2016 Flashcards
1. What is the most likely side effect of inhaled steroids? Decreased linear growth. Immunosuppression Moon facies Hypertension
Decreased linear growth.
- 15 month old is seen in your office. What would make you the most concerned?
Not pointing to show interest
No words and part of a bilingual family
Cannot scribble with crayon
Not pointing to show interest
- A mother brings in her three children with concerns over strep throat. They are ages 18 mo, 2.5 years and 4 years. They have low grade fever. The tonsils are enlarged on the two youngest and has exudate. The older sibling has tender lymphadenopathy. What is your approach?
Treat all with Pen V, no swabs
Swab and wait for the culture results. Treat based on results.
Swab and treat.
Follow-up in 48 hours
Follow-up in 48 hours
4. (repeat question). 15 year old female with superficial marks on her arms. Admits to cutting behaviours. What would make you reassured. The cutting makes her feel better She just broke up with her boyfriend There is a family history of depression. Smokes marijuana regularly
The cutting makes her feel better
5. (Repeat question): You are treating a 5 year old boy for constipation. In addition to disimpaction, his mother asks you how long he will need to be treated with PEG for? 3 months 6 months Until he’s toilet trained 3 weeks
6 months
6. (Repeat question): You attend delivery of a 33 week infant, who requires 15 minutes of resuscitation including PPV, CPR and 2 rounds of epinephrine. Apgars are 2, 4 and 4. Initial gas is 6.98. What disqualifies this patient from cooling? Gestational age Length of resuscitation APGAR at 10 min gas
Gestational age
7. (Repeat question): In ED - 4 year old girl with newly diagnosed diabetes. Glucose 18.7, initial gas 7.14, bicarb 11. Insulin infusion is started, 2 hours later the girl has decreased level of consciousness. What would be your immediate next step? IV mannitol Bedside glucose stat Stat calcium, MG, PO4 Stat CT head
glucose
- (Repeat question): It is the beginning of RSV season; who qualifies for RSV prophylaxis?
2mo with cystic fibrosis
4 mo ex 31+6 wk without chronic lung disease
9 mo ex 33+6 wk with chronic lung disease requiring home O2
15 mo old with congenital heart disease, now corrected
9 mo ex 33+6 wk with chronic lung disease requiring home O2
9. (NEW question): 4 yo old girl is treated with amox - clav then develops 2 episodes of bloody diarrhea and mild abdominal pain. She is afebrile and otherwise well. Her stool culture is positive for C.diff. Other than stopping her antibiotics, what else would you do? Oral metronidazole x 10 days Oral clarithromycin x 10 days Oral vancomycin x 10 days Follow-up, no additional abx needed
follow up
10. (Repeat question): 15 year old girl with SOB, no wheeze and no response to puffers. What would give you the strongest support for vocal cord dysfunction? Normal oxygen saturation Vocal cord abduction with inspiration Truncated inspiratory loop on spirometry Normal chest xray
truncated loop
11. (Repeat question): Neonate with E. coli bacteremia, midline abdominal mass on physical examination. Increased serum creatinine. What investigation would most likely confirm the diagnosis? Renal ultrasound VCUG CT abdomen Urine culture
VCUG
- (Repeat question): A 3 week old baby presents with poor feeding and poor weight gain. He is jaundiced and has hepatosplenomegaly. His bilirubin is 170 with conjugated 115. Which imaging would you do next?
Abdominal ultrasound with dopplers- worry about BA
HIDA scan
CT abdomen
MRI abdomen
US
13. (Repeat question): 14 year old girl with asthma has throbbing headaches associated with nausea, photophobia. Her mother has a history of migraines. What treatment do you offer for prophylaxis? Amitriptyline Propranolol Phenytoin Sumatriptan Ergotamine
amitryptiline
14. (Repeat question): a 3 year old boy is in your office. He is very energetic, aggressive and destructive. His height is on the 50th percentile and his weight on the 95th percentile. He is described as having a voracious appetite. He comes to see you and hugs you. He speaks in 1 word sentences. What is the diagnosis? Emotional deprivation Diencephalic syndrome Prader Willi syndrome ADHD
emotional deprivation
- (New question): a 14 year old boy has epigastric pain, dysphagia with solids and weight loss. He is scoped and diagnosed with eosinophilic esophagitis. What management would you recommend?
Referral to Allergy for skin testing to identify potential allergens
PPI
Oral fluticasone
Oral prednisone
fluticasone
24h old newborn with the picture shown above (small swelling, not crossing suture line). What to do/tell parents?
Head imaging to see extent
No further intervention and it will resolve spontaneously in 2-12 weeks
Provide analgesia and it will resolve spontaneously in the next few days
Monitor head circumference and Hgb x 24 hours as can become hemorrhagic shock
no further intervention
- 7 year old girl discloses to you that she has been sexually abused by her 15 year old brother for the last 2 years. On genital examination with her lying supine, you see a partial cleft in the inferior hymen rim. Which is true?
Diagnostic of previous trauma to the hymen
Congenital malformation
Normal variant
Diagnostic of sexual abuse
normal variant
7 year old girl with persistent cough, wheeze, nighttime cough, worse with activity. FEV1/FVC is 75%, bronchodilator increases her FEV1 by 15%. What do you recommend?
Inhaled corticosteroid with SABA PRN
Avoid the activities that trigger the symptoms
ICS with SABA PRN
You are called to see a newborn with the following rash. What is it? (erythema, papule, spares folds) Herpes simplex virus Miliaria - comes at 1 week Erythema toxicum - comes at 24-48 hours Neonatal pustular melanosis
erythema toxicum
4 year old adolescent girl who you haven’t seen in the last 2 years comes in for routine check-up. When she bends forward, you note a large thoracic asymmetry. Spine X-ray shows a Cobb angle of 50 degrees. What do you do next? Repeat X-ray in 3 months Custom thoracolumbar spine brace Spinal fusion Electro-something stimulation
spinal fusion
Young boy with an axillary lymph node for the last 10 days. He has been afebrile and otherwise well. The node is mildly tender, no overlying erythema. Which investigation would be most useful?
a) Monospot for EBV
b) TB
c) Bartonella
d) excisional biopsy
Bartonella
Mother uses marijuana for chronic pain. Breastfeeding. What do you tell her about the risks to the baby:
a) continue breastfeeding. Benefits of breastfeeding outweigh risk of marijuana
b) marijuana is contraindicated due to risks on the developing brain
c) recent studies on the legal use of marijuana found no risk
d) Counsel to stop using marijuana. Risks to baby unknown.
d) Call CAS
risks to baby unknown
oung boy with varicella infection. A lesion on his leg has become larger and red. Now has large painful indurated area that is a bluish hue overlying. Which antibiotics to use?
a) penicillin and clinda- Nec fasc
b) ceftriaxone and vanco
c) Cloxicillin
d) pipercillin and tazobactam
penicillina dn clinda
A 10 year old boy with previously repaired TAPVD comes to your office with symptoms of ADHD. He is on no medications currently and has been well. Your next best step is:
a) Start stimulants
b) ECG
b) Refer to psychiatry
d) Continue to monitor
ECG
