2018 - MCQ Flashcards
(134 cards)
1
Q
Teen girl presents to your office with recurrent episodes of syncope on extreme exertion. She is diagnosed with long QT syndrome. What
is the next best step in management?
a. Calcium channel blocker without high intensity exercise restriction
b. Calcium channel blocker with high intensity exercise restriction
c. Beta-blocker without high intensity exercise restriction
d. Beta-blocker with high intensity exercise restriction
A
Beta-blocker with high intensity exercise restriction
2
Q
Adolescent male, who is 97th percentile for height presents with 2/6 systolic murmur at the left lower sternal border that is worse
when he stands up. Two uncles had “MI”s in their 30s. What is your next investigation?
a. Echocardiogram
b. ECG
c. EEG
d. Holter
A
ECG vs ECHO
Marfans
3
Q
Child in grade 1 with history of repaired TAPVR. He has been diagnosed with ADHD. After taking a thorough history and physical exam, you next step is: a. ECG b. Echocardiogram c. Start a stimulant medication with no further investigation d. Stimulants are contraindicated ---- a. Start stimulants b. ECG c. Refer to psychiatry d. Continue to monitor
A
Start a stimulant medication with no further investigation
4
Q
An adolescent presents with syncope on exercise. On examination you note a parasternal heave and listen to a mid-systolic III/VI murmur radiating to the neck on the 2nd Lt intercostal space. What is the most likely cause:
a. AS
b. MR
c. PS
A
Aortic stenosis
5
Q
3-month old with a few days of decreased feeds, vomiting and tachypnea. Presents to ED unresponsive. Cap refill 3 seconds, pulses palpable. Liver edge 5cm. Resp rate 70, Heart rate 230 BPM. Otherwise normal exam. Diagnosis?
a. CHF secondary to myocarditis
b. Inborn error of metabolism
c. SVT
d. sepsis
A
SVT
6
Q
8 yo male with CF, 6 weeks cough, congestion, NO fever. +weight loss (no mention of sputum) with decrease in FEV1. Most likely bug?
a. Burkholderia Cepacia
b. Aspergillus
c. Pseudomonas
d. Stenotrophomonas
A
pseudomonas
7
Q
16 year old has visited the ED multiple times with acute cough and wheeze. Never responds to bronchodilators. Otherwise healthy and well-adjusted. Which investigation will give you the most likely diagnosis?
a. PFTs
b. CXR
c. Rhinolaryngoscopy
A
Rhinolaryngoscopy
8
Q
A teenage boy who is well adjusted presents with recurrent episodes of cough and wheeze that do not respond to a bronchodilator. How will you make the diagnosis? a. Flexible nasolaryngoscopy b. CT chest c. Chest X-ray d. PFTs
A
Flexible nasolaryngoscopy
9
Q
A 12 year old with asthma, is on a low dose inhaled corticosteroid. They were previously well controlled, but now use their SABA 4-5 times per week. Other than checking adherence, and technique how do you adjust the treatment?
a. Change to a medium dose ICS
b. Switch to alternate ICS
c. Add a LABA in addition to low dose ICS
d. Add Montelukast
A
Add a LABA in addition to low dose ICS
10
Q
What oxygen saturation reading would prompt administration of supplemental oxygen for a one month old with RSV bronchiolitis?
a. 88%
b. 90%
c. 94%
d. 96%
A
90%
11
Q
What is the mechanism of risperidone increasing prolactin?
a. Risperidone increases lactotrophs
b. Risperidone blocks dopamine receptors, which usually inhibits prolactin secretion
c. TRH
A
Risperidone blocks dopamine receptors, which usually inhibits prolactin secretion
12
Q
Hyponatremia (sodium 116) in a 1-2 month old. Mom has been feeding glucose water. No seizures. Hypotensive (70/46ish) with tachycardia. What do you do?
a. NS maintenance
b. ½ NS maintenance
c. Bolus NS 20mL/kg
A
Bolus NS 20mL/kg
13
Q
A newborn baby has bony defects in the sacrum, lumbar vertebrae and also thoracic vertebrae. What is the most common cause?
a. Infant of diabetic mother
b. Trisomy 13
c. Holoprosencephaly
d. FAS
A
IDM
14
Q
Baby with jaundice at 4 days of life. Now 1 week old. Total bili 380, conjugated 150-190) and presenting with poor feeding, one episode of vomiting, and temperature of 35. No vital signs mentioned. What is most likely diagnosis?
a. Biliary atresia
b. Galactosemia
c. Neonatal hepatitis
d. Sepsis
e. Alpha 1 antitrypsin (not option on another exam)
A
sepsis
15
Q
3 day old infant born at 3000g, now at 2693g, exclusively breast fed, primigravida mother. Mother is feeding 9 times in 24 hours, and baby has 7 wet diapers in the past 24 hours. Physical exam is normal. What do you do?
a. Supplement with 15-30ml formula after each feed
b. Do bloodwork including bili, creatinine and electrolytes
c. Follow closely and weigh baby again in 24 hours, continue breastfeeding.
d. Start mom on motilium/domperidone to increase milk production
A
Follow closely and weigh baby again in 24 hours, continue breastfeeding.
16
Q
A mother has HbsAg+. What is the correct management of her newborn?
a. HBIG and vaccine within 12 hours
b. Vaccine within 12h and Ig within 7 days
c. Vaccine now and Ig within 1 month
d. HB vaccine now and do serology in one month
A
HBIG and vaccine within 12 hours
17
Q
A 7 day old baby comes to the ED with a history of bloody stool. He is pale and tachycardic with a low hemoglobin. He was born at home, and had an uneventful course. What is the diagnosis?
a. Hemorrhagic disease of the newborn
b. Meckels diverticulum
c. Anal fissure
d. CMPA
A
Hemorrhagic disease of the newborn
18
Q
What is the most common long term complication of necrotizing enterocolitis?
a. Intestinal stricture
b. Malabsorption
c. GERD
A
Intestinal stricture
19
Q
Cyanotic newborn whose CXR shows large heart and decreased pulmonary vascular markings (oligemic lung fields). What is the MOST common cause (what is the diagnosis)?
a. TOF
b. Truncus arteriosus
c. TGA
d. TAPVR
A
TOF
20
Q
Neonate with platelets of 12, otherwise normal CBC, has petechiae. After transfusion platelets are still low. Moms platelets are normal. How do you manage?
A. Transfuse PLA-1 negative platelets.
B. Give IVIG
C. Pooled donor platelets
A
Transfuse PLA-1 negative platelets
21
Q
An exclusively breastfed baby comes to your office at five days of life with a total bill of 240, unconjugated. Term. Well. What do you do for management? (No bili chart provided)
A. Admit the child for phototherapy
B. Reassure and continue regular care
A
Reassure and continue regular care
22
Q
What is a cause of a false negative sweat chloride? A. Hypothyroidism B. Edema C. Eczema D. Hypogammaglobulinemia
A
??
Edema and Hypogammaglobulinemia
23
Q
APGAR scores for a baby. 1 minute: HR 80, grimace with suction, blue, limp, irregular resps. 5 minute: still hypotonic, HR 140, no response to suction, acrocyanosis, irregular resps.
a. 4,4
b. 3,4
c. 3,5
A
3,5
1,1,0,0,1 and 1,2,0,1,1
24
Q
Baby with newborn screen positive for PKU, otherwise currently well, no family history. What do you do next?
a. Repeat phenylalanine level
b. Restrict phenylalanine in diet
c. Test for BH4 deficiency
A
Repeat phenylalanine level versus Restrict phenylalanine in diet
25
Term newborn baby in the nursery is found to be jittery, tachypneic with nasal flaring, with myoclonus. Normal glucose. Based on the most likely diagnosis, what is your next management?
a. Morphine
b. Benzodiazepine
c. Phenobarbital
d. Ampicillin and Gentamicin
morphine
26
Why do we irradiate blood given to premature infants.
a. Decrease CMV
b. Decrease GVHD
c. Sterilize RBC
d. Decrease hemolytic reactions
Decrease GVHD
27
Why do we irradiate blood given to premature infants.
a. Decrease CMV
b. Decrease GVHD
c. Sterilize RBC
d. Decrease hemolytic reactions
Decrease GVHD
28
Adolescent girl with multiple episodes of fainting after prolonged standing. She has preceding symptoms of light headedness, and vision contraction then going black. On one occasion, her father caught her and kept her in a seated position. She then had a short period of generalized tonic clonic convulsions and loss of bladder control. What is your next investigation?
a. MRI
b. EEG
c. Orthostatic vasovagal syncope
d. Holter monitor
?? Orthostatic vitals?
loss of bladder control may indicate seizure however?
EEG?
29
A 7-year-old male has idiopathic generalized tonic clonic epilepsy. He is on valproate. He is doing well and has been seizure free for 9 months. The family doctor did a valproate level as a part of his health supervision and it was 290 (normal 350-700). What do you do?
a. No change to valproate dose
b. Increase the valproate to therapeutic range
c. Discontinue the valproate since he doesn’t need it
No change to valproate dose (TB)
30
A child who is typically on clobazam for seizures has a GTC seizure at home witnessed by the father. His father gave him a dose of IN midazolam that stopped the seizure in 2 minutes. 10 minutes after arriving to the ED, he has another GTC. What will be your INITIAL treatment?
a. IV phenytoin
b. IV fosphenytoin
c. Intranasal midazolam
d. IV midazolam
IV midazolam??
Do they have an IV?
Intranasal midaz also seems ok?
31
A child develops bilateral ascending paralysis after a GI infection (diarrhea) with stool cultures positive for campylobacter. Nerve
conduction studies show neuropathy. What is the management?
a. Pulsed Steroids
b. IVIG
c. Antibiotics
d. NSAIDs
IVIG
Guillain Barre Syndrome
32
A 3 year old girl presents to your clinic, with concerns that she has had a recent increase in falling. She was noted by her mother to walk at 11 months of age. On examination you note bilateral increased tone in her lower extremities. What is your diagnosis?
a. X-linked Adrenoleukodystrophy
b. Metachromatic leukodystrophy
c. Spastic diplegic cerebral palsy
d. Myotonic dystrophy
?
| Spastic diplegic cerebral palsy (TB)
33
A child presents with polyuria, and polydipsia. Her serum sodium is 150, and her urine is very dilute (low specific gravity). Administration of vasopressin results in the rapid decrease in serum osmolality, and increase in urine osmolarity. MRI brain demonstrates thickening of the pituitary stalk. What is the diagnosis?
a. Histiocytosis
b. Craniopharyngioma
c. Prolactinoma
d. Hypothalamic hamartoma
Histiocytosis - b/c of thickening of the pituitary stalk
34
What is the most specific indicator of seizure activity in a neonate?
a. Irregular respirations
b. Tachycardia
c. Eye movements
Eye movements
35
2-year-old child presents with proximal muscle weakness and decreased DTRs in the legs what is the diagnosis?
a. Congenital myopathy
b. Neuromuscular junction
c. Peripheral neuropathy - is possible, but would likely be more distal
d. Spinal cord injury
Congenital myopathy (TB)
36
Term newborn baby in the nursery is found to be jittery, tachypneic with nasal flaring, with myoclonus. Normal glucose. Based on the most likely diagnosis, what is your next management?
a. Morphine
b. Benzodiazepine
c. Phenobarbital
d. Ampicillin and Gentamicin
morphine
37
5 month old with vomiting for 6 hours intermittently, has had 3 or 4 episodes of flexion and extension of arms and legs, drowsy after, abdomen is distended, which test would reveal diagnosis?
a. EEG
b. CT abdomen
c. Abdominal ultrasound
d. Abdominal XR
Abdo U/S for intussusception
Could also be infantile spasms? - then EEG
38
3 year old boy with nephrotic syndrome, started on steroids. Presents with abdominal pain and distended abdomen with dullness over the flanks bilaterally with diffuse rebound tenderness. Which investigation is most likely to confirm your diagnosis?
a. Abdominal X-ray
b. Exploratory laparotomy
c. Barium swallow
d. Paracentesis
- ------------------------
a. CT abdomen
b. Paracentesis and culture
c. Abdominal U/S
d. Surgical exploration? Or ?laparotomy
Paracentesis
39
3 week old hospitalized male, who has a history of antenatally diagnosed hydronephrosis. He has had a post natal ultrasound that showed moderate to severe unilateral hydronephrosis. Normal renal function. How do you manage the infant?
a. Consult urology prior to discharge
b. Order an outpatient VCUG
c. DMSA
d. Reassure
Consult urology prior to discharge
40
A 15 year old boy presents with 24-hour history of acute dysuria, pyuria. He has a tender scrotum with swelling. Urinalysis shows
WBC. What is the best course of management?
a. Antimicrobials for him
b. Antimicrobials for him and his sexual partner
c. Consultation to urology for surgical detorsion
d. Rest, analgesia and supportive care
Antimicrobials for him and his sexual partner
41
A 4-month-old infant female presents with failure to thrive and the following bloodwork:
Gas: pH 7.24, CO2 30, HCO3 16. BW: Na 138, Cl 111, K 5, PO4 2.1, glucose 4. What is the underlying disease?
a. Renal tubular acidosis
b. Cystic fibrosis
c. Fanconi syndrome
d. Mitochondrial disorder
RTA
42
Child with nephrotic syndrome. What is the most likely consequence associated with this disorder?
a. DVT
b. Encephalopathy
c. Acute renal failure
d. Heart failure
DVT
43
Child presents with brown urine. UA with hematuria and proteinuria. Hypertensive to sBP 160. C3 and C4 are both normal. What is likely diagnosis?
a. IgA nephropathy
b. MPGN
c. PSGN
d. SLE
IgA nephropathy
- only one with normal C3
44
12 year old girl with 3 weeks of fever, malaise and polyarthralgias (migratory). No arthritis. On exam today appears pale, joint
exam is normal. Bloodwork shows: ESR 75, creatinine 59, WBC 3, normal platelets. Lymphopenia. Urine shows trace blood
and protein. What is the most likely diagnosis?
a. SLE
b. Systemic JIA
c. Rheumatic fever
d. Post-streptococcal GN
e. Septic arthritis
SLE
45
A child with Kawasaki disease received IVIG. 24-hours later, she develops gross hematuria, with 3+blood and protein present on
urine dipstick. Her lab work demonstrates elevated unconjugated bilirubin, LDH, and transaminases. What is the cause of this reaction?
a. Hemolytic IVIG reaction
b. Renal vein thrombosis
c. Anaphylaxis
d. High-dose ASA causing bleeding
Hemolytic IVIG reaction
46
A child is diagnosed with systemic JIA, and now presents with evidence of macrophage activation syndrome (cannot remember the
labs) . What of the following will be reduced?
a. fibrinogen
b. LDH
c. triglycerides
d. Ferritin
fibrinogen
47
```
A school aged girl who plays soccer comes to your office with concerns of persistent heel pain. She has pain in running and jumping while playing soccer but not in swimming. When you squeeze her Achilles’ tendon, it hurts. What is the diagnosis?
A. Calcaneal apophysitis
B. Achilles tendonitis
C. Plantar fasciitis
D. Calcaneal stress fracture
```
??
| Calcanea apophysitis versus Achilles tendonitis
48
12-year-old kid comes in with rib pain and a few weeks of fever. White count is normal. Chest x ray shows mottled appearance of ninth rib with periosteal reaction and new bone formation. Most likely diagnosis?
a. Osteosarcoma
b. Ewing sarcoma
c. Osteoid osteoma
d. Osteomyelitis
Ewing's sarcoma
49
3 year old with a fever of 39.1˚C and severe ear pain for 2 days. On exam the tympanic membrane is bulging and erythematous. What is the best management plan?
a. Amoxicillin (75-90 mg/kg) BID for 5 days
b. Observe and re-examine after 24-48 hrs.
c. Offer a Rx for amoxicillin but tell the family to fill it if symptoms persist for another 24hr
d. Amoxicillin (75-90 mg/kg) BID for 10 day.
Amoxicillin (75-90 mg/kg) BID for 5 days
>2yo
50
A child is admitted with S. pneumoniae bacteremia and is started on Ampicillin. Shortly after receiving antibiotics, they are noted to have decreased LOC and urticaria. Tachycardic and Hypotension are noted. What is the best next step?
a. Benadryl IV.
b. 20ml/kg NS bolus.
c. Epinephrine 0.01mg/kg IV
d. Oral cetirizine
- ------
a. IV diphenhydramine
b. Restart ceftriaxone
c. 20mL/kg NS
d. Epinephrine IV
20ml/kg NS bolus or Epi IM
51
```
Boy with a week of myalgias and fever. Presents with bilateral swelling and pain extending from the ear to the angle of the jaw.
What medication?
a. Amox-clav
b. Analgesia and supportive management
c. Dexamethasone
d. IVIg
```
Analgesia and supportive management
52
A child at daycare bites another child and causes bleeding from a superficial bite. Both are immunized but their hepatitis B status is unknown. The next best step is:
a. Check Hep B serology
b. Give both the Hep B vaccine
c. HIV testing
d. Give both the Hep B immunoglobulin
- ----
a. Do HBV serology on both
b. Give oral clavulin prophylaxis to the bitten child
c. Check both for HBV surface Antigen and antibodies
d. Give Hepatitis B vaccine to both
Give both the Hep B vaccine
53
6 month old, mother with hepatitis C (antibody positive, HCV RNA positive). Babe is well with normal liver enzymes and negative anti-HCV antibody. What do you do?
a. Reassurance, no further testing needed
b. Check HCV RNA
c. Repeat serology in 6 months
d. Liver biopsy
Reassurance, no further testing needed
54
Fully immunized 2 year old has a fall in the playground with a significant deep arm laceration. After laceration has been cleaned and sutured, what further management is advised?
a. Supportive care only
b. Amoxicillin-Clavulanate
c. Tetanus immunoglobulin and toxoid
d. Tetanus toxoid
Supportive care only
55
2 month old male with a history of nasal congestion, bilateral conjunctivitis, cough and fever. On exam his vital signs are stable. Xray shows bilateral pneumonia. CBC shows high eosinophils. What do you treat with?
a. IV ampicillin
b. PO erythromycin
c. PO dexamethasone
d. Supportive care only
- -----
a. Erythromycin
b. Ceftriaxone
c. Supportive care only
d. Ampicillin
PO erythromycin
56
Child with sickle cell disease, who is travelling to South East Asia. What infectious agent are they at particular risk for?
a. Typhoid fever
b. Hepatitis A
c. Dengue fever
d. Tuberculosis
Typhoid fever
SCD= salmonella (salmonella Typhi)
57
New immigrant 2 year old from a refugee camp in Turkey. Parents present for immunizations. They say he had 3 doses of oral polio
vaccine and 4 doses of DAT (diphtheria, pertussis, tetanus). What vaccine do you recommend?
a. DTAP-IPV-Hib and pneumococcal
b. Pneumococcal and Hib
c. No vaccines needed
d. Pneumococcal, Hib and IPV
DTAP-IPV-Hib and pneumococcal
58
Adolescent contact lens wearer presents with bilateral purulent conjunctivitis. You wipe away the exudate and find the conjunctiva are significant injected. They were previously started 36 hours ago on ciprofloxacin drops with no improvement
a. Refer to ophthalmology
b. Continue cipro drops
c. Admit and start IV antibiotics
Refer to ophthalmology
59
Child admitted with orbital cellulitis and started on ceftriaxone with significant improvement in redness, fever, and appearance of the eye. The next day there is swelling of the other eye, and the child is lethargic. What do you do?
a. Consult for surgical drainage of orbital abscess
b. MRI orbits
c. Start vancomycin
d. Start dexamethasone
MRI according to Dr. O'Conner
60
Child with varicella. A lesion on his leg has become larger and red. He now presents 3 days later with a large painful indurated area that has a bluish hue overlying. What antibiotics do you use?
a. Piperacillin and tazobactam
b. Penicillin and clindamycin
c. Ceftriaxone and vancomycin
d. Cloxacillin and gentamicin
Penicillin and clindamycin
Nec Fasc
61
A child is brought to your clinic by his father after a recent G tube placement. A picture is provided of a G tube site with granulation tissue. What is your management?
a. Silver nitrate cautery
b. Reassure
c. Topical antimicrobials
d. Topical fungal cream
Silver nitrate cautery
62
A four year old child presents to your office with a history of fever, myalgias and a rash. They provide a picture that looks like parvovirus B19. When can she return to daycare?
a. When she feels well enough
b. After the rash has subsided
c. After the fever and rash resolve
d. After 5 days
When she feels well enough
63
A mother has just given birth to a well appearing infant. The infant’s father has spent the last 12 months in Brazil. The child’s growth parameters are normal. What is your management?
a. Reassurance
b. Zika PCR of blood and urine and head ultrasound
c. Zika serologies
d. MRI head
See Hamilton Review slides
64
An 11yo child presents with a unilateral facial droop. The entire half of his face is paralyzed. Taste seems to be intact. There are vesicles in the external ear canal. What is your management?
a. Steroids alone
b. Steroids and acyclovir
c. Acyclovir alone
d. Reassurance, will self-resolve
Steroids and acyclovir
65
A 3-week-old baby with bronchiolitis is admitted to hospital. On day 2 of illness, they have a fever of 39˚C. A chest X ray is done
which shows a consolidation in the right middle lobe. What microorganism is most likely responsible for the fever?
a. RSV
b. S. pneumo
c. GBS
d. GAS
RSV
66
A six year old girl returns from a camping trip to Nova Scotia with her family. Has erythematous rash with red centre and concentric ring around it. Also with fever, malaise, arthralgias. What is your management?
A. Prescribe oral doxycycline
B. Prescribe oral amoxicillin
C. Start amoxicillin if testing returns positive for Borrelia burgdorferi
D. Start doxycycline if testing returns positive for Borrelia burgdorferi
Prescribe oral doxycycline
67
Question regarding the vertical transmission rate of HIV?
| a. 1%
1%
68
You are seeing a 4mo with a 24 hour history of poor feeding and vomiting. He has just started solids. On examination, hypotonic (face and extremities), pupillary reflex normal, DTR absent. What is the diagnosis?
a. Botulism
b. Tetanus
c. Spinal muscular atrophy
d. Myotonic dystrophy
Botulism
69
Unimmunized kid with nasal discharge (acute purulent rhinitis) and low grade fever. Nasal culture shows H. influenza. What do you do?
a. Ceftriaxone
b. Conservative management
c. Sinus X-ray
d. Amoxicillin
Conservative versus amox.
depends on length of time of fevers/congestion (sinusitis or not)
colonization likely
70
A 2-year-old Asian child presents with a history of URTI symptoms. He is pale. HR 130. Grade III/VI SEM. Stable. MCV 58, Hgb 53, and high RDW. Otherwise well. What is your management?
a. Transfuse pRBCs
b. IV iron
c. PO iron
d. Hemoglobin electrophoresis
Transfuse pRBCs
Hgb electrophoresis is not management
71
8years old boy with history of severe GERD, abdominal pain, progressive dysphasia with solids and weight loss. He has lost
2. 3kg as a result of his restrictive eating. Labs are normal. What is the best test for diagnosis?
a. H.pylori urea test.
b. Breath hydrogen test.
c. Endoscopy and biopsy.
d. Upper GI series.
Endoscopy and biopsy.
72
10 year old boy who has a significant episode of gastroenteritis requiring hospitalization. Lost 6kg recently. Normal height/growth. Denies body image concerns. Now only drinking liquids and liquid nutritional supplements. What is the most likely diagnosis?
a. ARFID
b. Anorexia nervosa
c. Achalasia
d. Esophageal stricture
ARFID
73
An 8-month-old with quad cerebral palsy and GERD. He is not able to feed orally. He is currently NG fed with bolus feeds for the past few months, and has had significant improvement in his interactions since starting tube feeds. He has GERD which is well
controlled on ranitidine, and no respiratory symptoms or noted aspiration. What is the best management?
a. Gastrostomy tube
b. Gastrostomy tube plus fundoplication
c. Continue NG feeds
d. GJ tube
e. pH probe
G-tube
74
6 month old (previously well) with 1 week of poor feeding, emesis, jaundice, and acholic stool. Found to have mass in RUQ. What is the diagnosis?
a. Choledochal cyst
b. Biliary atresia
c. Alagille
d. Hepatoblastoma
Choledochal cyst
75
6-month-old with 5 vomiting episodes over the last 12 months, associated with pallor, lasting 2-3 hours. Not bloody, not bilious. Consolable. Between episodes she is other well, growing and thriving, with a normal examination. What do you want to do?
a. Reassure
b. Refer to gastroenterology
c. Neuroimaging
d. Start PPI
Reassure
76
Breastfed infant (few months old) with severe eczema, failure to thrive and CMPA (stem gave you this diagnosis. What is the management?
a. Continue breastfeeding
b. Hydrolyzed formula
c. Breastfeed and have mom eliminate all dairy and soy from her diet
d. Probiotics
Breastfeed and have mom eliminate all dairy and soy from her diet
77
3wk old, has straining and is fussy 15 minutes before passing stools, stools are non bloody and soft. After passing stools is well and not fussy. Gaining weight well, is breast fed and is otherwise healthy. Mom is ++ concerned and has already sought out 2 other consults with no answers. Best management?
a. Reassure
b. Low dose lactulose
c. Xray abdomen
d. Put mom on “bovine protein-restricted” diet
Reassure
78
2-year-old girl with anemia and painless bright red blood per rectum. What test will best reveal the diagnosis?
a. Meckel scan
b. Abdominal ultrasound
Meckel scan
79
A 4-year-old presents with a history of 2 episodes of vaginal bleeding, and several cafe au lait macules (2 small, one large). On the 97 th and 99 th percentiles for weight and height. What is the diagnosis?
a. McCune Albright syndrome
b. Neurofibromatosis
McCune albright
80
Infant presents with a history of eczema, multiple episodes of acute otitis media, and some bleeding symptoms. WBC 4.5, Hgb 120,
Platelets 20. What is the diagnosis?
a. Wiskott Aldrich syndrome
WAS
81
```
A 6mo with depressed nasal bridge and elfin facies. Labs show elevated calcium level. What is the most commonly associated
cardiac condition?
a. Supravalvular aortic stenosis
b. Endocardial cushion defect
c. Tetralogy of Fallot
```
Supravalvular aortic stenosis
| William's Syndrome
82
A child presents with increased oral secretions. When an NG is placed, it is noted to be coiled in the upper esophagus. The child is also noted to have a vertebral defect. How is this transmitted (i.e. what is the genetic inheritance of VACTERL)?
a. Sporadic
b. Multifactorial
c. Autosomal dominant
d. Autosomal recessive
Sporadic vs multifactorial
Does include environmental factors (being studied) - but inheritance pattern appears to be sporadic?
83
Which condition can be diagnosed with microarray
a. 22q11 deletion
b. Pradar Willi
c. Fragile X
d. Myotonic dystrophy
22q11
| - best for duplication & deletions
84
Female newborn with puffy hands/feet, low lying posterior hairline and shield chest. Most likely cardiac lesion
a. Bicuspid aortic valve
b. Pulmonic stenosis
c. TOF
d. TAPVD
e. MVP
Bicuspid aortic valve
| could also be coarct
85
Caudal regression syndrome features. Most likely associated with?
a. Maternal diabetes
b. DiGeorge
Maternal diabetes
86
9 year old girl whose parents are undergoing a divorce. What is her most likely reaction?
a. She will blame herself
b. She will take sides (loyalty conflict)
c. She will try to make everyone happy
d. Developmental regression
She will take sides (loyalty conflict)
87
9 year old male sustains a fracture of his skull in an MVC and requires prolonged hospitalization. His parents then come to your office with concerns about his behavior. He is having outbursts at school, cannot complete assignments, and has sleep issues (wont sleep on his own sleeps in parents room), repeatedly draws pictures of the car accident, won’t get into car unless checks seat belt 3
times. What is the diagnosis?
a. PTSD
b. Conduct disorder
c. ADHD
d. Mild brain injury
PTSD
88
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16yo male who is brought by his parents for concerns of recurrent violent thoughts. He condones that he has frequent powerful
violent thoughts, and images in which he imagines himself hurting people. He has no history of aggressive or violent acts, but fears he
may act on these thoughts some day. What is his diagnosis?
a. Scizophrenia
b. OCD
c. Manic episode
d. Conduct disorder
----------
a. Schizophrenia
b. Behavioural problem
c. OCD
d. Antisocial personality disorder
```
OCD
89
A teenager has an episode of syncope after getting an influenza immunization. He then presents to the ED unable to walk, and has an episode in which he simultaneously has stiffening of his right upper arm, and jerking of his left lower leg. He then appears to lose consciousness, but during this time demonstrates protective reflexes. He appears in no distress, and seems unconcerned by his inability to walk. What is the diagnosis?
a. Conversion disorder
b. Somatization
c. Post-concussion seizure
Conversion disorder
90
You are counselling a transgender female adolescent. What anticipatory guidance do you discuss?
a. Sperm banking
b. Eventual Pap smears
c. Oocyte preservation
d. Teach how to do self-breast exams
sperm banking
91
A baby is born to an exclusively vegan mother, who intends to breastfeed until 6 months of life. What vitamin is the most important to supplement the baby with?
a. Folate
b. Iron
c. Calcium
d. Vitamin B12
vit B12
92
A girl presents to the ED with cannabis withdrawal syndrome. What is most in keeping with this presentation?
a. Abdominal pain
b. Palpitations
c. Sensory disturbance
d. No symptoms
abdo pain
93
A 15 year old male presents to the ED after being at a music festival. He has hypertensive, combative, agitated. No nystagmus. He has mydriasis and flushed skin. How do you manage him?
a. Supportive care only
b. Diazepam
c. Atropine
d. Give activated charcoal
- ---------
a. Physical restraints
b. Olanzapine
c. Diazepam
d. Flumazenil
Diazepam
94
15 years old female who is known to have irregular periods since she was a child, hirsutism and has pustular acne. Her growth parameters are at 50%. Which of the following will be you included in your surveillance screening (what test to do now/next):
a. OGTT
b. Lipid panel
c. Dexamethasone suppression test
OGTT
95
```
A girl has her period from April 2-7 and then again from April 23-30. What is the legnth of her menstrual cycle
A. 7 days
B. 14 days
C. 21 days
D. 28 days
```
21 days
96
```
An adolescent comes to your office desiring contraception. She asks you for the most effective treatment. In addition to condoms, you recommend the following as the most effective treatment:
A. Low dose combined oral contraceptive
B. Progestin only pill
C. Progesterone containing IUD
D. Transdermal patch
```
Progesterone containing IUD
97
12 yo F, started menarche 6 days ago, multiple days of heavy bleeding, soaking through multiple pads, changing q1h. No FHx bleeding disorder. What will be your initial management?
a. High dose combined oral contraceptive
b. Tranexamic acid
c. IV estrogen (Premarin)
d. Admit for D&C
High dose combined oral contraceptive
98
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?
a. Benign rolandic epilepsy
b. Sleep onset association disorder
c. Night terrors
Sleep onset association disorder
99
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?
a. Increase his medication dosage
b. Assess him for gambling problems
c. Add a mood stabilizer
d. Reassure
Assess him for gambling problems
100
7 year old with chronic cough. Only happens at school. Doesn’t happen at home. When it happens at school they bring him home and it goes away. What is your diagnosis?
a. Vocal tic
b. Asthma
c. Separation anxiety
Separation anxiety
101
7-year-old with school refusal. How do you get them to go back?
a. Gradual return to school
b. SSRIs
Go back to school
102
Child (4 year old female) with sore throat, started on antibiotics but persistent fever. Presents to ED with ulcerations on tonsils and pharynx and also has moderate anterior cervical lymphadenopathy bilaterally. CBC showed: WBC 26, Hb 80, Plt 15. Diagnosis?
a. ALL
b. AML
c. EBV
d. Lymphoma
- ------------------------------------------
a. Peritonsillar abscess
b. Retropharyngeal abscess
c. EBV
EBV
103
A 5 year old boy has had fever and sore throat. Initially prescribed amox, defervesced. A few days later returns with brassy cough, high fever, toxic appearance. What is next in management?
a. Nebulized epinephrine
b. Dexamethasone
c. Call ENT
d. Lateral neck XR
Call ENT
104
15 year old with one week of sore throat. Got better then started getting worse again. Was started on penicillin 3 days ago by GP. Now presenting with pain, temp 38.8 and unable to open mouth (trismus). What is the dx:
a. Pharyngitis
b. Paratonsillar abscess
c. Retropharyngeal abscess
PTA
105
4 year old kid with fever, and swelling behind the ear with anterior displacement of ear. Which eye findings do you expect?
a. Lack of lateral eye movement
b. Lack of upward eye movement
c. Lack of downward eye movement
d. Lack of medial eye movement
Lack of lateral eye movement
106
```
1 year old child presents to ER with seizures. Retinal exam photo attached (hemorrhage). What is the most likely diagnosis?
A. Tay Sach disease
B. Retinopathy of prematurity
C. Child abuse
D. Toxoplasmosis
```
Child abuse
107
A 4-month-old presents with a narrow elongated head, dolichocephaly, and frontal bossing. What suture is most fused?
a. Lambdoid
b. Sagittal
c. Coronal
d. Metopic
Sagittal
108
Toddler with intussusception, seen last week and treated with air enema reduction. Returns with similar symptoms, but now looks sick, tachycardic, hypotensive with abdominal pain and guarding. What do you do next?
a. Air enema
b. Nasogastric decompression
c. Consult surgery
d. Abdominal ultrasound
Consult surgery
109
You examine an 8-month-old infant and find the right testicle is not palpable in the scrotum. What is the most important next step in management?
a. Refer to surgery
b. Ultrasound to locate the testicle
c. Reassess in 2 months
d. Refer to endocrinology
Refer to surgery
110
8-month-old with a 3cm umbilical hernia. No strangulation. What is your next step in management?
a. Continue to monitor
b. Referral at 2y if still persistent
continue to monitor
111
4-5 year old boy with pubic hair Tanner 3, enlarged penis, prepubertal testes, What investigation do you order next?
a. Brain MRI
b. Testicular Ultrasound
c. Adrenal androgen levels
d. LHRH stimulation test
Adrenal androgen levels
112
Term male neonate with a birth weight of 4kg. Father concerned about penis size. On exam stretched penile length is 3cm.
Both testes are palpable in the scrotum. What is your next course of action?
a. Check 17-OH P.
b. Microarray/karyotype
c. Order testosterone, LH and FSH
d. Reassure that penile size is normal
Reassure that penile size is normal
113
A child presents with DKA. Given initial set of labs: pH 7.06, bicarb 7, lytes given Na 120s, Cl 100s, anion gap 20 (you must
calculate AG yourself). Started on normal saline and 0.1 U/kg/hr of insulin. Several hours later, patient looks better. Given second set of
labs: pH 7.03, bicarb still 7 (?), but AG 8, Na 140s, Cl 130s. What is the cause of the acidosis?
a. Hyperchloridemia
b. Inadequate insulin administration
c. Hypoventilation
d. Lactic acidosis
Hyperchloridemia
114
A child presents after a significant ingestion of his grandmother’s bottle of iron pills. He developed nausea and hematemesis and
was brought to the hospital. In the ER he was fluid resuscitated, deferoxamine was started and an abdominal radiograph demonstrates
many iron pills still in his stomach. What is your next step in management?
a. Activated charcoal
b. Whole bowel irrigation
c. Endoscopic removal of iron
d. Ipecac
Whole bowel irrigation
115
13 year old girl with T1DM who has a recent history of unprovoked hypoglycemic episodes, and sensation of abdominal distension. She is 3% for height and 10% for weight. She is tanner stage 1 for breast development and pubic hair.
a. LH, FSH
b. TSH, T4, and anti TPO antibodies
c. Anti TTG
d. Karyotype
??
| anti-TTG
116
8-month-old child with VSD, hypocalcemia, hypertelorism and cleft palate. Ionized calcium of 0.81. Asymptomatic. How do you manage his hypocalcemia?
a. Calcium supplements
b. PO Vitamin D
c. PO Calcitriol (active Vitamin d)
d. IV Calcium
PO calcitriol
They are getting at DiGeorge (hypoparathyroidism)
Vitamin D important for calcium absorption in the gut
in hypoPTH, need ACTIVE form of vitamin D b/c need PTH to activate vitamin D, despite a normal kidney
If supplement Vit D, helps absorption from the calcium - can pull enough from diet
117
What is the most common reason for secondary adrenal insufficiency?
a. exogenous steroids
b. Adrenoleukodystrophy
c. Infection
d. CNS trauma
exogenous steroids
118
Girl with diffuse goiter. TSH 30. What are you most likely to find?
a. Anti-TPO
b. Anti-TSH
anti-TPO
119
13-month-old with low calcium, seizure. Exclusively breastfed, no supplementations or medications. Solid foods appropriately introduced at 6 months. (more description of calcipenic rickets) Which lab value matches the diagnosis:
a. Increased alk phos
b. Decreased PTH
c. Increased 1,25 Vitamin D
d. Low phosphate
Increased alk phos
120
```
A mother brings in her four year old child for assessment of his development (she is concerned). He can ride a tricycle and briefly stand on one foot, he knows his name and gender. He can make a tower of 10 blocks and draw a circle and copy a cross. He engages in parallel play. What is his developmental age?
A. 24 months
B. 30 months
C. 36 months
D. 48 months
```
36 months
121
18 month old who wakes up screaming, inconsolable, parents at loss of what to do. Does not recall events.
a. Reassure
b. EEG
c. MRI
d. Refer to psych
Reassure
122
The Mother of a 3.5 yo girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentences. She has associated facial twitches and blinking. What do you recommend?
a. Reassure
b. Referral to SLP
c. Developmental assessment
d. Audiology
Referral to SLP
123
Female with diagnosis of autism. What is the best test to diagnose a possible underlying diagnosis?
a. Microarray
b. Fragile X testing
c. Karyotype
d. TSH
Microarray
124
Toddler with episodes where she doesn’t get her way, cries/throws tantrum, then loses consciousness and sometimes turns blue. These episodes are increasing in frequency. What do you recommend?
a. Ignore the behaviour and put her in timeout after the episode
b. Refer for behavioural therapy
c. Interrupt the behaviour with a time-out before behaviour has a chance to escalate
d. Give in to what she wants to avoid the behaviour
Interrupt the behaviour with a time-out before behaviour has a chance to escalate
125
Adopted child. What is worse?
a. Isolated microcephaly
b. Failure to thrive – HC, weight and height all down
Isolated microcephaly
126
A 3-year-old male is brought to you because the mother has concerns about his language. He guides mom’s hand to things that he wants, has 25 single words, and can follow 2 step commands. His fine motor and gross motor development is normal. What is this most consistent with?
a. Expressive language delay
b. Receptive language delay
c. Autism Spectrum disorder
d. Normal variant
ASD
127
Prepuberal girl brought to the ED saying she has been sexually abused by her brother for a couple of years. On exam you note absent hymenal tissue at the 12 o’clock position. What does this represent?
A. Indicative of abuse
B. Indicative of trauma
C. This is a normal variant
Normal variant
| Not between 3-9 o'clock
128
Four year old girl brought to ED by a CPS worker for concerns of sexual abuse. She has a reddened and irritated vulva with vaginal discharge. How do you manage this?
A. Reassure that discharge is physiologic
B. Do STI screening and treat if positive
C. Recommend stopping bubble baths and ensure wiping front to back
D. Topical therapy with mupirocin ointment
Do STI screening and treat if positive
Due to concerns from CPS worker. Otherwise would think vulvovaginitis.
129
```
Baby is born with an approx 3 centimeter hemangioma (noted at birth) over the left lower portion of the lip toward the jaw. What is
the correct investigation for surveillance?
a. MRI head
b. Ophthalmology consult q 6 months
c. Endocrine consult
----
a. Ophthamology consult
b. MRI head
c. No additional testing
d. CBC in 6 months
```
MRI head
130
3 year old male, who previously had eczema on his face, treated with mild potency corticosteroids. He has the sudden onset of the
following rash: Picture shows significant erythema, crusting over the lower portion of the face, perhaps involving the mouth?
How do you manage?
a. Acyclovir
b. Cefazolin
c. Switch to a more potent topical steroid
d. Reassure
Cefazolin
131
A teenager with a history of asthma presents to your office in the summer with numerous hypopigmented oval macules on her face
and chest. These areas are poorly demarcated, and have a fine scale. What is your diagnosis?
a. Post inflammatory hypopigmentation
b. Pityriasis alba
c. Tinea versicolor
d. Vitiligo
Pityriasis alba
132
Boy with mucocutaneous lesions involving the trunk, hands and mouth that started 2 days ago. Seemed like SJS. He has a one week history of fever, pharyngitis and malaise. He was started on amoxicillin and acetaminophen three days ago.
What is most likely responsible for his presentation (photo similar)?
A. Mycoplasma
B. Amoxicillin
C. Acetaminophen
D. HSV
mycoplasma (MRM)
133
```
You are called to see a 36 hour old term infant as a new rash has appeared. He is otherwise well, afebrile and in no distress. See photos (white little papules). What is the diagnosis.
A. Miliaria
B. HSV
C. Neonatal pustular melanosis
D. Erythema toxicum
```
Milliaria
134
Girl with itchy head. Upon closer inspection, you see live lice and eggs at the base of hairs. Mom asking when can she return to school?
a. Does not need to be restricted from returning to school
b. Return when no more adult lice seen
c. Return after one application of pediculocide
d. Return when no more eggs/nits seen
Does not need to be restricted from returning to school
