2016 and 2017 Exams Flashcards by Caitlin Carew

An infant has a sacral dimple. What would make you more concerned about spinal dysraphism?
Slate-gray nevus over dimple
Located 2 cm from anal verge
3 mm in diameter
Located above the gluteal cleft

Located above the gluteal cleft

atypical dimple (deep, >5mm, >25mm from anal verge)
consider early neurosurgery referral (before imaging) for dimples superior to the gluteal cleft (hallmark of dermal sinus tract that predispose to meningitis

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You see a teenager in your clinic with progressive dysphagia to solids and epigastric pain.  He has been diagnosed with eosinophilic esophagitis, and a referral has been sent for allergy testing.  In the meantime, what should you do?
Elimination diet
Oral fluticasone by MDI
Proton-pump inhibitor
Oral Prednisone

Proton-pump inhibitor

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ou see a child with fever, arthralgias, and a rash on his lower limbs (see picture below). What test needs to be done now?
Abdominal ultrasound
Urinalysis
IgA

Urinalysis

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You see a mother in clinic with her 6 month-old infant.  The mother is anti-HCV positive, and has a history of IV drug use.  The infant’s anti-HCV is negative.  What do you do for the infant?
HCV PCR
Reassure
Livery Biopsy
Repeat anti-HCV in 6 months

Reassure

CPS statement - if baby has a negative HCV antibody at any time, it means transmission did not occur or the infection was cleared

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A 6 year old boy is brought into the ER by ambulance after a high speed MVA. He is moaning and not responsive, extends his arms and legs to pain. His respiratory rate is 18, BP is 120/60, HR is 130. His pupils are 4mm bilaterally and reactive. What is your next step of management?

a) RSI
b) Mannitol
c) CT head
d) NS bolus

a) RSI

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An 11 year old boy has been calling his mother very frequently to see if she’s alright because he worries that something terrible is going to happen to her. He does not want to go to school because he worries about leaving her. En route to school, he never steps on the cracks and when a green car passes, he needs to take an alternate route. What do you use to treat?

a) Benzodiazepine
b) Family therapy
c) Fluoxetine
d) Gradual exposure therapy

d) Gradual exposure therapy

c) Fluoxetine - for more severe OCD

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An 18 year old boy has asthma, for which he is on inhaled salbutamol and fluoxetine, 250ucg INH bid. He has 3-4 exacerbations per month, for which he doubles the dose. He was last on oral prednisone a few weeks ago. He now presents to the ED with 1-2 days of illness, decreased PO intake and vomiting, dizziness and feeling unwell. His glucose is found to be 1.8. What is the etiology?

a) X-linked adrenoleukodystrophy
b) Ketotic hypoglycemia
c) Adrenal insufficiency
d) Addison’s disease

c) Adrenal insufficiency

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A 3 year old girl is on 50ucg of fluoxetine INH BID for asthma. She has 2 nightly exacerbations per week and has missed a few days of daycare. On exam, she is breathing comfortably and has no wheeze; however, she does have a prolonged expiratory phase. How do you change your management?

a) Add a LABA
b) Add a Leukotriene inhibitor
c) Start oral prednisone
d) Increase dose of fluoxetine to 100ucg BID

d) Increase dose of fluoxetine to 100ucg BID

For older kids can consider staying on low dose in haled corticosteroid and adding LABA

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An 18 month old girl has periorbital swelling. Her albumin is 26. Her urine is negative for protein. What do you do for diagnosis?

a) Serum tripsin
b) Stool alpha anti-tripsin
c) Urine creatnine excretion
d) ECHO

b) Stool alpha anti-tripsin

Stool alpha-1-antitrypsin is screen for PLE

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A girl presents for scalp itching and is found to have nits and lice. What do you recommend regarding return to school?

a) After completing treatment
b) Immediately
c) After she is found to have no evidence of infection

b) Immediately

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A 10 year old child twists his ankle playing soccer. He presents to the ER, where he is able to bear some weight but with ++ pain. What findings on physical exam would prompt you to order an x-ray?

a) If he has pain on palpation anterior to the medial malleolus
b) If he was unable to walk immediately after the injury
c) If he has pain on palpation posterior to medial malleolus
d) If there is swelling

b) If he was unable to walk immediately after the injury
c) If he has pain on palpation posterior to medial malleolus

Ottawa ankle rules: An ankle X-Ray series is only required if there is any pain in the malleolar zone and…
Bone tenderness at the posterior edge or tip of the lateral malleolus (A)
OR
Bone tenderness at the posterior edge or tip of the medial malleolus (B)
OR
An inability to bear weight both immediately and in the emergency department for four steps

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An 8 day old infant presents with Na 164, K 4.7. What is the most likely etiology?

a) Munchausen by proxy
b) Inadequate breastfeeding
c) CAH
d) RTA

b) Inadequate breastfeeding

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What is the best way to prevent people with disabilities from suffering sexual abuse

a) Less autonomy
b) Putting them in day facilities with more supervision
c) Better sexual education

c) Better sexual education

CPS:

institutional: chaperoning physical exams and procedures, supervised outings
educational: sexual health education on personal rights, safer sex and sexual abuse

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A child presents a few days after tonsillectomy with dysphagia and worsening pain, on standing Tylenol. He is afebrile. You admit and start him on IV fluids. What is your next step in management - there is a picture of an eschar

a) Start Nystatin
b) Start amoxicillin
c) Start Codeine
d) Optimize dosing of acetaminophen

c) Start Codeine

Could be acetaminophen - but seems like already optimized

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For adolescent girls, which would be the most concerning in terms of height velocity
Tanner stage 2, growing 6cm/year
Tanner stage 3, growing 4cm/year
Tanner stage 4, growing 5cm/year
Tanner stage 5, growing 1cm/year

Tanner stage 3, growing 4cm/year

PIR: girls have growth spurt between tanner 2-3, occurs over 2-3 years, peak height velocity ranges from 6-10cm/year

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Which is true of ophthalmia neonatorum
The most common organism is Neisseria Gonorrhea, but it is now almost always resistant to the prophylaxis, therefore prophylaxis is not indicated
Ophthalmia neonatorum can lead to significant eye injuries and blindness, therefore antibiotic prophylaxis is indicated
The most efficient way of preventing it is through screening and treatment of pregnant women rather than the current prophylaxis

The most efficient way of preventing it is through screening and treatment of pregnant women rather than the current prophylaxis

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8 year old anxious kid. No issues with body image or fear of gaining weight. He has become more selective with his eating and now only eats chocolate pudding. His weight has decreased from 50th%ile to 10th%il.e. What is the diagnosis?

a) Picky eater
b) Avoidant/Restrictive food intake disorder
c) Anorexia nervosa
d) Bulimia

b) Avoidant/Restrictive food intake disorder

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What is important to know in order to determine if BP is within normal range?

a) Weight
b) Ethnicity
c) Height
d) Age

c) Height

this is what most groups are saying

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Repeat question about a 9 year old whose parents are getting a divorce and they ask what type of behavior she will exhibit:
Developmental regression
Pick sides (mother vs. father) and blame the other parent
Try to make everyone happy
Blame herself for the divorce

ANSWER: Pick sides (mother vs. father) and blame the other parent - school age children have strong sense of rules and fairness and may pick sides

Developmental regression - <3 years
Try to make everyone happy - no one
Blame herself for the divorce - blame self and becomes clingy age 4-5

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10 month old recently immigrated from refugee camp in Turkey. He received 3 oral vaccines and 3 injectable vaccines in his lifetime (question did not specify which vaccines). What do you give him at his first visit to you?
Pneumococcal + Hib
DTAP/IPV/Hib + Pneumococcal
DTAP/IPV/Hib + Pneumococcal + Hep B
No other vaccination at this time

DTAP/IPV/Hib + Pneumococcal + Hep B

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Newborn with difficult delivery. Myrdriasis. Normal tone. Slightly irritable. What is his Sarnat stage?

a) 0
b) 1
c) 2
d) 3

b) 1

mydriasis mild, normal tone mild, irritable not mentioned but ?in keeping with hyperalertness (mild)

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PGE1 being started for a duct-dependent lesion in a newborn. Which of the following is the following is MOST important to monitor for?
Hypertension
Hypoglycemia
Hypoventilation
Lactic acidosis

Hypoventilation

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1 month old with achondroplasia. What is the MOST important investigation to request at this time?
EEG
MRI brain
Xray spine

MRI brain

PIR health supervision for achondroplasia
central apnea from compression of vessels at foramen magnum leads to unexpected death in infants with achondroplasia
every infant with achon should have assessment including neuro history, exam, neuroimaging and polysomnography
neuroimaging can be by CT or MRI - visualize brainstem and upper cervical cord

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5yo boy with tympanostomy tubes, presenting with 7 days of left otorrhea and ear pain. He is afebrile and otherwise well. What is the BEST next step in management?
Reassurance
Otic quinolone and steroid drops
Amoxicillin

Otic quinolone and steroid drops

UTD: uncomplicated acute t-tube otorrhea - topical therapy with fluoroquinolone plus steroid drops x5-7 days
observation is an option as about half will resolve spontaneously
complicated TTO (including severe symptoms like fever, lethargy, severe ear pain, associated URTI symptoms) treat with amox

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``` 12 year old embarking upon a vegan diet. Which of the following is the BEST advice to give? Take VB12 supplements Take Zinc supplements Take VitD supplements See a dietician ```

See a dietician

12 yo boy breaking things at home, not listening to instructions, and skipping school. He seems angry. What is the next BEST step? Parent training Start an atypical anti-psychotic Start an SSRI

Parent training

Mother of a 3 yo girl is concerned about her speech. She said her first words at 11 months. There are no concerns with development. She has had difficult speaking: will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speaking in the middle of sentences. This is associated with facial twitches and blinking. What do you recommend? a. Audiology b. Developmental assessment c. Reassure d. Refer to SLP

d. Refer to SLP Kids with stuttering should be referred to SLP (differentiate stuttering from developmental dysfluency - 2 or more repetitions, airflow interrupted, tension, pauses after dysfluency)

A 2 yo boy presents with pallor. He has been drinking 1L of milk each, but does each a varied diet. Bloodwork is as follows: Hb 49, MCV 80. RDW is 14%. Peripheral blood smear: normal. Hemoglobin electrophoresis: Hb A and Hb S [exact wording on exam]. Which of the following conditions is most likely? Transient erythroblastopenia of childhood Iron deficiency anemia c. Sickle cell disease

Transient erythroblastopenia of childhood TEC: previously healthy kids 6 months to 3 years of age moderate to severe normocytic anemia reticulocytopenia

A 6-week old boy has begun having loose stools, some of them blood-tinged. Exclusively breastfed. Which is most likely? Meckel’s b. Food protein-induced proctocolitis c. Infectious colitis

b. Food protein-induced proctocolitis

At what age should screening begin with PAP smear? 21 years 18 years After sexual intercourse

21 years

A child presents to ER with bruising on face and her response to pain is withdrawal on one side only. Vitals revealed hypotension. What is your next management step: CT head GIve NS bolus bolus via intraosseous Hydrocortisone IV

GIve NS bolus bolus via intraosseous

Adolescent girl with bulimia who smokes 1.5 packs/day wants to quit, and is interested in nicotine replacement. Which of the following is a contraindication? There is no contraindication That she still smokes a few cigarettes once in a while That she is <18 years old Her eating disorder

There is no contraindication Bupropion contraindicated with bulimia (seizures)

``` Child with acute otitis media is taking amoxicillin and has two episodes of bloody diarrhea, Is otherwise afebrile and well. Besides discontinuing the current antibiotic, what else would you do to manage this child? Close follow up PO metronidazole PO vancomycin PO clindamycin ```

Close follow up

``` 2 year old infant presents with refusal to weight bear and is found on imaging to have a spiral fracture. What is the most likely explanation? Toddler’s fracture Non accidental injury Metabolic bone disease Osteogenesis imperfecta ```

Toddler’s fracture

Child is admitted with strep pneumo bacteremia and started on ampicillin. Shortly after receiving antibiotics has decreased LOC and urticaria. Tachycardic and hypotensive. What would you do? IV epinephrine (**it really said IV, not IM!) IV benadryl Normal saline bolus Oral cetirazine

Normal saline bolus

Teen female with type 1 diabetes presents with decreasing weight, falling off the growth curve. Weight was previously at the 50th percentile and now is below the 10th. Doing well in school and gets all A’s in her classes. HbA1C 7.5%. What is the most likely cause? Eating disorder Diabetic ketoacidosis Celiac disease

Eating disorder

Two year old child is brought in by her parents for concerning behaviour. Cries and screams when she is not able to get what she wants and sometimes these episodes are associated with her turning blue and having jerking movements (breath holding spell). Parents want to know what to do about these episodes? Ignore the behaviour, then put the child in time out afterwards Interrupt the behaviour with a time out before it escalates Give the child what they want to avoid the behaviour

Interrupt the behaviour with a time out before it escalates

``` 5 year old boy with with 3-4 days of ear pain, controlled by acetaminophen. He is afebrile and tearful on exam, with a dull tympanic membrane with evidence of middle ear effusion. What is your next step in management. No treatment, reassess in 48 hours 5 days amoxicillin 7 days amoxicillin 10 days amoxicillin ```

No treatment, reassess in 48 hours depends if there is a bulge or not - if no bulge, don't treat, if there is a bulge should treat

Woman 28 weeks pregnant, with 2 and 5 year old children at home. What is the best way to prevent influenza in the new baby within the first 6 months of life? Inactivated vaccine for mom right now Inactivated vaccine for mom after birth Inactivated vaccine for dad and two kids, no vaccine for mom Inactivated vaccine for dad, live attenuated vaccine for two kids, no vaccine for mom

Inactivated vaccine for mom right now

``` You are seeing a 1 day old newborn, with truncus arteriosus. What are they most likely to develop over the first week of life? pulmonary edema severe cyanosis shock pulmonary hypertension ```

pulmonary edema

``` 2 month old child is found to have respiratory distress and focal right-sided crackles on exam. A CXR was done showing a defect of the right diaphragm, CHD vs evantration. What is the next test? Diaphragm Fluroscopy MRI chest CT chest Exploratory laparoscopy ```

Diaphragm Fluroscopy Next test should be U/S; if still can’t tell on U/S UTD says there is some promise for a new MRI technique but it’s not generally used yet. “the results of the [U/S[ study may not always be definitive, and thus the diagnosis in these unresolved cases is only made with direct visualization in the operating room” - radiopedia - fluoroscopy to assess diaphragmatic movement with inspiration

``` What is the minimum requirement to sit in a car with a seatbelt and no car seat? 135cm 145cm 150cm 155cm ```

145cm | and 36kg

``` Description of a 2 month old baby with colic. Tolerating breastfeeding well, normal exam. What is the best management? Encourage mom to continue breast feeding Add cows milk based formula in diet Add soy based formula in diet Simethicone ```

Encourage mom to continue breast feeding

``` Patient with CF, description of pulmonary exacerbation with a decrease in FEV1 and decrease in weight, increase cough with increased sputum. What is the likely pathogen? Burkholderia cepatia Pseudomonas aeruginosa Stenotrophomonas Aspergillus ```

Pseudomonas aeruginosa If rust tinged sputum then aspergillus

``` 7 year-old girl discloses that her 14 yo step brother has been sexually abusing her. On exam you find a complete cleft in the posterior hymen. This is: Diagnostic of sexual abuse Diagnostic of previous hymenal injury Normal variant Congenital abnormality ```

Diagnostic of previous hymenal injury

``` Teenage boy with acne, currently on topical antibiotic and BP in the AM, and topical retinoids in the PM. No symptomatic improvement. What is your next step in management? Minocyclin Clindamycin Isotretintoin Cefazolin ```

Minocyclin

2 year old child with fever for the past 2-3 weeks (up to 39 C), lymphadenopathy and mild hepatosplenomegaly presents complaining of joint pain. There is no true arthritis, but complains of pain with movement of joints. Hgb 91, WBC 9 (45% lymp, 55% PMN), platelets of 110. What is your next step in establishing diagnosis? a. BMA b. Blood culture c. ANCA, ESR and RF d. EBV serologies

a. BMA

11 year old boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management? a. Alarm b. Imipramine c. DDAVP d. Oxybutynin

a. Alarm

10 year old girl with migratory arthritis for last 10 days, now affecting left wrist. She is febrile, and has an ESR of 40. Most LIKELY diagnosis is a. SLE b. Rheumatic fever c. JIA d. Septic arthritis

b. Rheumatic fever

18 month old boy with first episode febrile seizure. What factor influences likelihood of repeat febrile seizure? a. MRI result b. EEG result c. Family history of febrile seizures d. Etiology of fever

c. Family history of febrile seizures

2 year old with mild metatarsus adductus and tibial torsion who has had intoeing since birth. There has been no improvement. They are presenting to your office today. The best advice is: 1. Reassurance 2. Hip, knee, tibia, foot x-rays 3. Referral to orthopedics 4. Advise them not sit in W position

1. Reassurance

15 year old girl who has undergone puberty, with a normal exam, who is in your office and shares that she feels that she has always identified more as a boy. She is is very distressed by her breast growth and menstruation. Most appropriate plan: a. Listen attentively and referral for gender dysphoria b. LH, FSH, estrogen levels c. Listen attentively and reassure that this is part of normal development

a. Listen attentively and referral for gender dysphoria

16 year old girl presenting with fever and disseminating rash. She has a fever of 39.5, and blood pressure of 85/40, HR 130, RR 30 and saturations of 92%. She has bounding pulses and capillary refill 2 seconds. She has already received 60 cc/kg of normal saline. What is the most appropriate choice for treatment? a. Dopamine b. Epinephrine c. Norepinephrine d. Dobutamine

c. Norepinephrine

2 year old swallows a 8 mm coin battery 2 hours ago. Stable. On x-ray, it is found in the stomach. What is the next step in management? a. Consult for endoscopic removal b. Wait for 48 hours, follow serially with x-rays c. Wait for 10 days, follow serially with x-rays D. Reassess if it does not appear in the stoo

c. Wait for 10 days, follow serially with x-rays NASPGHAN for asymptomatic patients: younger than 5 years and battery greater than 20mm should have emergency endoscopic removal 5 or older and ingested battery greater than 20mm should have repeat XR in 48h all ages, battery <20mm repeat XR in 10-14 days if battery has not passed in stool - if still in stomach remove it endoscopically

Kid with orbital cellulitis of the right eye being treated with ceftriaxone. Next day lethargic and swelling/erythema of the left eye develops. What do you do? Add vancomycin Consult surgery to drain an orbital abscess MRI brain

MRI brain

A 15 year old otherwise healthy female is sexually active and comes in for a annual health check. According to the Greig health record, which of the following should she get: Chlamydia, gonorrhea testing Chlamydia, gonorrhea and HIV testing Chlamydia, gonorrhea, HIV testing and Pap smear

Chlamydia, gonorrhea and HIV testing

``` A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it? Today 1 month 6 months 11 months ```

Today

Which of the following is most consistent with a boy who is tanner 3? Increased axillary hair Voice deepening Pubic hair is becoming curly

Pubic hair is becoming curly Voice deepening - tanner 4

16 year old girl complains of feeling dizzy and palpitations – it occurs within 5 minutes of standing upright. Her supine blood pressure is 118/70 and her supine heart rate is 84bpm. When she stands up, her blood pressure is 116/68 and her heart rate is 120bpm. What is the diagnosis? Orthostatic hypotension Long QT Postural orthostatic tachycardia syndrome

Postural orthostatic tachycardia syndrome

A 10 year old boy comes to the emerg with eye pain. On exam, there is conjunctival injection and tearing of the eye. There is no purulent discharge. There is no periorbital rash. He has a cold sore on his lip. What is the next step in management? Do a slit lamp exam with fluorescein Prescribe polytrim eye drops Prescribe topical steroid eye drops

Do a slit lamp exam with fluorescein

``` A 7 year old boy has recent onset hyperactivity and inattention in school. On exam, he also has ataxia. His maternal uncle died at the age of 10 with similar symptoms. What does he have? Friedrich ataxia X-linked adrenoleukodystrophy DMD Ataxia telangiectasia ```

X-linked adrenoleukodystrophy

A 4 year old girl has AOM and postauricular swelling. CT scan shows mastoiditis. Other than IV antibiotics, what else should be done? a. Myringotomy b. Topical antibiotics

a. Myringotomy

``` A 7 day old baby has lax abdominal muscles, bilateral cryptorchidism, poor urine stream and bilateral abdominal masses. What is the most likely cause of the abdominal masses? a. Hydronephrosis B. Multicystic kidneys C. Polycystic kidneys D. Wilms tumor ```

a. Hydronephrosis

What makes you worried about starting fluoxetine on a teenager with depression: a. History of cardiac surgery b. History of anxiety c. Family history of bipolar disorder d. Family history of suicide

c. Family history of bipolar disorder

A teenager has long QT syndrome. He also has been having syncopal episodes while participating in sport. What is the best course of management: a. Start CCB and restrict vigorous activity b. Start CCB and do not restrict activity c. Start beta blocker and restrict vigorous activity d. Start beta blocker and do not restrict activity

c. Start beta blocker and restrict vigorous activity

5 year old with exercise intolerance. On examination he has a slight heave at the left lower sternal border. His first heart sound is normal, the second heart sound is split and quieter. He has a Harsh ejection systolic murmur loudest at the left upper sternal border. What is the most likely cause? a. Mitral stenosis b. Mitral valve prolapse c. Aortic stenosis d. Pulmonary stenosis

d. Pulmonary stenosis

1 month old with bronchiolitis admitted with poor feeding . On examination there is mild intercostal recession, tachypnea and bilateral wheeze. At what oxygen saturation do you apply oxygen: a. < 88% b. < 90% c. <94% d. <96%

b. < 90%

You are treating a teenage boy with pericarditis. You suspect that his pericarditis might be secondary to SLE. Which of the following is most supportive of this diagnosis? a. Positive RPR b. Positive ANCA c. Positive HLAB27 d. Thrombocytosis

a. Positive RPR

0 year old girl with an enlarged thyroid, diffuse nontender. T4 6.6 TSH >50, thyroid antibodies positive. What is your next step in management? 1. Start methimazole 2. Order thyroid ultrasound 3. Order radionuclide scan 4. Start levothyroxine

4. Start levothyroxine

Boy with stable ADHD has been on a stable dose of stimulant for the last two years. Had started to become very aggressive when spoken to and gets easily frustrated when he doesn't get what he wants. You’ve already ruled out psychosocial stressors. What do you want to do as your next step: 1. Benzo prn 2. Increase psychostimulant 3. Add SSRI 4. Add atypical antipsychotic

2. Increase psychostimulant

What is the utility behind a fecal calprotectin? 1. To differentiate between functional abdominal disorder and IBD. 2. To differentiate between IBS and IBD 3. To determine the severity of inflammation in IBD 4. To diagnose post infectious IBS

2. To differentiate between IBS and IBD UTD: increased fecal calprotectin associated with presence of gut inflammation - if negative in low suspicion of IBD can rule out IBD, if positive in high suspicion of IBD can rule in IBD

Child with 5 vomiting episodes over the last 12 months, associated with pallor, lasting 2-3 hours. Between episodes she is other well, growing and thriving, with a normal examination. What do you want to do 1. Reassure 2. Refer to gastroenterology 3. Neuroimaging 4. Start PPI

1. Reassure :***nat’s group said B - some sources say need to scope since cyclic vomiting is diagnosis of exclusion

Child with BMI 25. Cough and shortness of breath with gym class. Dad had allergic rhinitis and boy has history of mild eczema. FEV1 82% and FVC 80%. With ventolin, FEV1 increases to 87% and FVC to 85%. Treatment? 1. salbutamol prior to exercise  2. steroid inhaler 3. Physical conditioning program 4. steroids po

3. Physical conditioning program

``` 17 year old male with history of enthesis related JIA comes to your office. Just had a new baby girl with his girlfriend and would like to quit smoking for her sake. What puts him MOST at risk of not being able to quit Chronic illness Male gender Older adolescent Parenthood ```

Chronic illness all others make you more likely to quit

Mother brings her 6 month old baby boy to you office. He has had two episodes of AOM since birth. He also has eczema and some bloody stool. He also had prolonged bleeding after his circumcision. What is the likely diagnosis?

Wiskott Aldrich

``` 16 year old girl comes to your office. Her BMI is 27 and she has stage 1 hypertension. No protein present on urinalysis. What is the next step in managing her high blood pressure? Beta blocker Calcium channel blocker Lifestyle ACEi ```

Lifestyle

A 7yo boy has been complaining intermittently over the last 2 days of abdominal pain and has had non-bilious emesis. He has had several dark red mucousy stools. He is tender on palpation over the RUQ. Which imaging test would reveal the diagnosis? 1. UGI 2. Technetium 99 scan 3. Abdo U/S 4. Colonoscopy

3. Abdo U/S - intussusception

Child with hemihypertrophy. Other than Wilms tumors, what other neoplasm do you need to screen for: a) Neuroblastoma b) Hepatoblastoma c) No other neoplasms

b) Hepatoblastoma

``` Child referred to you with suspicion of celiac disease. Had anti-TTG done, which was negative. What is your next step. Refer to GI Endoscopy with biopsy Anti-gliadin antibodies Measure IgA ```

Measure IgA

Newborn baby with bump on head as shown below. Term infant, afebrile, spontaneous vaginal delivery. What should you do? CT brain, to determine the extent of the bleed as this can be very serious Close observation over 24 hours with serial head circumference measurement Repeat CBC Reassure that this will resolve over the course of 2-12 weeks

Reassure that this will resolve over the course of 2-12 weeks

Baby in the NICU with significant hypotonia, requiring gavage feeding. Puffy hands and feet. What is the most likely diagnosis? Prader Willi Turner’s Trisomy 21

Prader Willi

Newborn baby with 0.8 x 0.4 cm blister on right hand. Term infant, normal pregnancy. Mom had normal antenatal screening with no concerns, normal physical exam. Born by spontaneous vaginal delivery. What should you do? a. Reassure b. Treat with antibiotics c. Treat with acyclovir

a. Reassure

1. 8 year old girl with epigastric discomfort for many months, progressively getting worse and now waking her up at night time. Her father has peptic ulcer disease, and she has in fact tried his antacids with some relief. What should you do? Reassure, she can use the antacid as needed Treat empirically with PPI, amoxicillin, clarithromycin Urea breath test Esophagoduodenoscopy with biopsy

Esophagoduodenoscopy with biopsy - looking for ulcers to decide if you should treat (new guidelines - antimicrobial resistance getting worse) *Urea breath test - only for monitoring, along with serology, not diagnosis

``` Toddler with long history of eczema currently receiving treatment with topical steroids comes in with an acute worsening of his rash, as shown below -punched out lesions. What is the best treatment? Cefazolin Acylovir Reassurance Topical nystatin ```

Acylovir

``` 6 year old boy with history of ADHD on Vyvanse. His mother notes him becoming more withdrawn and secretive over the past year, wanting to spend all his time in his room and away from friends and family, on his computer. She has also noted money missing from her purse and strange charges on her credit card from an unknown source. What should you do? Increase his medication dosage Assess him for gambling problems Add a mood stabilizer Reassure ```

Assess him for gambling problems

``` ID 9 week old baby presenting with fever (~39.5). Tachycardic and irritable. Labs demonstrated WBC 4.5 (60% neutrophils, 40% leukocytes), serum glucose 4.5. LP done, shows 400 RBCs, 100 WBCs, glucose 1.5, protein normal. Gram stain of CSF is negative for bacteria. How do you treat? Ampicillin and cefotaxime Vancomycin and ceftriaxone Cefuroxime and Acyclovir Acyclovir alone ```

Vancomycin and ceftriaxone

``` A mother brings in her baby with concerns about his head shape. This is what the head looks like (this was the exact photo from the exam!)  What is the most likely diagnosis? Positional plagiocephaly Lambdoid craniosynostosis Dolicocephaly Scaphocephaly ```

Positional plagiocephaly

A girl comes in complaining of this itchy rash. What is the diagnosis? Herald patch with diffuse maculopapular rash

Pityriasis rosea

A 5 year old by has had a one week history of fever and cough. He was started on amoxicillin. He develops this rash (there was a blurry photo of what looked like Erythema Multiforme). What is the most likely etiology of the rash? Mycoplasma HSV Amoxicillin

Mycoplasma

What is the most common side effect of marijuana? Increased insulin secretion Gynecomastia

Gynecomastia

A 5 day old baby is seen in your clinic. Pregnancy was unremarkable, no ABO incompatibility. The baby is breastfeeding. The unconjugated bilirubin is 200. What do you do? (**note: they did NOT provide the phototherapy curves!) Start phototherapy Reassure Check for G6PD

Reassure

What is the most common cause for central apnea in a 2 month old baby who is an ex-34 weeker? (*note: ‘apnea of prematurity’ was not an answer option) Seizures RSV

RSV Yes this does cause central apnea

A neonate has congenital CMV and the audiology screen shows sensorineural hearing loss. How do you treat? Valganciclovir for 4 weeks Valganciclovir for 6 months Reassure

Valganciclovir for 6 months

A young child who comes to the ER with hypoglycemia. Improves very quickly and completely with IV dextrose. What would be in keeping with this diagnosis? Urinary ketones Inappropriately high insulin level Failed ACTH stim test

Urinary ketones

A newborn baby with platelets of 10. Mom also has low platelets. What is the diagnosis? Autoimmune thrombocytopenia Alloimmune thrombocytopenia TAR

Autoimmune thrombocytopenia

``` 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

No words and part of a bilingual family

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 hour

Swab and wait for the culture results. Treat based on results.

``` 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.

``` 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

``` 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

``` 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 ```

Bedside glucose stat

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

``` 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, no additional abx needed

``` 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 inspiratory loop on spirometry

``` 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

``` 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 HIDA scan CT abdomen MRI abdomen ```

Abdominal ultrasound with dopplers

``` 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 ```

Amitriptyline

``` 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

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

PPI

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

Inhaled corticosteroid with SABA PRN

``` 14 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

c) 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 c) Counsel to stop using marijuana. Risks to baby unknown. d) Call CAS

c) Counsel to stop using marijuana. Risks to baby unknown.

Young 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 b) ceftriaxone and vanco c) Cloxicillin d) pipercillin and tazobactam

a) penicillin and 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

a) Start stimulants

A boy with Hemophilia A who is managed at home with recombinant Factor VIII presents with increasing episodes of bleeding and hemarthrosis of the ankle despite medication compliance. Your next step: a) Check FVIII and inhibitor levels b) Add DDAVP to the current regime c) Try another FVIII product d) Manage ankle with NSAIDs and rest.

a) Check FVIII and inhibitor levels

You are called to a twin delivery. Twin A is 2800g with Hct 0.70 and Twin B is 2100g and Hct 0.40 What are you most likely to see in Twin A: a) Hypoglycemia b) RDS c) CHF

c) CHF

A baby is diagnosed with Erb’s palsy. What are you likely to see: a) symmetric Moro b) intact biceps reflex c) intact grasp reflex d) intact wrist extension

c) intact grasp reflex

You are seeing an adolescent male with a history of asthma. He is complaining of worsening asthma symptoms despite compliance with his inhalers. He admits that his group of friends has recently starting vaping and dripping. You advise: a) Advise him not to be around his friends when they are dripping b) advise him there is no harm in the use of e-cigarette products c) Advise him to not be around his friends when they are using e-cigarette products d) Advise him not be around his friends when they use e-cigarette products with nicotine e) He should tell his friends to stop vaping

c) Advise him to not be around his friends when they are using e-cigarette products

A 10 year old with sickle cell anemia presents with fever and respiratory distress. On CXR there is a new infiltrate. Your next most important step: a) Order type and screen and transfuse - only transfuse if needing oxygen b) IV antibiotics c) IV hydration at 2x maintenance d) Start hydroxyurea

b) IV antibiotics

An 7 day old term Asian baby presents with jaundice. He looks well. Mom’s blood type AB+, baby B+. Hgb 104, bilirubin 207, retics 8%. Most likely etiology: a) Sepsis b) ABO incompatibility c) G6PD d) Thalassemia

c) G6PD

A 15 year-old female presents to you after her 17 year-old male partner was treated for gonorrhea. What do you need to do before you provide her with antibiotic treatment: a. Provide right away b. Call CAS c. Call parents for consent 4. Call CAS and call the parents for consent

a. Provide right away

12 year-old teen presents to your office and tells you she would like to begin a vegan diet. What is the best advice you can give her today: a. Vitamin B12 b. Iron c. Consult a dietitician or nutritionist d. Calcium supplements

c. Consult a dietitician or nutritionist

``` 4 year old child with nephrotic syndrome on steroids. Presents with a swollen and tender abdomen. Looks septic. What test would give you the diagnostic: a. Paracentesis b. CT scan c. MRI D. Laparotomy ```

a. Paracentesis

6 year old child who was growing 3 cm/year, height now <5th percentile and 50% for weight. Bone age 4 years. Diagnosis? a. Celiac disease b. GH deficiency c. Turner syndrome

b. GH deficiency

15 year-old male present with mild popular and comedogenic (? papulopustular, not comedogenic?) acne on face, trunk and back. Previously only using soap to wash his skin. Next step for treatment: a. Tetracycline PO b. Erythromycin cream c. Combination of topical retinoid and benzoyl peroxide d. Other topical

c. Combination of topical retinoid and benzoyl peroxide

Which of the following would be the most helpful in confirming the diagnosis of ADHD in a 12 year-old male a. Symptoms are only at school b. Difficulty making friends c. Forgets his homework at school d. Spends a lot of time playing video games

c. Forgets his homework at school

What is the most common presentation of a 2-day old newborn with cyanotic heart disease? a. bounding/dynamic precordium b. normal pulses and quiet precordium c. decreased pulses and poor perfusion d. tachypnea and nasal flaring e. palpable thrill

b. normal pulses and quiet precordium

3 yo girl with history of URTI presents with stridor. Vitals normal and stridor present when crying. What is the best management? a. Single dose of oral steroid b. Racemic epinephrine c. Nebulized steroids d. Humidified oxygen

a. Single dose of oral steroid

What other test would do immediately in an 8-hour neonate with elevated 17 OHP a. Glucose b. Sodium c. Testosterone d. Karyotype

d. Karyotype as long as well

6 yo girl with diagnosis of JIA and pain in one knee. CRP 58. Sedimentation 25. ANA negative. No uveitis. What is the next step in management a. NSAIDS b. Methotrexate c. Intra-articular corticosteroids d. Oral steroids

a. NSAIDS

4 year old with CF, most likely deficiency: a. Iron b. Calcium c. Vitamin D d. Zinc

c. Vitamin D

Baby with suspected trisomy 21 with a petechiael rash, high WBC, anemia, and thrombocytopenia. On exam, has hepatosplenomegaly. What is the most likely reason for his presentation? Sepsis CMV infection Transient myeloproliferative disorder

Transient myeloproliferative disorder

``` 8 year old (no description of his health). Parents with DM2, when to screen for DM2? Now At puberty At 10 With more risk factors ```

With more risk factors BMI >85th AND 2 of: T2DM in first or second degree relative high risk racial group (aboriginal, black, asian, pacific islander) signs of insulin resistance or conditions associated with insulin resistance maternal history of GDM

``` Boy with wheezing and respiratory distress and urticaria after lunch. What should you treat with? Oral Dexamethasone Inhaled ventolin IM Epi IV Diphenhydramine ```

IM Epi

``` Teen with cystic fibrosis has worsened cough, sputum, drop in PFT. What is the most appropriate antibiotics to start? Ceftaz + tobra Clox and tobra Clox and ceftaz PO cipro ```

Ceftaz + tobra IRL depends on what they grow and what they are resistant to… as a general principle need 1 abx for all bugs except need double coverage for pseudomonas… based on that, ceftaz and tobra is a good option (BUT ceftaz doesn’t have great staph aureus coverage so not ideal)

``` Teen girl with hypertension and BMI 30. What is best way to determine long term damage from the HTN? ECG Echo Serum creatinine Fundoscopy ```

Echo

``` Girl with systemic JIA well-controlled on methotrexate then re-presents with fever, unwell, rash, liver 3 cm below costal margin. What is the most likely diagnosis MAS Sepsis Methotrexate toxicity Autoimmune hepatitis ```

MAS

``` 28 week infant, 32 weeks currently. Feeding well on gavage feeds. Using HF 4L/min room air. What should his transfusion threshold be? 100 75 85 115 ```

``` When should repair for a persistent hydrocele occur? 6 months 12 months 18 months 24 months ```

12 months

``` 4 yo child initially presented with otitis media. Developed post-auricular inflammation consistent with mastoiditis. After the child receives parenteral antibiotics, what is the next best step for management? Observation Myringotomy Steroids Steroid and antibiotic drops ```

Myringotomy

``` Young child with hypotonia, only some facial movements, no deep tendon reflexes. +Fascicultations on tongue. Parents are asking about chance of recurrence if they have more children. What do you tell them? 25% 50% 50% if the child is male Sporadic ```

25% SMA autosomal recessive

2 year old girl, picky eater. (long stem about how she is otherwise healthy but doesn’t like to eat certain foods). Has not gained any weight in the last few months. Has always been trending on the same percentile. What do you advise parents? Offer a variety of accepted foods and allow child to choose what to eat Offer multiple snacks throughout the day Let the child pick whatever they want

Offer a variety of accepted foods and allow child to choose what to eat

``` 4 year old boy presents with a few days of cough, respiratory symptoms, fever. Sats are normal (95% in room air). CXR shows a consolidation in the left lower lobe. What is the best antibiotic? Ceftriaxone Ceftriaxone and azithromycin Azithromycin Amoxicillin ```

Amoxicillin

``` 13 y.o. Girl presents with antalgic gait and pain for 2 weeks. She has difficulty with rotation and adduction of her leg. X-ray was similar to the one below. What is the diagnosis? Septic joint Calve-Perthes SCFE Fracture Post-infectious ```

SCFE

``` 14 y.o. Girl with new onset weight loss and amenorrhea. On exam you find lanugo hair. What is the diagnosis Addison’s disease Hypothyroidism Turner’s Eating disorder ```

Eating disorder

``` A 5 y.o boy is hurt in a MVA. At the scene, EMS note that he does not open his eyes, moans incomprehensibly, and extends his arms to painful stimuli. Vitals: HR 110 RR 14 BP 120/85. He has a c-spine collar in place. What should be your next step? Give mannitol Hyperventilate Intubate Urgent CT head ```

Intubate

A mother with untreated Nisseria gonorrhoea gives birth to a newborn via a vaginal delivery. What should be the next step? Conjunctival culture, CBC, blood culture, CSF, IV Ceftriaxone Conjunctival culture, CBC, blood culture, IV Ceftriaxone Conjunctival culture, IM ceftriaxone Conjunctival culture and await results for treatment

- A or C depending on if baby is well or unwell Conjunctival culture, CBC, blood culture, CSF, IV Ceftriaxone Conjunctival culture, IM ceftriaxone

8y boy had URTI two weeks ago; now presents with fever >40, unable to weight bear on right leg. WBC is 18, ESR 40 (? I think) and CRP 80. What is next step in management? Admit and start IV abx Nsaids Urgent orthopedic consultation

Urgent orthopedic consultation

``` A child with grade IV unilateral VUR presents with second UTI. Most recently she had a pylonephritis that was cultured and resistant to TMP-SMX and nitrofurantoin. You are thinking of starting prophylaxis. What do you start? Cefixime TMP-SMX Ciprofloxacin No prophylaxis indicated. ```

No prophylaxis indicated.

``` Child presents in respiratory distress a few days after URTI with cough, tachypnea and fever. White out lung on CXR. What is your next test? Lateral decubitus x-ray Chest ultrasound Chest CT Diagnostic thoracentesis ```

Chest ultrasound

4.2 kg infant born to a mother with gestational diabetes. Glucose at 2 hours of age is 2.1. What is your management? Continue to measure glucose every 3-4 hours for the next 36 hours. Feed the infant. Recheck glucose in 1 hour. Feed the infant. Recheck glucose before next feed in 3-4 hours. Continue to monitor glucose every 3-4 hours for the next 12 hours.

Continue to monitor glucose every 3-4 hours for the next 12 hours.

``` Mother has recurrent HSV. THere were no active lesion at delivery. For how long after delivery is the infant at risk for PERINATAL transmission? 2 weeks 6 weeks 16 weeks 36 weeks ```

6 weeks

``` Patient seeing you for health surveillance with achondroplasia at 1 month of age. What do you have to do as part routine surveillance? ECG EEG MRI brain Renal ultrasound ```

MRI brain

REPEAT Toddler with dehydration. 12 kg. Irritable, no tears. What is your management? 1200 cc/kg ORT over 4 hours 600 cc/kg ORT over 4 hours IV fluids

1200 cc/kg ORT over 4 hours moderate dehydration - ORT 100ml/kg over 4 hours (mild = 50ml/kg over 4 hours)

influenza vaccine – intranasal, 1 yo healthy and 3 yo with asthma, got oral steroids one month ago and now takes low dose inhaled corticosteroids 1. contraindicated in 1 yo 2. contraindicated in 3 yo 3. contraindicated in both 4. both can have it

1. contraindicated in 1 yo Licensed for age 2-59 years, contraindicated in immunocompromise

8 yo boy with 1.5 x 2cm left supraclavicular node, non tender, smooth, noticed in the last few days 1. ebv 2. TB 3. Excisional biopsy 4. Bartonella

3. Excisional biopsy

What ECG change is characteristic of Rheumatic fever? Prolonged PR interval Sinus tachy

Prolonged PR interval - minor criteria

``` Kid presents with 3rd febrile seizure in the past month. Otherwise well, no post-ictal. What do you do? Reassure EEG Admit MRI brain ```

Reassure

``` Baby born at 42 weeks after placental abruption, asystolic since birth and ongoing appropriate resus. After how long can you stop resuscitating? 15 minutes 10 minutes 20 minutes 30 minutes ```

10 minutes

``` Baby with G-tube that looks like this: (This was the exact photo on the exam) - granuloma Reassure Silver nitrate cautery Topic ABx Fungal abx cream ```

Silver nitrate cautery

``` Description of a kid with Kawasaki Disease. What is the most common laboratory finding? Neutropenia Hypoalbuminemia High IgA ASOT ```

Hypoalbuminemia

Mother brings in her 2 kids and wants them to get the intranasal flu shot. Daughter is age 12 months and healthy. Son is age 4 and on inhaled corticosteroids for asthma, had an admission 1 month ago requiring 5 days of oral steroids. What do you do? Neither child can have the intranasal flu shot Both kids can have the intranasal flu shot Only the daughter can have it Only the son can have it

Only the son can have it

Child with in-toeing and difficulty walking. What would make you suspicious that this is spastic diplegic CP? Prematurity, global developmental delay, normal reflexes Prematurity, delayed motor milestones, increased reflexes Birth asphyxia, global developmental delay, normal reflexes Birth asphyxia, delayed motor milestones, increased reflexes

Prematurity, delayed motor milestones, increased reflexes

``` 13 year old female who had menarche at 11. Presents with menomethorrhagia, Hgb 84. Most likely cause? Von Willebrands Increased Progesterone Decreased Estrogen Prolonged endometrial buildup ```

Von Willebrands

A 29+2 week GA infant in the NICU. When should ROP screening start? a) 31 weeks b) 32 weeks c) 33 weeks d) 34 weeks

c) 33 weeks

A 9 year old boy has been refusing to go to school for the last 3 months. He becomes upset when discussing attending school and says he wants to be homeschooled. a) Allow him to be homeschooled this year. Return to school next year. b) Return to school immediately following gradual protocol and desensitization. c) Start Citalopram. d) Start Fluoxetine

b) Return to school immediately following gradual protocol and desensitization.

A kid with asthma and eczema has an acute worsening of his eczema. What would you treat him with? (honey crusted lesions) Acyclovir Steroids Cefazolin Vancomycin

Cefazolin

``` A 15 yo boy with depression and conduct disorder presents to emergency with confusion and agitation. His vitals are T 38.9, P 110, BP 145/95. He has lead pipe rigidity and tremor. Glucose, electrolytes, Ca, Mg, PO4 are normal. CK is elevated (8900). What is the most likely cause? Serotonin syndrome Alcohol ingestion Neuroleptic malignant syndrome Amphetamine overdose ```

Neuroleptic malignant syndrome

A 10 month old baby wakes up every 2 hours and needs to be rocked back to sleep by his mom. What is the most likely cause? Benign rolandic epilepsy Sleep onset association disorder Night terrors

Sleep onset association disorder

4.4 kg on day of life 2, in the NICU due to profound hypotonia requiring tube feeds. Has swelling of the hands and feet and bilateral undescended testes. Likely Cause: Noonan SMA Congenital myotonic dystrophy Prader-Willi

Prader-Willi

7 year old female on the third percentile for height. Dad is 175, Mom is 155. Calculate mid-parental height?

158.5cm

Criteria for brain death? EEG Two examiners 24 hours apart No response to hypercapnea test

No response to hypercapnea test

4 year old healthy kid with slight systolic ejection murmur heard at LLSB and MLSB. There is a variable split S2. Exam is otherwise normal. Cause for murmur? Benign Bicuspid aortic valve VSD Pulmonary stenosis

Benign

5 year old with tick bite 2 week ago. Now has developed large erythematous lesion with central clearing. Which of the following would you give? PO Amoxicillin PO doxycycline IV ceftriaxone

PO Amoxicillin

``` Most common cause of hypertension in a newborn? Hydronephrosis Coarctation of aorta Renovascular CAH ```

Renovascular

2 year female with onset of thelarche. Bone age and stature 3 years. What do you tell her mom? Will resolve Gradual progression to puberty Fast progression to puberty

Will resolve

35+6 week infant born to a mother who is GBS unknown. ROM x 12 hours. Infant is well. What do you do? CBC, Cx and Empiric abx x 36h. CBC and observe if WBC <5 CBC and observe if WBC >5 What to do based on new guidelines?

CBC and observe if WBC >5 Based on new statement… late prems manage same as term infants as long as they are well enough to stay with mom. Should be observed for at least 48 hours

The parents of a 16 year old boy found him threatening to kill himself with a knife. He has recently had a significant decline in school performance. He complains of hearing voices. Feels weird for minutes to hours. Family history of depression and suicide. Likely diagnosis? a. drug abuse b. depression c. schizophrenia d. brain tumor

c. schizophrenia

``` 6 m.o baby with bronchiolitis symptoms. What is the best evidence supporting treatment: A.oral dexamethasone B. Oxygen C. nebulized epinephrine D. nebulized salbutamol ```

B. Oxygen

16 year old girl. Failing in school, used to be a straight A student. Decreased need for sleep. Recently buying clothes. Family hx of suicidal and depression. How do you treat Lithium Fluoxetine Clonidine

Lithium

``` 36 mo baby what is the best predictor of cognition? Gross motor Fine motor Social language ```

language

You suspect a 3 year old female of having autistism spectrum disorder. What diagnostic test would MOST likely reveal an abnormality? a. karyotype b. very long chain fatty acids c. fragile x testing d. chromosomal microarray

d. chromosomal microarray

An 18 month-old female presents to the emergency department with a febrile seizure secondary to an acute otitis media. This is her third febrile seizure in three months. What is the next step in management? a. EEG b. CT head c. Neurology consult d. Reassure parents, and no further investigations

d. Reassure parents, and no further investigations

A 3 month old male infant presents to the emergency department with a 1 month history of “spit ups” and 2 day history of projectile vomiting. His last two vomits were bilious. On exam, he looks dehydrated and unwell. His abdomen is distended, non tender, with no palpable masses. What diagnostic test would MOST likely reveal the underlying abnormality? a. Abdominal ultrasound b. Barium enema c. Upper GI series d. Abdominal X ray (anterioposterior and lateral)

c. Upper GI series intuss vs malrotation, could consider AUS

``` What is the best way to monitor effectiveness of thyroid replacement in autoimmune thyroiditis? A. T4 B. free T4 C. T3 D. TSH ```

D. TSH

``` Which ECG change is characteristic of acute rheumatic fever? A. Peaked T waves B. Prolonged PR interval C. Sinus tachycardia D. Prolonged QRS ```

B. Prolonged PR interval

A child has been sick with vomiting and diarrhea. Mom has been feeding sugar water. Comes in with sodium 108, urea 13, cr 95. How do you manage? a. fluid restrict b. correct sodium to 135-140 in 24 hrs a. correct over 4-6 hrs by giving 3% NaCl c. correct sodium to 118 -120 in 24 hrs

c. correct sodium to 118 -120 in 24 hrs

A 16 year old boy admits to recently having repetitive thoughts of violence. He has impulses to act on these, but is able to hold off doing so. What diagnosis is most likely? a. Schizophrenia b. Behavioural problem c. OCD d. Antisocial personality

c. OCD

A kid has been seizing for 30 minutes, HR 220, breathing difficult to assess but SPO2 93%, glucose 4.2. a. RSI b. insert IO c. insert IV d. intranasal midazolam

d. intranasal midazolam

What is the best way for a 7 year told to ride in the back of a car, in the middle seat with no head rest? (pictures shown,taken from CPS statement) a. Forward facing car seat b. Booster seat with no back c. Booster seat with a full back d. Seat belt

c. Booster seat with a full back

What is the recommended vitamin D supplementation for a 6 month old baby living above the 55th latitude during winter months? a. 200 international units b. 400 international units c. 600 international units d. 800 international units

d. 800 international units

A child presents with hypertension, urine dip shows blood and protein, creatinine and urea are elevated, C3 and C4 are normal. What is the most likely diagnosis? a. SLE b. Membranoproliferative glomerulonephritis c. Post-infectious glomerulonephritis d. IgA nephropathy

d. IgA nephropathy

A 13 year old boy with Type 1 diabetes tells his parents that he hopes his diabetes kills him because he doesn’t want to live anymore. He’s had a lower appetite the last few months (?also said sleeping more). Psychiatry has assessed him and feels he is not at an acute risk of self harm. What is the best thing to do now to ensure his safety? a. Start fluoxetine b. Admit him c. Parents to provide constant supervision d. Parents to take over control of his insulin injections

d. Parents to take over control of his insulin injections

``` A mom brings in her son for concerns around his school performance, but feels he is cognitively normal. He has trouble with reading, and has trouble understanding when he reads to himself. His teacher has been spending more resource time with him, and when she reads aloud to him, he understands well. What is the most likely diagnosis? a. Myopia b. Dyslexia c. General learning disorder D. Speech apraxia ```

b. Dyslexia

A 10 year old boy presents with 12 hours of scrotal pain. He has focal tenderness at the upper pole of the testis with a focal blue discolouration, and there is some edema. What is the best next step? a. Ultrasound b. Analgesia and scrotal support C. Urology consult

b. Analgesia and scrotal support

A child is involved in an MVC. He was sitting in the back seat with a seat belt on at the time. He now presents with ecchymosis around the area of the lap belt. He has not voided since the accident and can’t move his legs. What is the most likely diagnosis? a. Kidney rupture b. Fracture of L1-L2 c. Bleeding into his spine c. Pelvic fracture

b. Fracture of L1-L2

What is the most common cause of sensorineural hearing loss? a. Hyperbilirubinemia b. Genetic c. CMV (did NOT say congenital) d. Recurrent otitis media

b. Genetic

A 12 year old was in an MVC that resulted in severe splenic laceration requiring splenectomy. What does she need now? a. Penicillin prophylaxis b. Penicillin prophylaxis and meningococcal and pneumococcal vaccines c. Meningococcal and pneumococcal vaccines d. Nothing required

b. Penicillin prophylaxis and meningococcal and pneumococcal vaccines

5 year old with recent moderate-to-severe asthma exacerbation. His mother is in your office and angry because both of his recent episodes have been after weekend visits with his father. His father and his father’s new girlfriend both smoke in the home. What is your next step? Schedule an appointment to talk with the father Observe only Report the father to CAS Stop the boy from spending weekends with his father

Schedule an appointment to talk with the father

16 year old competitive hockey player who had a history of asthma that was asymptomatic for 7 years. Has been having exercise induced symptoms and he’s using ventolin 6x/week before and during games. PFTs show normal FEV1 and FEV1/FVC but he has a positive methacholine challenge. What do you recommend? Low dose inhaled corticosteroids Stop playing high level hockey 5 day course of oral corticosteroids LABA in the morning on the days of the games

Low dose inhaled corticosteroids

``` 13 year old girl presents to the ED with a generalized tonic clonic seizure. Her parents say she’s been drinking a lot of water recently. Her labs: Na 118, Cl 86, osm 262, Urine Na 20, serum urine osm 68. What’s the MOST likely diagnosis? T1DM Psychogenic polydipsia SIADH Adrenal insufficiency ```

Psychogenic polydipsia hypotonic serum <280 - implies true hyponatremia (if >280 suggests pseudohyponatremia/presence of osmotically active substances like glucose) urine osm <100 is normal water excretion - primary polydipsia urine osm >100 is impaired water excretion - rule out hypothyroid and adrenal insufficiency, then check urine Na urine Na <20 think CHF, nephrotic syndrome urine Na >40 think SIADH, renal salt wasting

CAS worker brings in a 4 year old girl with concerns regarding sexual abuse. The child has mild vulvovaginitis (erythema) with vaginal discharge. What is your NEXT step: Screen for STI and culture vaginal Topical therapy with mupirocin cream Tell them to avoid bubble baths and ensure wiping front to back Reassure that discharge is physiologic (or something like that)

Screen for STI and culture vaginal

4 month girl with FTT. Has the following bloodwork. What’s the most likely diagnosis? Gas: pH 7.24, CO2 30, HCO3 16 BW: Na 138, Cl 111, K 5, PO4 2.1, glucose 4 Fanconi syndrome RTA Mitochondrial disorder CF

RTA Fanconia is one of the RTA type II but have low phosphate

10 year old girl diagnosed with optic neuritis 3 months ago. She is currently asymptomatic. How do you counsel her mother: Chance of recurrence is low The gamma globulin she received protects against recurrence Risk of macular degeneration She is at significant risk of developing MS

She is at significant risk of developing MS - risk is 20%

5 yo girl diagnosed with nephrotic syndrome and on high dose steroids. You’ve counselled that she shouldn’t receive any live vaccines. What should she get now? HPV vaccine HAV vaccine Pneumococcal polysaccharide (23-valent) vaccine Meningococcal conjugate vaccine

Pneumococcal polysaccharide (23-valent) vaccine

Child with systemic JIA. Presents with fever, purpuric rash, hepatosplenomegaly and irritability. What is the MOST likely diagnosis? a . methotrexate toxicity B. macrophage activation syndrome C. sepsis

B. macrophage activation syndrome

``` 10 month girl recently immigrated to Canada from a refugee camp in Turkey. She’s had 3 doses of oral polio vaccine and 4 doses of DAT (diptheria, pertussis, tetanus). What vaccine do you recommend now? Pneumococcal conjugate and Hib Pneumococcal, HIB and IPV DTap-IPV-Hib and pneumococcal No vaccines needed ```

Pneumococcal conjugate and Hib (she hasn’t had these yet)

``` 2 month old baby in SVT (ECG is rapid, no P waves) - has been feeding poorly last few days. On exam has mild respiratory distress and no palpable peripheral pulses. What is most appropriate next step? Carotid massage Adenosine Asynchronous counter shock Digoxin ```

Adenosine

``` 2 yo girl from Mediterranean background. What values are most representative of thalassemia minor? Hgb 100 MCV 75 RBC 2.61 Hgb 100 MCV 60 RBC 4.81 Hgb 80 MCV 75 RBC 2.81 Hgb 80 MCV 60 RBC 3.21 ```

Hgb 100 MCV 60 RBC 4.81 Mentzner index >13 think Fe deficiency, <13 think thalassemia (MCV/RBC)

Teenage girl with recurrent syncope after prolonged standing. Has prodromal symptoms (lightheadedness, etc). What is the MOST likely diagnosis? Neurocardiogenic Long QT Postural orthostatic tachycardia syndrome

Neurocardiogenic

Child with concussion. When can she return to play? Back at school full time with no symptoms and no accommodations After symptom free for 7 days

Back at school full time with no symptoms and no accommodations

Baby with large congenital (melanocytic?) nevus on face. What is she at risk for?

Melanocytosis of the leptomeninges

What to tell an adolescent about marijuana side effects: 1. gynecomastia 2. testicular atrophy 3. Insulin stimulation

1. gynecomastia

CBC abnormalities, short child, bifid thumb, café au lait spots, hypopigmented lesions 1. schwachman diamond 2. fanconi anemia 3. Dyskeratosis congenita

2. fanconi anemia

metabolic acidosis after fasting with URTI. No ketones. Hypoglycaemia. Mildly raised LFTS. 1. FAOD 2. Mitochrondrial 3. Hyperinsulinism

1. FAOD

9 y.o. Girl parents worried about her final height. What is her mid parental hight? Mother 155cm, father 174cm

158