2017 - MCQ Flashcards by Josh Penslar

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

RSI

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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

If he has pain on palpation posterior to medial malleolus

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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:

a. CT head
b. Give NS bolus bolus via intraosseous
c. Hydrocortisone IV

Give NS bolus via IO

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6 month old child presents to the emergency department with significant facial swelling and bruising (r/o NAI??) Given vital signs, tachycardia and hypotension with BP 60/40s. SpO2 99%. Respiratory rate is normal, pupils are equal and reactive. Most appropriate next steps?

a. CT head
b. Insert IO and give bolus of normal saline
c. Give mannitol
d. Intubate

Insert IO and give bolus of normal saline

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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 stool

Wait for 10 days, follow serially with x-rays

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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

ARFID

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At what age should screening begin with PAP smear?

a. 21 years
b. 18 years
c. After sexual intercourse

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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?

a. There is no contraindication
b. That she still smokes a few cigarettes once in a while
c. That she is <18 years old
d. Her eating disorder

No contraindication

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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?

a. Eating disorder
b. Diabetic ketoacidosis
c. Celiac disease

Eating Disorder

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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 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

Listen attentively and referral for gender dysphoria

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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

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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!)
2. IV benadryl
3. Normal saline bolus
4. Oral cetirazine

Normal saline bolus

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Picture with white papule

a. HSV
b. Neonatal erythema toxicum
c. Pustular melanosis
d. Miliaria

Miliaria

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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 (I think)

Minocycline

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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

pulmonary stenosis

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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?
A. Orthostatic hypotension
B. Long QT
C. Postural orthostatic tachycardia syndrome (TB)

POTS

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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

Start beta blocker and restrict vigorous activity

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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

age, for screening purposes

height, sex

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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

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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

Better sexual education

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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

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9 year old whose parents are getting a divorce and they ask what type of behavior she will exhibit:

a. Developmental regression
b. Pick sides (mother vs. father) and blame the other parent
c. Try to make everyone happy
d. Blame herself for the divorce

Pick sides (mother vs. father) and blame the other parent

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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

Refer to SLP

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Description of a 2 month old baby with colic. Tolerating breastfeeding well, normal exam. What is the best management?

a) Encourage mom to continue breast feeding
b) Add cows milk based formula in diet
c) Add soy based formula in diet
d) Simethicone

Encourage mom to continue breast feeding

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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

Adrenal insufficiency

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

Inadequate breastfeeding

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

Tanner stage 3, growing 4cm/year

Which of the following growth velocities is most concerning in a female? a. SMR 1 and growing at 6cm/year b. SMR 2 and growing at 4cm/year c. SMR 3 and growing at 8cm/year d. SMR 5 and growing at 1cm/year

SMR 2 and growing at 4cm/year

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

Pubic hair is becoming curly

10 year old girl with an enlarged thyroid, diffuse nontender. T4 6.6 TSH >50, thyroid antibodies positive. What is your next step in management? a) Start methimazole b) Order thyroid ultrasound c) Order radionuclide scan d) Start levothyroxine

Start levothyroxine

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

Myringotomy

5 yo 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? 1. Reassurance 2. Otic quinolone and steroid drops 3. Amoxicillin

Otic quinolone and steroid drops

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

Optimize dosing of acetaminophen

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? 1. Do a slit lamp exam with fluorescein 2. Prescribe polytrim eye drops 3. Prescribe topical steroid eye drops

Do a slit lamp exam with fluorescein

A 1 month-old baby presents to your office with 24 hours of unilateral eye swelling and discharge. They appear like the following image. What is the diagnosis? 1. Dacryocystitis 2. Orbital Cellulitis 3. Bacterial conjunctivitis 4. Neuroblastoma

Dacryocystitis

1 month old with achondroplasia. What is the MOST important investigation to request at this time? 1. EEG 2. MRI brain 3. Xray spine

MRI brain

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? A. Friedrich ataxia B. X-linked adrenoleukodystrophy C. DMD D. Ataxia telangiectasia

X-linked adrenoleukodystrophy

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? a. Elimination diet b. Oral fluticasone by MDI c. Proton-pump inhibitor d. Oral Prednisone

Elimination diet

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

Stool alpha anti-tripsin

12 year old embarking upon a vegan diet. Which of the following is the BEST advice to give? 1. Take VB12 supplements 2. Take Zinc supplements 3. Take VitD supplements 4. See a dietician

See a dietician

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

Food protein-induced proctocolitis

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

??unknown Possibly - To differentiate between functional abdominal disorder and IBD. Used in its with known IBD to assess treatment - so also ? severity of inflammation

A 2 yo boy presents with pallor. He has been drinking 1L of milk each, but does eat 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? a. Transient erythroblastopenia of childhood b. Iron deficiency anemia c. Sickle cell disease

Transient erythroblastopenia of childhood

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

Immediately

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? a. Pneumococcal + Hib b. DTAP/IPV/Hib + Pneumococcal c. DTAP/IPV/Hib + Pneumococcal + Hep B d. No other vaccination at this time

DTAP/IPV/Hib + Pneumococcal

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? a. Close follow up b. PO metronidazole c. PO vancomycin d. PO clindamycin

Close follow up

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. a) No treatment, reassess in 48 hours b) 5 days amoxicillin c) 7 days amoxicillin d) 10 days amoxicillin

No treatment, reassess in 48 hours

Patient with description of pneumonia, and LLL opacity on chest x-ray. Emesis and fever for the past 2 days, crackles on exam. What do you treat with? a) Azithromycin b) Ampicillin c) Ceftriaxone d) Cefuroxime

ampicillin

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? a) Inactivated vaccine for mom right now b) Inactivated vaccine for mom after birth c) Inactivated vaccine for dad and two kids, no vaccine for mom d) Inactivated vaccine for dad, live attenuated vaccine for two kids, no vaccine for mom

Inactivated vaccine for mom right now

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

BMA most likely as would want to rule out Leukemia Could be Lupus - but antibody choices are wrong (ANA, ESR, CRP, ENA) EBV - unlikely to have joint pain

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? 1. Add vancomycin 2. Consult surgery to drain an orbital abscess 3, MRI brain

MRI brain

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

Today

You see a child with fever, arthralgias, and a rash on his lower limbs (see picture below). What test needs to be done now? a. Abdominal ultrasound b. Urinalysis c. IgA d. (googled Henoch Schonlein Purpura - the picture did look quite a bit like this)

urinalysis

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? a. Toddler’s fracture b. Non accidental injury c. Metabolic bone disease d. Osteogenesis imperfecta

toddler's fracture

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

Rheumatic fever

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

Reassurance

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 (syphilis) b. Positive ANCA c. Positive HLAB27 d. Thrombocytosis

Positive RPR (syphilis)

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 (TB) d. Oxybutynin

?? ddAVP only for sleep overs? Alarm best long term

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

Hydronephrosis

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

Located above the gluteal cleft

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

Family history of febrile seizures

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? a. Amitriptyline b. Propranolol c. Phenytoin d. Sumatriptan e. Ergotamine

Amitriptyline

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

25% | AR - SMA

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

Reassure

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

She is at significant risk of developing MS (TB)

Which is true of ophthalmia neonatorum a. The most common organism is Neisseria Gonorrhea, but it is now almost always resistant to the prophylaxis, therefore prophylaxis is not indicated b. Ophthalmia neonatorum can lead to significant eye injuries and blindness, therefore antibiotic prophylaxis is indicated c. 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

Newborn with difficult delivery. Mydriasis. Normal tone. Slightly irritable. What is his Sarnat stage? a) 0 b) 1 c) 2 d) 3

Stage 1

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

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

Fluoxetine

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

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

Hx of Bipolar

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

Increase psychostimulant (TB)

16 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 a. Assess him for gambling problems b. Add a mood stabilizer c. Reassure

Assess him for gambling problems

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

Increase dose of fluoxetine to 100ucg BID

``` 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 eventration. What is the next test? Diaphragm Fluoroscopy MRI chest CT chest Exploratory laparoscopy ```

?? | MRI chest versus diaphragm fluoroscopy

``` 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

``` 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% ```

<90%

2017 - MCQ Flashcards

(77 cards)