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Flashcards in 2015 Exam Deck (35):
1

Boy with lupus. Most likely test consistent with lupus:
- ANCA (+)
- HIGH plt
- HLA B27 (+)
- (+) RPR

(+) RPR

SLE: Thrombocytopenia typically (high much less common), ANA, anti-dsDNA antibodies, anti-Sm, False (+) RPR (syphilis test)

2

Absent reflexes. Fasciculation in 6 wk old with poor feed and hypotonia. What is next most diagnostic test?
- MRI
- thyroid function
- metabolic screen
- genetic testing

Genetics!

SMA= absent reflexes +/- tongue fasciculation
= SMN1 gene testing

3

3 y.o. with CP with pneumonia. Consolidation with effusion. best tx:
- cipro
- clinda + gent
- cefuroxime + azithro
- amp+ gent

Clinda + gent

CLIN= anaerobes, staph, strep
Gent= gram (-) bacilli and pseudomonas

4

Post tonsillectomy. Na 121 with serum osmolality 260. most consistent with:
- urine osmolality > serum
- serum osmolality> urine
- Urine Na < 0
- high U/O

Urine osmolality > serum.

Two factors:
- excessive hypotonic fluid in Sx
- SIADH due to non osmotic causes post-op (pain, low fluid etc.)

SIAD= low UO= urine osm > serum

5

2 y.o. with 2 wk proximal muscle weakness:
- congenital myopathy
- neuromuscular
- peripheral neuropathy
- SC injury

Congenital Myopathy

Central= HIE= DTR up, muscle bulk and power normal/low

Anterior Horn Cell= PROXIMAL; DTR low or absent
i.e. SMA= hypotonia, proximal, fasciculation, areflexia. SMN1 gene testing!

Peripheral= DISTAL.
i.e. Charcot Marie Tooth= teens, slow DISTAL weakness, tripping, foot drop, inverted champagne of lower leg, high arch, hammer tone, flat feet
W/U: nerve conduction study, EMG +/- genetic testing

Neuromuscular: muscle bulk and power normal but fluctuate.
i.e. Myasthenia Gravis= Ptosis, EOM weak, normal pupil, feeding issue, symmetric progressive distal limb with rapid fatigue. EMG!

Muscular Dystrophy=
i.e. DMD= distal= calf hypertrophy, muscle bx.

Myotonic Dystrophy = tent mouth, low DTR

6

When is the live flu vaccine contraindicated?

< 2

severe asthma (active wheeze, PO or high dose ICS, medically attended wheezing in last 7d)

immunocompromised

pregnancy

on ASA

<48h after antiviral agent against flu given

7

AOM with myringotomy tubes. Purulent drainage. Afebrile.
- Cx and wait
- Topical Abx and corticosteroid drop
- High dose amox
- Standard dose amox

Topical Abx and Corticosteroid Drop

8

Lots of pRBC. ECG complication?

Peaked T waves= high K

9

Acute rheumatic fever ECG finding?

Prolonged PR interval.

10

HTN, high temp. tachycardia. Due to?
- cocaine
- LSD
- marijauna

Cocaine= Sympathomimetic

11

Describe APGAR:

0-1-2

Appear= Blue, Acro, Pink
Grimace= None, grimace w/ stimulated, vs. 2 is sneezing, coughing or pulling away with stimulation
Pulse= None, < 100, > 100
Activity/Tone= 0, some flexion, full
Resp= None, Irregular, Full

12

Best test for nutritional vitamin D deficiency?
- Ca
- 1, 25 (OH)D
- 25-Vitamin D
- PTH

25 Vitamin D

13

BB screen comes back (+) for Carnitine palmitoyltransferase 2 deficiency. Best course until confirmed:
- start PO carnitine
- feed frequent (q3h)
- a.a. formula
- hyper caloric formula

= F.a. Oxidation Defect

= Avoid fasting!

14

What tumour is beck with Wiedemann at higher risk for?

Wilm's Tumour
Hepatoblastoma
Neuroblastoma
Adrenocortical carcinoma

Reminder: macrosomia, macrogloassia, omphalocele, HSM, ear pit, hypoglycaemia due to hyperinsulinemia, hemihyperplasia

15

Why do we irradiate blood given to prem?
- less CMV
- less GVHD
- sterilize RBC
- less hemolytic rxn

Less GVHD

Goal= prevent transfusion associated graft-versus host disease

Indication: infant, immunosuppressed or dficienct, bone marrow/stem cell transplant, intrauterine transfusion

16

Hemoglobin electrophoresis patterns:

HbAS (sickle trait)= ++ A + S
Hb SS (sickle dx)= ++ S; no A
Beta thal minor= A + variable F
Beta thal major= +++ F. No A
Alpha major= ++ A; HbH
HbBart= ++ HbH; no A.

17

8 y.o. with T1DM with abdo pain. Lost wt. Pruritic bulls lesions on extensor surface of arms + trunk. Likely dx?
- celiac dx
- IBD
- eosinophilic gsatroenteropathy
- eosinophilic gastroenteropathy
- parasitic infection

Celiac Dx

Dermatitis herpetiformis

18

What glomerular dx has low C3?

Post infectious
Membranoproliferazive
AI and Vasculitis (SLE)
Subacute bacterial endocarditis

Versus Normal
= IgA, anti-GBM, HSP, alport, polyarteritis nodosa

19

Leukocoria. Name 3 DX?

Retinoblastoma
Cataracts
Advanced ROP
Coats Dx
Toxocariasis

20

What do you do for SIADH

Fluid restrict

21

Most imp and two other organism for splenic pt?

Streptococcus pneumoniae

Other: Salmonella, Neisseria meningitidis, Haemophilus influenzae

22

Contractility vs. Peripheral vascular resistance. Describe the pattern for:
- Dopamine
- high dose epi
- low dose epi
- dobutamine

Dopamine: Up both
High dose: Up both
Low dose Epi: Contractibility up but no change to PVR
Dobutamine: Same as low dose epi

23

What are two investigations or dermatomyositis?

CK, AST, LD
EMG
+/- Muscle Bx

Reminder clinical dx:
= Classic Rash (heliotrope of eye lid + grotton) + min. 3 of
> weakness (symmetrical proximal)
> muscle enzyme (CK, AST, LDH)
> EMG change (Short small motor unit, fibrillation, (+) sharp wave)
> Muscle bx (necrosis, inflammation)

24

Short gut syndrome sequelae. Other than malnutrition and malabsorption:

➢ Dehydration
➢ Vitamin deficiency
➢ Malnutrition (i.e. Vitmain B12, folate, fat soluble vitamins, zinc, copper)
➢ **** Bacterial Overgrowth
➢ High rate of sepsis and cholestasis since may depend on TPN for long time
o **** Catheter infections
o ***** Cholestasis
➢ Central line infection, liver failure w/ long TPN use
o *** *Sepsis

25

Describe good control asthma:

< 4 daytime /week;
no nightly;
activity normal
no missed school

Moderate= daily daytime but no weekly night
Severe= weekly night use

26

Describe 4 organs other than MSK involved with DMD and their effect:

Cardiac: Cardiomyopathy
Resp: Hypoventilation
GI: constipation

OTHER: GI: obesity
OTHER: Steriod affect= osteopenia
CNS: intellectual impairment
MSK: intoning, calf hypertrophy, scoliosis, mobility down

27

Methanol long term complication

Blindness

28

Methanol treatment

ABC
Fomepizole
Give ethanol to stop methanol metabolism
+/- Na bicarb, folate, hemodialysis

29

4 features of atypical febrile seizure

More than 1 in 24 hour
Seizure > 15 minute
Focal symptom

+/- age < 6 or > 6 y.o.?

30

5 absolute contraindications for OCP int teen?

Migraine with aura
Severe cirrhosis
Severe uncontrolled HTN
History of Stroke
History of VTE or DVT
Current breast cancer

31

Name 3 RF for refeeding syndrome?

Weight < 80% of ideal weight for age, height and sex.
Not eating > 10 days.
Other: fast re-feeding

32

4 High risk groups for sever influenzae?

Pregnancy
< 5 year old (Neonates and Infants) (6-59 months)
Aboriginal, Inuit and First Nation.
Children with chronic disease. (i.e. CVS, liver, renal dx, neuro, anemia, CA etc.)
On Chronic ASA therapy
Elderly

33

FEV1 drop in CF. 5 reasons?

Infection: Pseudomonas
Infection: Stenotrophomonas
Infection: Burkholderia cepacia
Viral LRTI
ABPA
Smoking
Natural progression= Worsening bronchiectasis (progression of dx)
Non adherence to treatment (although they said she is)

34

Neonatal lupus. Two most common antibodies?

Anti-Ro
Anti-Lau

35

Three signs of neonatal lupus aside from congenital heart block:

Discoid rash
Hepatitis
Thrombocytopenia/ cytopenia