa
Mastoiditis; can look like otitis externs because pinna can be pushed out (re: swelling), has retroauricular swelling.
74
4 year old child presents to the ER complaining of headache, purulent nasal discharge, fever, earache, and nasal congestion of the last 8 days. An x-ray of the sinus reveals thickening of the maxillary sinus.
Which one of the following findings suggests a complication of the sinusitis?
- Cervical adenitis
- Purulent tonsillitis
- Serous otitis
- Purulent conjunctivitis
- Periorbital cellulitis
periorbital cellulitis
Periorbital vs orbital cellulitis
```
Preseptal= periorbital
septal = orbital
```
Orbital = protrusion of eye and decreased ROM or orbital muscles and eye pain. (proptosis, visual acuity decreased)
75
14 year old girl had a first generalized tonic-clonic seizure, for which no cause can be found on investigation. She is developmentally quite normal and is doing well in school.
what is the likelihood of this girl having one or more seizures in the next two years?
```
5%
90%
15%
1%
40%
```
40%
76
10 year old male presents to the emergency room with a 22 hour history of painful lower extremities and severe abdominal pain. On physical exam, you note a temperature of 37. 7 and severe arthritis of both knees along with a purpuric rash located on the lower extremities and buttocks. The stool is positive for occult blood and urine dipstick for protein and blood. Which of the following is the most likely diagnosis?
- Juvenile rheumatoid arthritis
- Post-streptococcal glomerulonephritis
- Schonlein-Henoch vasculitis
- Rocky mountain spotted fever
- Meningonococcemia
HSP vasculitis
- platelets normal
- non thrombocytopenic purpura
If kid has similar presentation to HSP and has low platelets.
Meningococcemia can mimic HSP (but cannot move extremity). Petechiae, sick, febrile,
Organism that causes meningococcemia; neisseria meningitis.
77
A 2 year old girl has a 2 day history of abdominal pain fever and bloody diarrhea. Which one of the following is the best diagnostic investigation?
- Barium enema
- Stool for Clostridium difficile toxin
- Stool for culture and sensitivity
- Complete blood count and differential
- Stool for virology
Stool for C &S
78
2 year old toddler is brought to the ER 8 hour after accidental ingestion of gasoline. On examination she is afebrile and has no respiratory distress. Chest x-ray is normal. Which one of the following is most appropriate intervention?
- Antibiotic to prevent pneumonitis
- Discharge home, but to return if tachypenic
- Induce vomiting to empty the stomach
- Oral corticosteroid treatment
- Admit to ward for observation only
discharge home but return if tachypnic.
Approach; Hydrocarbon ingestion
6h of observation if asymptomatic. if CXR is fine after 6h, send home.
Mainly don't want them to vomit and then get into lungs and becomes absorbed.
79
16 month old girl presents with history of high-grade fever. Her physical examination is normal which one of the following investigations would be most useful?
- Blood culture
- Urine analysis and culture
- Lumber puncture
- Erythrocyte sedimentation rate
- Chest X ray
urinalysis and culture.
key ix to order if no focus
80
13 year old girl sustains a minor injury to the left side of her back in a school basketball game. On examination little is found except for asymmetric shoulder levels. While she bends over, the right posterior chest is elevated. Which of the following are these findings most readily suggestive of?
- An iliopsoas muscle spasm
- hematoma
- Rhabdmyosarcoma
- An accessory rib
- Scoliosis
scoliosis
you need cobbs angle to make decision. If cobs angle >45 need constructive surgery, need to get it fixed at that age.
<25 cobbs angle = observe
81
What treats rocky mountain spotted fever?
doxycyline
82
What treats rocky mountain spotted fever?
doxycyline
83
An 18-month old boy is evaluated in a routine follow-up visit. His past medical history is notable for recurrent acute otitis media and 3 hospitalizations for severe pneumonia beginning at 4 months of age. His maternal uncle also had recurrent infections and died of meningitis at the age of 4 years. On physical exam, he is afebrile with normal vital signs. His height is in the 5th percentile for age, and his weight is in the 3rd percentile. His physical exam is notable for boggy and inflamed nasal mucosa, post-nasal drainage, absent tonsils, and digital clubbing. Laboratory studies are remarkable for low levels of all immunoglobulins classes and the near absence of B-cells.
What is the most likely diagnosis?
```
A. Chronic granulomatous disease
B. X-linked agammaglobulinemia
C. Chediak-Higashi syndrome
D. DiGeorge Syndrome
E. Wiskott-Aldrich syndrome
```
X linked agammaglobulinemia
84
A one year old with congenital agammaglobulinemia is at most risk for which of the following?
```
Bronchopulomonary aspergillosis
Candida albicans esophagitis
Disseminated herpes simplex infection
Pneumococcal pneumonia
Pneumocystis carnii pneumonia
```
Pneumococcal Pneumonia
85
A 10-month-old boy is evaluated in the office for a routine well-child visit. His past medical history is notable for four episodes of acute otitis media. His immunizations are up-to-date. On physical exam he is afebrile with normal vital signs. He has a pruritic, weepy, erythematous rash on his face and torso. A complete blood count is notable for thrombocytopenia.
```
What is the most likely diagnosis?
A. Chediak-Higashi syndrome
B. Wiskott-Aldrich syndrome
C. DiGeorge Syndrome
D. Chronic granulomatous disease
E. X-linked agammaglobulinemia
```
Wiskott-Aldrich
86
A 10-month-old boy is evaluated in the office for a routine well-child visit. His past medical history is notable for four episodes of acute otitis media. His immunizations are up-to-date. On physical exam he is afebrile with normal vital signs. He has a pruritic, weepy, erythematous rash on his face and torso. A complete blood count is notable for thrombocytopenia.
```
What is the most likely diagnosis?
A. Chediak-Higashi syndrome
B. Wiskott-Aldrich syndrome
C. DiGeorge Syndrome
D. Chronic granulomatous disease
E. X-linked agammaglobulinemia
```
Wiskott-Aldrich
87
A mother brings her 4 week old baby to your office for examination. She complains that he does not drink much and that she does not know what to do. His birth weight was 3.5 kg. His present weight is 3.6 kg. Which one of the following is the most appropriate course of action?
Refer mother and child to a social worker for evaluation and give another appointment in 1 week
Order a complete blood count and a sweet chloride test
Reassure the mother that some children do not gain much weight during the first month of life
Evaluate caloric intake and parent interaction
Change the milk formula for an iron enriched formula
Evaluate caloric intake and parent interaction
88
Each of the following is an important component in the neuromotor assessment of infants below 3 months of age EXCEPT:
```
Evaluation for asymmetry of movement
Assessment of primitive reflexes
Evaluation of abnormalities in tone
Evaluation of the forward parachute response
Measurement of head circumference
```
D. Evaluation of the forward parachute response
89
A newborn girl is noted to have a palpable clunk when the hip is abducted, flexed, and lifted forward Which of the following is the most likely mechanism of disease?
Decreased epiphyseal blood flow resulting in osteonecrosis
Displacement of the capital femoral epiphysis
Failure of osteoid to mineralize
Increased intra-articular pressure
Muscle imbalance resulting from spasticity
Shallow, poorly developed acetabulum
Shallow, poorly developed acetabulum
90
An otherwise healthy 6-month-old girl is brought to the physician because of a hemangioma on her neck that has been enlarging since 6 weeks of age. The lesion was 0.5 cm at 6 weeks of age and is now 2 cm. It is raised, erythematous, and blanches with pressure; there is no ulceration Growth is appropriate for age, and laboratory studies show no abnormalities. Which of the following is the most appropriate next step in management?
```
Observation
Intralesional antiangiogenic factor therapy
Intralesional interferon therapy
Oral corticosteroid therapy
Laser therapy
```
A. Observation
Make sure vision is fine and no A/w issue prior to observation
91
An otherwise healthy 6-month-old girl is brought to the physician because of a hemangioma on her neck that has been enlarging since 6 weeks of age. The lesion was 0.5 cm at 6 weeks of age and is now 2 cm. It is raised, erythematous, and blanches with pressure; there is no ulceration Growth is appropriate for age, and laboratory studies show no abnormalities. Which of the following is the most appropriate next step in management?
```
Observation
Intralesional antiangiogenic factor therapy
Intralesional interferon therapy
Oral corticosteroid therapy
Laser therapy
```
A. Observation
Make sure vision is fine and no A/w issue prior to observation
92
A post-term newborn, delivered with a breech presentation, develops respiratory distress which does not improve. Chest radiograph shows streaky, linear densities, and cultures are negative.
What is the most likely diagnosis?
A. Meconium aspiration syndrome
B. Persistent pulmonary hypertension of the newborn
C. Pneumonia
D. Transient tachypnea of the newborn (TTN)
E. None of the above
MEC Aspiration
93
A 38 5/7-week estimated gestational age girl is examined in the special care nursery at 3 hours of life who developed tachypnea and mild respiratory distress 10 minutes ago. Mom’s prenatal history was uncomplicated and her prenatal labs were not concerning for infection. She required no ventilatory support at delivery. The baby has the following vital signs: temperature 36.9°C (98.4°F), heart rate 136/min, respiratory rate 83/min, blood pressure 75/42, and oxygen saturation 93%. She has some shallow breathing with mild subcostal retractions and no grunting or nasal flaring, and she is otherwise well perfused with good femoral and brachial pulses. A chest X-ray reveals a flat diaphragm, prominent vascular markings, and fluid in the interlobar fissures. No granular densities or opacities/air brochograms are seen.
What is the next step in management of this patient?
A. Continuous positive airway pressure (CPAP)
B. O2 via nasal cannula
C. Surfactant
D. Conservative management with orogastric tube feeds or IV fluids for nutrition
E. Intubation
CPAP
94
One hour after delivery, a 1 077-g (2-lb 6-oz) newborn is in respiratory distress. She was born at 28 weeks’ gestation following an otherwise uncomplicated pregnancy and delivery. The mother received routine prenatal care and intrapartum antibiotic prophylaxis. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. On initial examination, the newborn appeared pink and was active. Currently, her temperature is 36.4°C (97.5°F), pulse is 160/mm, respirations are 60/mm and shallow, and blood pressure is 68/44 mm Hg. Examination shows grunting, nasal flaring, and intercostal retractions A chest x-ray shows a granular appearance of the parenchyma with air bronchograms. Which of the following is the most likely diagnosis?
Meconium aspiration pneumonia
Respiratory distress syndrome of the newborn
Streptococcus agalactiae (group B) infection
Total anomalous pulmonary venous return
Transient tachypnea of the newborn
RDS
95
One hour after delivery, a 1 077-g (2-lb 6-oz) newborn is in respiratory distress. She was born at 28 weeks’ gestation following an otherwise uncomplicated pregnancy and delivery. The mother received routine prenatal care and intrapartum antibiotic prophylaxis. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. On initial examination, the newborn appeared pink and was active. Currently, her temperature is 36.4°C (97.5°F), pulse is 160/mm, respirations are 60/mm and shallow, and blood pressure is 68/44 mm Hg. Examination shows grunting, nasal flaring, and intercostal retractions A chest x-ray shows a granular appearance of the parenchyma with air bronchograms. Which of the following is the most likely diagnosis?
Meconium aspiration pneumonia
Respiratory distress syndrome of the newborn
Streptococcus agalactiae (group B) infection
Total anomalous pulmonary venous return
Transient tachypnea of the newborn
RDS
96
A 3 day term infant has episodes of breathing for 10-15 seconds followed by apnea for 5 to 10 seconds. There are no changes in skin color or heart rate. Which of the following is the most appropriate step in management?
```
Administer caffeine
Administer theophylline
Apply continuous positive airway pressure
Provide supplemental oxygen
Reassure the parents
```
reassure
97
Prostaglandin E infusion can be used for initial management in each of the following neonatal heart lesions EXCEPT:
```
Pulmonary atresia
Coartaction of the aorta
Tetralogy of fallot
Patent ductus arteriosus
Hypoplastic left heart syndrome
```
D. Patent ductus arteriosus
98
When do VSD get repaired if it doesn't close?
1year
99
A 3-week-old male infant is brought into the pediatrician for several episodes of cyanotic lips during feeding. His mother notes he becomes severely agitated during his feeds and looks as though he is holding his breath. Physical examination reveals a calm male infant sleeping in his mother’s arms. Cardiac examination reveals a crescendo-decrescendo murmur best heard at the left upper sternal border and a single S2. Lungs are clear to auscultation bilaterally, with no rales or rhonchi noted. Abdomen is soft, nondistended, with normoactive bowel sounds. Skin examination reveals no signs of cyanosis. A chest x-ray is performed in the office and reveals an elongated apex of the heart.
What is the most likely diagnosis?
```
A. Large VSD
B. Transposition of the great vessels
C. Breath Holding spell - review
D. Hypertrophic obstructive cardiomyopathy (HOCM)
E. Tetralogy of fallot
```
Tetralogy of fallot
100
A 2 day old breast fed newborn, who was delivered at home, presents to the Emergency Department with umbilical stump bleeding. The mother has been on phenytoin during her pregnancy, PT and PTT are prolong which of the following is the most appropriate treatments?
```
Administer factor VIII
Administer 1-2 mg of vitamin K
Administer 20 ml/kg of whole blood
Administer platelets
Administer 10 mL/kg of packed cells
```
B. Administer 1-2 mg of vitamin K
101
```
A previously healthy 7 weeks-old boy is brought to the physician because of a 3-day history of vomiting. His mother says that he has been taking his cow milk-based formula well but vomits after every feeding. The vomiting has been increasing in amount and force; the vomitus appears to be nonbloody, nonbilious undigested formula. He appears mildly dehydrated. He is at the 25th percentile for length and 10th percentile for weight. Vital signs are within normal limits. The remainder of the examination shows no abnormalities.
Serum studies show:
Na+ 130 mEq/L
K+ 3.0 mEq/L (low)
Cl- 85 mEq/L (low)
HCO3- 34 mEq/L (high)
```
Which of the following is the most likely diagnosis?
```
Formula intolerance
Gastroesophageal reflux disease
Intussusception
Pyloric stenosis
Volvulus
```
Pyloric Stenosis
102
A 1-day-old 2460-g (5-Ib 7-oz) boy has progressive abdominal distention. He was born at 38 weeks’ gestation following an uncomplicated pregnancy and delivery Since birth, he has had two episodes of bilious vomiting after feedings and has not yet passed meconium. The abdomen is distended and firm with visible loops of bowel. There are no external hernias, and the anus is patent. X-rays of the abdomen show several dilated loops of bowel with air-fluid levels A barium enema shows an abrupt change in caliber at the midsigmoid colon from normal-sized bowel to dilated bowel proximally. Immediately after the barium enema, he has a large, explosive bowel movement.
Which of the following in utero events is the most likely cause of these findings?
Abnormal caudal migration of ganglion cells
Abnormal pancreatic and intestinal gland secretions
Failure of normal bowel rotation
Persistent patency of the processus vaginalis
Vascular accident involving a segment of bowel
Abnormal caudal migration of ganglion cells
103
A nurse calls the attending physician to examine an infant born at 28 weeks in the NICU now one day of life . She mentions that the baby had been
voiding and stooling appropriately but today has been having bilious residuals
and
began experiencing some short episodes of apnea. On exam, the baby has increased abdominal girth and a distended abdomen with hypoactive bowel sounds.
Bloody stools are present in the diaper. Pulses are slightly diminished peripherally.
An abdominal film reveals dilated loops of bowel, thickening around the right colon, and pneumatosis.
```
A. Intussusception
B. Duodenal atresia
C. Necrotizing enterocolitis
D. Hirschsprung’s disease
E. Sepsis
```
NEC
104
A 2-day-old full-term newborn female in the well-baby nursery appears jaundiced. She was born to a G6P5 mother via a precipitous vaginal delivery. Increase neonatal indirect bilirubin. Mother’s blood type is A+ and her antibody screen is negative. Her parents are caucasian and there is no family history of jaundice. On physical examination, she is afebrile and has a small area of swelling over the back of her head. The rest of her physical examination is unremarkable. She has been breastfeeding well since birth and has passed meconium.
What is the most likely cause of this infant’s jaundice?
```
A. Glucose-6-phosphate dehydrogenase deficiency (G6PD) deficiency
B. Cephalohematoma
C. ABO Blood group incompatibility
D. RH incompatibility
E. Neonatal Sepsis
```
cephalohematoma
105
A 2500-g female infant born at term develops jaundice at approximately 18 hours of life. The infant appears generally well, is not lethargic, and is breast feeding well. Vital signs are normal, and examination of all systems reveals no abnormalities.
The infant’s bilirubin at 24 hours is 220 mmol/L. The indirect bilirubin is 205 mmol/L . The neonate is blood group B and Rh positive. The mother is blood group O and Rh positive. The neonate’s hemoglobin is 135 g/L, and the reticulocyte count is elevated.
What is the most likely cause of jaundice in this neonate and treatment ?
ABO blood group incompatibility
Phototherapy
Exchange transfusion
106
A 3 kg male infant was delivered by you at 40 weeks’ gestation. The mother’s blood type is group A and Rh positive. The neonate’s blood type is the same. At approximately 36 hours of age the neonate begins to develop visible jaundice.
The baby is being breast fed and is feeding well, approximately every 2 hours. The baby’s hemoglobin is 175 g/L. His total bilirubin is 171 mmol/L , and his indirect bilirubin is 154 mmol/L. His direct and indirect Coomb’s test result are negative.
On physical examination, the infant looks healthy, no lethargy, no difficulties with feeding, and no significant abnormalities apart from the yellow color of his skin and the whites of his eyes. There is no organomegaly.
What is the most likely diagnosis in this infant?
Management?
Normal physiologic jaundice
| Reassurance
107
What is rochester criteria for?
identify infants <60d of age with fever at low risk of serious bacterial infection
108
What is the criteria for rochester criteria?
Clinically well, WBC 5 -15, bands <1.5, Urinalysis <10, Stool <5wbc, Past health, N
109
Pastia Line
Scarlett Fever
110
What is the cause of scarlett fever?
GAS
111
What is the other name for GAS?
streptococci pyogenes
112
what causes fever, sore throat, conjunctivitis (viral)
adenovirus
113
A 12 year old present with inflamed pharynx & fever. He was treated with antibiotics. A week later he presents again with trismus. What is your diagnosis?
```
Tetanus
Pharyngitis
Infectious mononucleosis
Peritonsillar abscess
Streptococal tonsillitis
```
Peritonsillar
114
A 4-year old presents with an extremely sore throat, temperature of 39.5C , tender anterior cervical lymphadenopathy, Tonsillar exudates, a fine non- pruritic macular rash , no hepatomegaly nor splenomegaly, and some pain in both ears.
The most likely diagnosis is:
```
Bilateral AOM
Viral pharyngitis
Group A beta-hemolytic strep pharyngitis
Infectious mononucleosis
None of the above
```
C. Group A beta-hemolytic strep pharyngitis
115
Which of the following signs best distinguishes streptococcal pharyngitis from infectious mononucleosis?
```
Splenomegaly
Exudative tonsillitis
Lymphadenopathy
Elevated temperature
Skin rash
```
Splenomegaly
116
A 4 year old boy presents to your office with a 3 day history of pain with swallowing. He complains of feeling unwell, has a non-productive cough but no fever. On physical exam he has an erythematous pharynx, slightly swollen tonsils with no pustular exudates. There is no cervical lymphadenopathy. Which of the following organisms is the most likely causative agent?
```
Rhinovirus
Ebstein Barr virus
Cytomegalovirus
Mycoplasma pneumoniae
Streptococcus pneumoniae
```
Rhinovirua
117
A 2-week-old infant presents to the emergency department with fevers and poor feeding. During the past twelve hours the child has been less active than usual, has breast feed only once, and has had minimal urine output. Her temperature is 40°C, heart rate is 110 beats per minute, blood pressure is 90/48 mmHg, respiratory rate is 36 breaths per minute, and oxygen saturation is 97% on room air. On physical exam, she appears lethargic. The anterior fontanel is bulging. There is no heart murmur. Lungs are clear to auscultation bilaterally. Abdomen is soft, non-tender,There is no rash. A complete blood count, blood cultures, urine cultures, and cerebral spinal fluid (CSF) studies are obtained. The CSF appears cloudy. There are 4 red blood cells per mL, 1,480 white blood cells per ml(n-less than 10) with 85% neutrophils, glucose of 1.6(2-4 mmol/l), and protein of 0.65( 0.20-0.45g/l). The gram stain shows gram-negative rods.
What is the most likely pathogen causing this child’s symptoms?
```
A. Streptococcus agalactiae
B. Neisseria Meningitidis
C. Streptococcus pneumoniae
D. Listeria monocytogenes
E. Escherichia coli
```
e.coli
Staph and step are gam +ve
Neisseria meningitis = gram -ve diplococci
118
A child presented with a temperature of 41’C and a small white lesion on the buccal mucous membrane of the mouth followed by generalized macular papular rash, conjuctivitis, photo phobia. What is the management?
```
Give ASA to decrease fever
Give gamma Ig.
Notify the public health unit
Isolation of the family member
Give VZIG
```
Notify Public Health
give MMR vaccine to anyone who is exposed. For pregnant woman give IVIG
119
A young child with fever and convulsion which lasted 7 minutes has just been admitted to the ER. Which one of the following features would be against the diagnosis of a simple febrile convulsion?
```
The seizure involved the right arm and right leg
The seizure was stopped with lorazepam
She is 2 years old
She was incontinent of urine
She had a similar episode 4 months ago.
```
R arm and R leg
120
Suzy is a 6 week-old who has been in good health, except for a past history of two uncomplicated urinary tract infections (UTIs).
Her mother brings her to the office with symptoms of frequent diaper changes, and malodorous urine for 12 hours
What Abx use in UTI?
AMp/Gent
121
Is vesicouretheral reflux more common in boys or girls?
girls
122
Posterior uretral valves is more common in boys or girls?
boys
123
what are the causes of recurrent UTI in children?
vesicoureteral reflux, posterior urethral valves, ureterocele
124
You suspect Kawasaki disease (mucocutaneous lymph node syndrome) in an 18 month old child. Physical exam is likely to reveal each of the following EXCEPT:
```
Cervical lymphadenopathy
Edema of the hands and feet
Fissured lips
Polymorphous rash
Purulent conjunctivitis
```
Purulent conjunctivitis
125
A two-month old boy is brought to the physician for 24-hours of fever accompanied by coryza and irritability. Temperature is 38.9C, respiratory rate 42/min, heart rate 146/min. Other than his clear rhinorrhea, the physical exam shows no other source of infection. As part of his evaluation, a blood culture is obtained. The next day the blood culture is reported to be growing Streptococcus pneumoniae.
Which of the following is the most likely diagnosis?
```
Bacterial endocarditis
Occult bacteremia
Pneumonia
Urosepsis
Streptococcosis
```
occult bacteremia
126
A child, who has previously had a splenectomy, is brought to the ER with a fever of 39.7C. Which one of the following steps should be taken?
Give intravenous antibiotics
Give oral acetaminophen and cefaclor
Do a blood culture and follow up as outpatient
Do a complete blood count and observe for 6 hours
Give intravenous immunoglobulin
IV ABx
Encapsulated bugs that affect splenectomy patients; Strep Pneumo, H flu, neisseria Meningiditis
127
What organism causes occult bacteria in kids?
Strep Pneumo used to be NOW it is changed
128
Which one of the following statements about the risk of serious bacterial infections (SBI) in febrile children up to three months of age is false?
- The higher the body temperature, the higher the incidence of SBI
- S. pneumoniae is the most common organism causing SBI during the first 28 days of life
- Occult bacteremia is one of the most frequent causes of invasive infections in newborns
- Urinary infections are the most common SBI associated with a viral infection
- None of the above
S. pneumoniae is the most common organism causing SBI during the first 28 days of life
129
What do you do if you suspect meningitis in a kid >28d?
IM ceftriaxone
130
A 20 month old infant presents with a fever and refusal to eat solid food. Lesions of the type seen in the referenced illustration are also present in the interdigital spaces of the fingers. Which one of the following is the most likely diagnosis?
```
Rickettsia rickettsii infection
Sarcoptes scabiei infestation
Varicella
Beta-hemolytic streptococcal infection
Coxsackievirus A infection
```
E. Coxsackievirus A infection
131
A 10 month old native Canadian (Aboriginal) is flown to your hospital because of a fever of 38.5 ͦ C and a stiff neck. Which one of the following investigations is the best way to differentiate an aseptic meningitis from a tuberculous meningitis when examining the cerebrospinal fluid?
```
Ziehl-Nielsen stain
Presence of mononuclear leucocytes
Latex agglutination
Total cell count
Protein content
```
Ziehl Nielsen Stain
132
A 13-year-old girl is brought to the emergency department 4 hours after a 3-minute generalized tonic-clonic seizure that occurred at a party. Her symptoms began with bizarre behavior. She has had a low-grade fever and cough for 3 days. On arrival, she is arousable but confused; she does not answer questions appropriately and cannot follow commands. Her temperature is 38.9°C (1 02°F). Examination shows mild resistance to neck flexion. Deep tendon reflexes are brisk in all extremities. Babinski sign is present bilaterally. A CT scan of the head without contrast shows mixed areas of hyperdensity and hypodensity in the right temporal lobe. Cerebrospinal fluid analysis shows:
```
Glucose 1.19 (inc)
Protein 0.79(high)
Leukocyte count 35/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 30 (high)
```
Which of the following is the most likely causal organism?
```
Group B strep
Borrelia burgdorferi
Cytomegalovirus
Enterovirus
Herpes simplex virus
HIV
Listeria monocytogenes
Rickettsia rickettsii
Toxoplasma gondil
Varicella-zoster virus
```
Herpes
133
what virus loves the temporal lobe?
herpes simplex virus
134
A young boy presents with frequent episodes of rhinitis with fever and a purulent nasal discharge. On exam, he has tenderness over the maxillary sinus. What is the most likely complication if untreated?
```
Purulent meningitis
Ethmoidal sinusitis
Orbital cellulitis
Frontal sinusitis
Maxillary sinusitis
```
orbital cellulitis
135
A 3 year old girl is seen in the ER with high fever, redness of the right eye and proptosis with limitation of extraocular movements. Which one of the following is the most likely diagnosis?
```
Maxillary sinusitis
Periorbital cellulitis(preseptal)
Blow-out fracture of the orbit
Orbital cellulitis(septal)
Dacryocystitis
```
orbital cellulitis
136
Which of the following statements is correct concerning the treatment of upper respiratory tract infections (URI) in children?
- Decongestant and antihistamine use results in clinically significant improvement in symptoms at 48 hrs compared to placebo
- Stopping milk intake during a cold results in decreased mucous formation
- Prophylactic antibiotics prevent the occurrence of pneumonia
- Saline nose drops should be recommended for infants with URI
- Steam vaporizers or humidifiers decrease the nasal replication of viruses
-Saline nose drops should be recommended for infants with URI
no abx no decongestant
137
In the late summer, a 7 year old boy presents with persistent rhinorrhea and itchy eyes of 3 weeks’ duration. On examination, the nasal mucosa is pale and edematous. Which one of the following is the best management?
Refer to an ear, nose and throat specialist
Treat with oral antihistamines
Treat with nasal decongestants
Search for foreign body
Treat with oral antibiotics
oral antihistamines
138
Complications of acute otitis media include each of the following EXCEPT:
```
Perforation of tympanic membrane
Mastoiditis
Sinusitis
Conductive hearing loss
Chronic middle ear effusion
```
sinusitis
Weber lateralizes to bad ear
139
A 4-year old with extremely sore throat presents with 39.5C. Tender anterior Cx lymphadenopathy. Tonsillar exudates. Fine macular rash. No hepatomegaly nor splenomegaly. Some pain in both ears. Most likely diagnosis:
bilateral AOM
viral pharyngitis
Group A beta-hemolytic strep pharyngitis
Group B beta-hemolytic strep pharyngitis
None of the Above
GAS
140
A child has fever, sore throat, and bilateral, nonpurulent conjunctivitis. Which of the following organisms is most likely to cause this triad of symptoms?
```
Adenovirus
Cytomegalovirus
Beta hemolytic Streptococcus Group A
Parainfluenza virus
Respiratory syncytial virus
```
Adenovirus
Ear Pain with tonsillitis = referred pain from tonsils
141
Which of the following is the antibiotic of choice for a 1 year old with bilateral otitis media, who has no known drug allergies?
```
Clarithromycin
Cefaclor
Penicillin VK
Amoxicillin
Cortrimoxazole
```
Amoxicillin
142
A 5-year-old boy is brought to the physician because of a malodorous discharge coming from his right nostril. His parents report that the child developed frequent sneezing and mucus discharge for one week. They thought it was a common cold. The child is afebrile and in apparent good health. There is no history of allergic diseases or recurrent infections. Examination reveals obstruction of the right nasal fossa with associated purulent discharge from the right nostril. Which of the following is the most likely diagnosis?
```
Allergic rhinitis
Juvenile angiofibroma
Nasal foreign body
Nasal polyp
Rhinitis medicamentosa
```
Nasal FB
143
Each of the following statements about treatment for seasonal Allergic rhinoconjunctivitis in children is false, except:
- Intranasal beclomethasone use for one year has been associated with a reduced growth rate
- There is good evidence that immunotherapy reduces symptoms
- Oral antihistamines reduce nasal symptoms
- The most common side effect of nasal corticosteroids is epistaxis
- None of the above
There is good evidence that immunotherapy reduces symptoms
144
Coryza in a 3-week-old infant may lead to upper airway obstruction when the baby sleeps, but not when awake and crying because
- There is inflammation and edema of the larynx and trachea
- The extrathoracic trachea is floppy and collapses easily on quiet inspiration
- An infant is an obligate nose-breather
- The tongue falls back into the posterior oropharynx
- The tonsills become enlarged and obstruct the airflow in and out of the larynx
Obligate nose breather
145
You are evaluating a one-year-old child in the emergency department who presents with fever and mouth pain that started that morning. She has been irritable and unable to eat or drink. Her past medical history is unremarkable, however, she has not yet had her one year vaccinations. Her temperature is 39oC (100.4oF). On physical exam, her gums are markedly swollen, erythematous, and bleeding. She has vesicular lesions on the tongue, buccal mucosa, palate, and lips. There is also tender submandibular adenopathy. The rest of her physical exam is unremarkable.
What is the most likely diagnosis?
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A. Herpetic gingivostomatitis
B. Recurrent apthous stomatitis
C. Varicella
D. Impetigo
E. Hand-foot-and-mouth disease
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Herpetic Gingivostomatitis
146
honey crusted lesions
impetigo
