2019 - MCQ Flashcards
(94 cards)
1
Q
(Photo of EKG showing wide complex tachycardia)
Patient in ED waiting area with poor pulses, not responsive, first line therapy?
a. Adenosine
b. Sync cardiovert
c. CPR
d. Amiodarone
A
Sync cardiovert
2
Q
15 year old female with 5 prior episodes of syncope. Each one is associated with light headedness, going dark in field of vision. On one episode her father kept her upright and she had brief GTC activity with urinary incontinence. What is your initial investigation?
a. EEG
b. ECG
c. blood pressure lying and standing
d. Echo
A
ECG
3
Q
Term newborn, uncomplicated pregnancy, discharge physical exam is normal. There is a II/VI systolic murmur at the left sternal border. What is your next step: a - ECG b - CXR c - Routine care d - Echo
A
Routine Care
CPS says that you would do both CXR and ECG with 4 limb BPs if you fail CCHD - without this, one would assume routine care
4
Q
3 year old kid with multiple recurrent sinopulmonary infections. One pneumonia with lung abscess cultured Strep pneumo. Previous episode of stomatitis with secondary facial cellulitis. History of recurrent oral ulcers. Concern with what part of the immune system
a. T cell
b. B cell
c. Granulocytes
d. complements
A
B cell
5
Q
8 year old boy presents with itchy mouth and angioedema of lips and tongue after eating an apple. He is otherwise well. What do you do?
- Recommend avoiding raw apples.
- Recommend avoiding raw apples and prescribe EpiPen autoinjector.
- Recommend avoiding raw and cooked apples.
- Recommend avoiding all raw fruit.
A
Recommend avoiding raw apples and prescribe EpiPen autoinjector.
6
Q
Picture of abdomen (with herald patch)
a. Nummular eczema
b. Tinea
c. Pityriasis rosea
A
Pityriasis rosea
7
Q
1 week old infant presents with an umbilical granuloma. What is the treatment?
- Excise
- Silver nitrate
- Observe/reassure
A
Silver nitrate
8
Q
6 year old boy with varicella infection presents with progressive skin lesion on his limb - red with blue hue, increasingly large and now exquisitely painful. Which antibiotics should you treat him with? Clinda/gent Pen/clinda Piptazo ceftriaxone/vanco
A
Pen/clinda
9
Q
3 yo F with eczema presents with several days of rash seen in image. She is also febrile. How would you treat? Image shows large yellow crusts on erythematous base, on the eyelid, over the mouth (more yellow and crusty than above, some people said they saw lesions on the tongue) IV Acyclovir IV Cefazolin PO Acyclovir PO Cephalexin
A
PO Cephalexin
if patient unwell - IV cefazolin
10
Q
2 year-old previously healthy boy with a recent history of malaise and cough, and the new onset of rash, which predominantly involves his distal extremities (picture provided - whole body, confluent erythematous rash with bullae involving mucous membranes). He was started on amoxicillin 7 days ago in the context of his respiratory illness. Nikolsky sign is positive only in areas of involved skin. What is the most likely diagnosis? Staphylococcal scalded skin Toxic epidermal necrolysis Bullous pemphigoid Scarlet fever
A
??
SSSS versus TEN
11
Q
Teen female with blackheads on her forehead. She first noted these lesions 2 months ago, and has not previously sought medical attention. Which would be the MOST appropriate INITIAL treatment?
a. Benzoyl peroxide
b. Wash face frequently
c. Topical retinoid
d. Topical antibiotic
A
Benzoyl peroxide and topical retinoid both correct
12
Q
7 year old girl discloses sexual abuse by her 15 year old stepbrother for the past couple of years. On examination, there is a complete cleft in the posterior hymen. This is:
a. diagnostic of sexual abuse
b. a normal variant
c. a congenital abnormality
d. diagnostic of previous hymenal injury
A
diagnostic of previous hymenal injury
13
Q
9 month old has a left humeral midshaft fracture, no provided history. Normal development, previously healthy. Skeletal survey does not show any other fractures. Dilated fundoscopy exam is normal. Bloodwork is normal including CBC, extended electrolytes (Ca, Phos, Mg), ALP, urinalysis, liver enzymes (AST, ALT). Most appropriate management:
a. Abdominal ultrasound
b. Genetics referral
c. Repeat skeletal survey in 2 weeks
d. Repeat Ophtho exam in 2 weeks
A
Repeat skeletal survey in 2 weeks
14
Q
2 yr old with stuttering. Speaks in 3-4 word sentences. What would make you most concerned?
- Pauses between words
- Repeats full words
- Repeats part of words
- Tension in face
A
- Tension in face
15
Q
At what age are most children sure of their gender identity? 1- 4 2- 6 3- 8 4- 10
A
4
16
Q
A 10 year old boy with ADHD and is stable on stimulants for 2 years. He presents with increased aggressive behavior and difficulty following limits. His sleep and appetite are otherwise normal. After ruling out psychological stressors. Which of the following is the most appropriate action: 1- Increase his stimulant dose 2- Use benzo PRN 3- Add atypical antipsychotic 4- Add an SSRI
A
Increase his stimulant dose
17
Q
School aged child, difficulty making friends, doesn’t get invited to birthday parties. Doing well academically. Has a very organized desk and gets upset with people when they touch it. Does not make eye contact with classmates. 1- OCD 2 - ASD 3- Social anxiety 4 - ?
A
ASD
18
Q
21 month old female presents with right sided breast swelling. SMR 2 on the left and SMR 3 on the right. She is 75th for height and weight. No secondary sexual characteristics. What is the next investigation?
a. Reassurance
b. Breast ultrasound
c. LHRH stim test
d. Abdominal ultrasound
A
Reassurance
19
Q
14 years old teenage girl. Gaining ++ weight over last couple of years and now obese. Menarche at 12, still irregular in menses. Mild acne. LH, FSH, 17OHP normal. Hypertensive. Has marked purple striae on exam and central obesity. What is most likely?
PCOS
Cushing Syndrome
Hypothyroid
A
Cushing Syndrome
20
Q
15 year old gymnast presents with menstrual cycles once every 2-3 months. She had initial menarche at 11 years old. She has consistently been at the 25% for BMI. She has grade 3 acne and very mild facial hair growth. She has mildly elevated LH and testosterone. Her FSH, DHEAS, prolactin, and 17-OHP are normal. What is the most likely diagnosis? Physiologic anovulation CAH PCOS Adrenal tumour
A
PCOS
21
Q
A 9 year old boy has a BMI of 95%. His weight has been steadily increasing since 5 years of age. He watches TV 5 hours a day and has a sedentary lifestyle. His father died (or had) an MI at the age of 32. His blood work showed a high total cholesterol, high LDL, normal HDL, and normal TG. His TSH is on the upper limit on normal. What is the most likely diagnosis: 1- Familial hypercholesterolemia 2- Obesity related dyslipidemia 3- Familial combined dyslipidemia 4- Subclinical hypothyroidism
A
Familial hypercholesterolemia
22
Q
After discontinuing sources of vitamin D and Ca, what is your initial management of hypercalcemia?
a. Calcitonin
b. IVF
c. Furosemide
d. Pamidronate
A
IVF
23
Q
8 year old presents with bilateral conjunctivitis received topical antibiotics with no improvement. Does not describe pain but a sandpaper feeling and associated photophobia and tearing. On exam he has pseudomembrane keratoconjunctivis What is the most likely diagnosis? 1. allergic conjunctivitis 2. Uveitis 3. Bacterial conjunctivitis 4. Adenovirus keratoconjunctivitis
A
Adenovirus keratoconjunctivitis
24
Q
Infant presents with seizures. On assessment, still hypotonic and lethargic. Fundoscopy shown (can’t find exact photo; dot and blot hemorrhages that extend to periphery). Most likely diagnosis? Tay Sachs Toxoplasmosis NAI ?
A
NAI
25
16y sexually active male referred for scrotal mass/swelling: associated dull ache, on exam there is an irregular mass palpable in the left scrotum that increases when standing (no vitals given). The left testis is of normal size. diagnosis:
a. Spermatocele
b. Inguinal hernia
c. Epididymitis
d. varicocele
varicocele
26
A 17 month old boy is going for elective orchidopexy today. When he shows up he has a fever of 38.2 and copious yellow nasal discharge. He has an intermittent cough but otherwise appears well. Can he have his surgery?
Yes
Yes, but he needs to be observed overnight
No, wait until his symptoms resolve
No, wait until 6 weeks after his symptoms resolve
No, wait until 6 weeks after his symptoms resolve
27
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
28
```
A 9-week old baby is lying on his back in a stroller. Mother hears the baby cough, after which becomes stiff and red, followed by limp and pale. The episode lasts less than 30 seconds, after which baby returns to normal. What is the MOST likely diagnosis:
Seizure
GERD
Breath-holding spell
Bronchiolitis
```
GERD
29
28 week gestation mom lives with her husband and 2 and 5 year old kids. How best to protect future baby for first 6 months of its life?
Vaccinate everyone except the mother
Vaccinate mother with inactivated vaccine
Vaccinate father with inactivated vaccine and children with live vaccine
Vaccinate mother with inactivated vaccine
30
3yo previously healthy kid with ear pain for one day. One exam, T 37.8C and erythematous, bulging tympanic membrane. Best management?
Reassess in 24-48 hours
Amoxicillin 45-60 mg/kg/day divided BID x 5 days
Amoxicillin 75-90 mg/kg/day divided BID x 5 days
Amoxicillin 75-90 mg/kg/day divided BID x 10 days
Reassess in 24-48 hours
31
Ex-28 week premature baby in the NICU, now 8 weeks old. He is working up on feeds and gradually weaning oxygen, expected discharge in 2-3 weeks. When should he receive rotavirus vaccine?
Now
This baby is not eligible for Rotavirus vaccine (or something like that… maybe contraindicated?)
At time of discharge from NICU
At 2 months corrected gestational age
At time of discharge from NICU
32
```
4mo old with eruption of 2 new teeth, what do you do?
Brush with water only
Brush with fluoride toothpaste
Send to dentist now and every 6 months
Discontinue night time feed
```
Brush with water only
33
What is the most appropriate treatment for headlice when there is known resistance?
1. Dimeticone solution
2. Permethrin (Nix)
3. Pyrethrin (R&C shampoo)
4. Isopropyl-myristate/Cyclomethicone (Resultz)
Isopropyl-myristate/Cyclomethicone (Resultz)
34
What are the current recommendations for HPV Vaccine for 15 year old boy
1. 2 doses; now and 6 months later
2. 3 doses; now, then at 1, and 6 months
3. No vaccine
4. Wait until he's sexually active
3 doses; now, then at 1, and 6 months
35
```
You are seeing a 2 month old in your clinic being seen due to concerns with poor weight gain. Brith weight approx 3kg, currently weighs 4 kg. She is drinking 60mL of regular formula every 3 hours. What is her daily caloric intake?
60 kcal/kg/day
80 kcal/kg/day
100 kcal/kg/day
120 kcal/kg/day
```
80 kcal/kg/day
36
28 week prem now 8 weeks. On low flow O2. Will be admitted for another 2-3 weeks. When do you give rotavirus vaccine?
a. Not indicated
b. Now
c. In 2-3 weeks at discharge
d. At 8 week corrected
In 2-3 weeks at discharge
37
4 day old female baby with jaundice, Bili 420. Both parents well. Mom O-, baby B+. Coomb’s negative. Of Northern European ancestry. What is most likely cause of jaundice?
a. Rh incompatibility
b. ABO incompatibility
c. Hereditary spherocytosis
d. G6PD deficiency
ABO incompatibility
38
```
A teenage girl has decided to become vegan. What is the BEST management:
Refer to Dietician
Calcium Supplementation
Vitamin B12 supplementation
Vitamin D supplementation
```
Refer to Dietician
39
```
A teenage girl consults you for initiation of birth control. She has not yet had intercourse with her boyfriend and neither of them have STIs. Assuming “typical adolescent use” you recommend:
Depo Provera
Nuva Ring
Copper IUD
Combined Oral Contraceptive
```
Combined Oral Contraceptive
40
6y old female presents with wet underwear and new yellow discharge for the past 3 weeks. Her mother has been noticing her touch her perineum frequently. On examination she has erythematous labia Majora and perineum and yellow vaginal discharge:\. What is the cause?
a. foreign body
b. Candida
c. group A strep
d. pinworms
GAS
41
According to the WHO, which of the following can receive combined hormonal oral contraceptive pills?
1. Unexplained vaginal bleeding
2. Migraine with aura
3. Liver disease
4. Malignant hypertension
Unexplained vaginal bleeding
42
7 year old male with difficulties leaving mother, along with refusal to go to school. What treatment would you advise?
a) CBT
b) Benzo PRN
c) antipsychotic
d) family therapy?
CBT
43
Teenager took 15 tabs of an oral hypoglycemic and hospitalized. 48 hours later is stabilized. Demanding to leave. She is homeless and lives on the street. What is her greatest risk factor for repeated suicide attempt?
a. Mechanism of suicide attempt
b. Female
c. Being alone
d. Spontaneous suicide attempt
Spontaneous suicide attempt
44
7yo girl with abdominal pain in the morning before school, and physical exam normal exam. What do you do.
Send to school
Homeschool
Change schools then gradually send to school
Fluoxetine
Send to school
45
15 year old boy with depression. What would make you hesitate in prescribing fluoxetine?
a. Family history of suicide
b. Family history of bipolar disorder
c. Personal history of cardiac surgery
d. Personal history of ...
Family history of bipolar disorder
46
10 year old male presents with ataxia and ADHD features. Maternal uncle died at age 10. What is the most likely diagnosis?
fredrichs ataxia
X- linked adrenleukodystrophy
Ataxia telangectasia
X- linked adrenleukodystrophy
47
```
What genetic syndrome is MOST associated with a right aortic arch and tetralogy of fallot?
Down syndrome
Williams syndrome
Turner syndrome
DiGeorge syndrome
```
DiGeorge syndrome
48
```
2 week old, concern for micropenis 1.7cm. Testes were palpable, next workup?
Reassure
Microarray testing
LH, FSH, testosterone
Abdominal ultrasound
```
LH, FSH, testosterone
49
Hemivertebrae - most likely cause
1) IDM
2) FAS
3) Trisomy 13
IDM
50
```
Baby with ambiguous genitalia, proteinuria, and edema. What disease is this baby at risk of developing?
Wilms tumour
Adrenocortical carcinoma
Congenital mesoblastic nephroma
Neuroblastoma?
```
Denys-Crash Syndrome
Wilm's tumour
51
```
Child described with cleft palate, TOF, low calcium (features of digeorge). CBC shows Hb 110, plt 100. Baby blood type AB + (No mention of maternal plt results) He is going for cardiac surgery. - if he has blood loss what do you do?
Give him irradiated blood
Pla1 platelets
Maternal washed platelets
O neg blood
```
Give him irradiated blood
52
Boy with DMD. Weakness has progressed such that he is ambulating with an electric wheelchair. He has new onset morning headaches. What is the most likely cause?
a. Worsening cardiomyopathy
b. Brain Tumor
c. Nocturnal hypoventilation
d. Autonomic ...
Nocturnal hypoventilation
53
```
3yo boy referred to you for language delay. On his exam you notice the following finding (see picture below - exact same picture from Google - axillary freckling). What is the mode of inheritance of this condition?
Autosomal dominant
Autosomal recessive
X linked dominant
X linked recessive
```
AD
54
```
4 year old girl presents to you with progressive abdominal pain. She has a history of pulling out her hair. An upper GI is done as is shown below (stomach with a ball of stuff). What is the definitive management?
Endoscopy
Laparoscopy
Observe
Laparotomy
```
Endoscopy
55
```
18mo with periorbital edema and pallor on exam. Her albumin 26 and her urine is negative for protein. Labs also show anemia. What test is most likely to reveal the diagnosis?
Serum trypsin
Stool alpha-1-antitrypsin
24-hour urine creatinine clearance
ECHO
```
Stool alpha-1-antitrypsin
| Test for protein losing enteropathy
56
```
7yo kid with history of GERD, and new onset abdominal pain. How do you diagnose
Esophagoduodenoscopy and biopsy
Scope
Urea breath test
Stool for H pylori
```
Esophagoduodenoscopy and biopsy
57
```
Previously well 6 month old presents with a 1 week history of acholic stools with total bilirubin 350 and direct bilirubin of 200. Urine is cola coloured. RUQ mass. What is the most likely diagnosis:
Hepatoblastoma
Alagille
biliary atresia
choledochal cyst
```
choledochal cyst
58
Adolescent girl with intermittent epigastric pain for months. Normal weight and diet. Father has history of peptic ulcer disease. Tried dad’s antacids and experienced some relief. What would be the best management?
a. Amox, clarithro, and PPI
b. Scope + biopsy
c. Urea Breath Test
d. Stool antigen test
Scope + biopsy
59
2 year old boy swallowed a button battery. Mom calls you asking what to do?
1) Follow up with xray in 48h
2) Reassurance that lots of kids swallow small objects
3) Urgent Xray to determine where battery is
4) Urgent endoscopy
Urgent Xray to determine where battery is
60
```
2 year old presents with pallor, otherwise well. He eats a varied diet, and drinks 1 L of homo milk a day. Because he has no risk factors on history or physical, you do some blood work which shows the following:
· MCV 80, Hb 48
· HB electrophoresis: Hb A, Hb S
· Blood smear: normal
What is the most likely diagnosis?
1) sickle cell disease
2) congenital red cell aplasia
3) transient erythroblastopenia of childhood
4) Iron deficiency anemia
```
TEC
61
Girl with sickle cell who has had a stroke. How do you prevent secondary stroke?
1) hydroxyurea
2) folic acid
3) transfuse pRBC
transfuse pRBC
62
30 month easy bruising with bruises on bony prominences and thorax, otherwise exam unremarkable thrombocytopenia 23 large platelets on smear, no blasts, hb 125, wbc 9.1. What is the MOST appropriate management:
a. 1g/kg IVIG once with close follow
b. 2mg/kg prednisone X 4d with close follow up
c. avoid high risk activity and NSAIDs and close follow up
d. Anti D IG
avoid high risk activity and NSAIDs and close follow up
63
West Nile Virus - Which represents the most likely presentation?
a. Asymptomatic
b. Mild febrile illness
c. Meningoencephalitis
d. Something about Paralysis
Asymptomatic
64
A 6-month old whose mother is anti-HCV+ and HCV-RNA+, baby is anti-HCV+, asymptomatic, normal exam. What is the best management of the baby?
Repeat anti-HCV in 6 months (isn’t this right?)
Transaminases
Refer for liver biopsy
Obtain HCV-RNA
Obtain HCV-RNA
65
Infant with bilateral infiltrates and pneumonia symptoms with also bilateral conjunctivitis. Has eosinophilia on CBC. What do you treat with?
Ampi genta
po erythromycin
IV ampicillin
po erythromycin/azithromycin also
66
Boy with moderate WOB sating 92% on RA, decreased air entry to one side and associated consolidation - what is your antibiotic choice?
1) Ampicillin
2) Ceftriaxone
ampicillin
67
Girl with sickle cell who was bitten by a dog on her leg. After appropriate cleaning of the wound and checking the (immunization status of the dog) dog for rabies what is the next step?
1) Observe and follow up in 24h
2) IM ceftriaxone
3) Amox/clav
4) Topical mupirocin
Amox-Clav
| immunocompromised 1st line
68
```
Newborn who is IUGR, failed hearing screening, positive CMV PCR from urine, what do you do?
Reassure and follow up in 6 months
Ganciclovir for 2 weeks
Valganciclovir for 4 weeks
Valganciclovir for 6 months
```
Valganciclovir for 6 months
69
```
3 month-old admitted with proven RSV+ bronchiolitis. Noted to be mildly tachypneic with retractions on exam, requiring O2 0.5L/min. On the second day of admission, the patient becomes febrile to 39C, exam otherwise unchanged. What is the likely etiology of the fever?
GBS
Strep pneumo
GAS
RSV
```
RSV
70
1. Girl who is active. Heel pain worse with activity such as running and jumping. No concerns with swimming. Tender achilles on exam. How to manage.
a. Avoid activity and rest
b. Something that sounds like an air cast
c. Use NSAIDS for the pain
d. X-rays
Avoid activity and rest
71
12yo boy had an ankle injury in soccer. He currently reports pain but is able to weight bear. Which of the following would indicate a need to X-ray his ankle:
1. Tenderness over the anterior edge of the medial malleolus
Inability to weight bear immediately after the injury
Tenderness over the posterior edge of the lateral malleolus
Ankle swelling
Tenderness over the posterior edge of the lateral malleolus
72
Picture below - 4 yo child was eating normal diet, BMI at 75th percentile (did not mention anything about supplements or dietary restrictions).
a. Tibia Vara
b. Rickets
c. Genu Varum
d. Achondroplasia
? Rickets versus Tibia Vara (Blounts)
73
```
10 year old girl presents with dark urine for 1 day. No fever, dysuria, or abdominal pain. On exam non-toxic, normal vital signs except for hypertension, clinically mildly edematous. Urine dip shows large blood and protein. Bloodwork shows low C3. What is the most likely diagnosis?
Post-strep glomerulonephritis
Membranoproliferative glomerulonephritis
Lupus
IgA nephropathy
```
Post-strep glomerulonephritis
74
A 10 year old boy comes in with gradual onset of testicular pain over the last few days. On exam there is focal induration at the upper pole of the testis with a bluish hue. Testicular ultrasound with doppler shows increased blood flow and an enlarged epididymis. What is the best management?
Urine cultures and antibiotics
Call surgery
NSAIDs and bedrest
NSAIDs and bedrest
75
```
13 yr old male with BP 130/80, averaged from 3 readings at your office that visit. Height is 25% (They provided a blood pressure chart by age and height percentile). He is asymptomatic. What is your recommendation
1 - repeat BP check at next 3 visits
2 - send for ambulatory BP
3 - BUN/Cr, urine ACR
4 - BUN/Cr, urine ACR, ECG, lipids, u/s
```
Repeat BP check at next 3 visits
76
3 month old term baby has one episode of limpness, colour change. The episode lasts for 30 seconds, no precipitating factors. No previous episodes. Exam is normal afterwards. What is the BEST management?
a. Reassure and no further investigations
b. Admit for polysomnography study
c. EEG
d. Head ultrasound
Reassure and no further investigations
Meets criteria for a BRUE. ECG could be indicated. Not any other options are appropriate other than Reassure
77
Child with new ataxia. On exam irregular eye movements and some jerking of limbs. Most likely diagnosis?
1. Brainstem glioma
2. Juvenille myoclonic epilepsy
3. Neuroblastoma
4. Acute cerebellar ataxia
Neuroblastoma
Opsoclonus myoclonus ataxia
78
```
16 yo M presents with headache for the past 2 years, occuring once every 2 weeks. Have not changed in frequency or severity. Normal physical exam. Cough and bowel movements make headache worse. Best management step?
Amitriptyline
MRI Brain
Headache Diary
Flunarizine
```
MRI Brain
Chiari malformation - headaches worse with Valsalva maneuvers
79
4-15 year old boy has syncopal episode after an immunization. Then has jerking of right arm and right leg. Afterwards he is unresponsive but has protective reflexes. Fine after but unable to walk. He is unconcerned about his symptoms
1) LP
2) EEG
3) MRI
4) observe
Observe
80
```
8yo boy with 1 year of worsening tics including blinking, lip smacking, tugging at his ears, clearing throat, other vocal tics. Very distressed by this and teased by kids at school. What do you do?
Reassure and follow up in 6 months
Refer for psychological assessment
Start alpha 2 agonist
Start a benzodiazepine
```
Start alpha 2 agonist
Tourette syndrome with psychosocial impairment
81
6 day old term newborn male presents to the ED with blood in his diaper. Thought to be rectal in origin. Baby born term and at home with no apparent complications. On examination in the ED he is tachycardic and pale. What is the most likely diagnosis?
1. CMPA
2. Anal fissure
3. Hemorrhagic disease of the newborn
4. Meckles
Hemorrhagic disease of the newborn
82
Baby is 2 hours of life, term, 3 kg, spontaneous vaginal delivery, no resuscitation. Mom has chorioamnionitis. Baby is well on examination. Vitals given: 37.1C, HR 150, RR 50. (No mention of GBS status).
Best initial step in management:
a. Routine newborn care
b. Vitals q3-4h with CBC at or after 4 hours of life
c. CBC, cultures and vitals q3-4h until cultures come back
d. CBC, cultures and IV antibiotics
Vitals q3-4h with CBC at or after 4 hours of life
83
A 3 day old baby comes to your office. BW 3kg, now 2.75kg. breastfeeding 9x per day with 7 wet diapers. Well appearing on examination. What is your management?
1. Mother to start domperidone
2. Order electrolytes and bilirubin
3. Keep breastfeeding and follow-up in 24 hours
4. Supplement with formula after each feed(15-20cc)
Keep breastfeeding and follow-up in 24 hours
84
```
Newborn with head circumference <3rd centile and 1800g birth weight, term. Which is most likely to explain this?
Maternal preeclampsia
Maternal smoking
Maternal infection
Maternal malnutrition
```
Maternal infection
85
```
Term, 4 day old, BF baby - doing well. Total bili 240 (direct 10) - asked for management.
Phototherapy
Reassure
CBC
Liver enzymes
```
Day 4 or above - <250 is always normal. High risk 250; low risk 350
86
```
Infant, vomiting unwell for a few days, with HR 260bpm, resp distress and RR70, poor pulses, liver 4cm below costal margin - cause?
SVT
Myocarditis heart failure
Pompe disease
Lactic acidosis
```
SVT
87
```
Term newborn, has 2 vessel cord, clinically well and otherwise normal exam. What should you do?
Renal ultrasound
ABR
Nothing
Renal function tests
```
Nothing
88
```
6 day old baby presents bili 300/180 (total and conjugated), not feeding well for the past several days. Temperature of 35 C. What is the most likely cause?
Biliary Atresia
Sepsis
Galactosemia
Hepatitis
```
Sepsis
89
A newborn is being examined after possible perinatal asphyxia. He has hypertonia and is irritable. What is his Sarnat stage?
a) 0
b) 1
c) 2
d) 3
1
90
A baby is born pale, limp, with no respiratory effort. Grimace and cry with stimulation. Heart rate 90 bpm. What is the Apgar score? (exact wording from exam)
a. 2
b. 3
c. 4
d. 5
Pale: 0 limp:0 cry:2 resp effort: 0 HR 1
91
```
Kid presenting from a party. Aggressive and punched a wall at the party. Hypertensive, tachycardic, pupils dilated. Comes with bloody nose and blood/cuts on his hand. Asked for management
Haloperidol
Lorazepam
Phentolamine
Naloxone
```
Lorazepam
No antidote (sympathomimetic) - use benzo.
92
Boy on carbamazepine develops rash - what do you do?
1) Change anti-epileptic
2) Reassure
3) Urgent dermatology consult
4) See in clinic that day
See in clinic that day
93
7 year old male idiopathic tonic clonic epilepsy syndrome on Valproic acid. He has been seizure free for 9m. Blood work is completed by his doctor that reveals a low trough Valproate level at 290. What is your management?
a. stop AED
b. Leave him on his current dose as he is asymptomatic
c. Increase his dose to achieve a level to therapeutic range
d. Repeat level
Leave him on his current dose as he is asymptomatic
- stop AED (no, need 2 yrs Seizure free)
- Increase his dose to achieve a level to therapeutic range (yes if complex kiddo, bad status episodes)
94
12 year-old girl with previously well-controlled asthma on low-dose inhaled corticosteroid. Over the past month, she has had increased symptoms with ventolin use 4-5 times per week. What is the next appropriate step in management.
Montelukast
Continue low-dose CSI and add LABA
Switch to a medium-dose CSI
Prescribe a 3 day course of oral prednisone
Continue low-dose CSI and add LABA
She is 12yo. Next step.
(6-11yo - increase dose)
