Quiz 201718. Dr. St. Louis. 23/5/2017.

Quiz for May 23rd 2017

Dr. St. Louis

1. A 3-week-old infant was brought to the ED by his mother and grandmother with a concern of
vomiting. He was fine yesterday, but this morning he was fussy and started crying a lot. About 2 hours
prior to presentation to the ED he started vomiting, and at triage he was noted to have an episode of
bilious emesis. He is awake and alert on exam, but his lips are dry and he is tachycardic with a heart rate
of 190. What is the MOST likely diagnosis?

(A) Intussusception.

(B) Feeding intolerance.

(C) Malrotation and volvulus.

(D) Pyloric stenosis.

2. A 1-week-old infant is brought to the ED by his mother with concern of poor feeding for the past 12
hours and blood in his stool this morning. The mother states the infant was born 1 month early and
weighed almost 6 pounds. He seemed well when he was discharged home from the nursery on his third
day of life, but yesterday he cried more than usual and ate less than half his usual amount of formula.
On exam, the infant is lethargic with a distended abdomen. Stools are guaiac positive, and x ray
demonstrates pneumatosis intestinalis. What is the MOST likely diagnosis?

(A) Intussusception.

(B) Necrotizing enterocolitis.

(C) Hirschsprung's disease.

(D) Anal fissure.

3. You are seeing a 19-month-old infant who has had diarrhoea for 3 days. The child has had a low-grade
fever. Stools are not bloody. The parent is uncertain about urine output as there is so much stool on the
diapers. The infant is otherwise still active and willing to drink. On exam he is afebrile, heart rate is 124
beats per minute, respiratory rate is 24 breaths per minute, and when you examine his ears he cries and
has tears. His lips and tongue are dry. Skin turgor is normal, and capillary refill is 1-2 seconds. What is
the MOST appropriate therapy at this point?

(A) Place an IV bolus with 20 mL/kg of normal saline, check electrolytes,

and reassess.

(B) Place an IV with 20 mL/kg of normal saline, and reassess.

(C) Order oral rehydration solution 50 mL/kg over 4 hours, and reassess.

(D) Order oral rehydration solution 20 mL/kg over 24 hours, and reassess.

4. A 6-week-old infant presents with non-bloody, watery diarrhoea for 2 days. The parent states the
stools are now occurring every 15-30 minutes. The infant has become progressively lethargic and now
won't drink. He has a temperature of 37.0C, heart rate is 198 beats per minute, and respiratory rate is
40 breaths per minute. The infant is listless and does not cry with needle sticks. He has a sunken
fontanel and dry mouth. Capillary refill is 4 seconds, and there is tenting of the skin. The nurses have
been unable to place a peripheral IV. What should you do next?

(A) Place an intra-osseous line and administer a 20 mL/kg bolus of normal saline over 10 minutes, then
reassess.

(B) Consult a surgeon for a saphenous vein cut-down.

(C) Order oral rehydration solution 50 mL/kg over 4 hours, and reassess.

(D) Place an intra-osseous line and administer a 20 mL/kg bolus of D5 & 1/4; normal saline over 1 hour,
then reassess.

5. You are evaluating a 3-year-old child who presents with diarrhoea, lethargy, and decreased urination.
The last stool had blood streaks. On exam her blood pressure is 122/76 mmHg, heart rate is 150 beats
per minute, and she is pale. Pertinent laboratory studies include BUN of 36 mg/dL, Cr of 3.4 mg/dL,
haemoglobin of 7.1 g/ dL, and platelet count of 60,000. The urinalysis shows blood and protein. The
manual review of her blood smear shows signs of hemolysis. What is the MOST likely diagnosis?

(A) Rotavirus.

(B) Bacteremia secondary to Streptococcus pneumoniae.

(C) Henoch-Schonlein purpura.

(D) Haemolytic uremic syndrome.

6. An 18-month-old girl has had several episodes of non-bilious vomiting that started an hour before her
ED visit. The patient's mother denies any rhinorrhea, fever, cough, or a history of a fall, although she
notes that the girl has been crying more than usual. The girl is noted to be lethargic, pale, and weak on
arrival. After intravenous fluids, she continued to vomit. An abdominal radiograph is suggestive of
intussusception. You know that:

(A) Intussusception is the most common cause of intestinal obstruction in infants between 6 and 36
months of age.

(B) A normal abdominal radiograph rules out intussusception.

(C) The classic triad of colicky abdominal pain, palpable abdominal mass, and currant jelly stools is seen
more than 90% of the time.

(D) Contrast enema is the preferred method of diagnosis and treatment in patients with intussusception
without signs of perforation or peritonitis.

(E) The lack of stools mixed with blood and mucous (currant jelly stools) virtually rules out this
condition.

7. Choose the most accurate statement regarding the diagnosis of paediatric urinary tract infections:

(A) A properly collected bag specimen is recommended for infants and nontoilet-trained children.

(B) The combination of positive nitrite and leukocyte esterase markers on urine dipstick is both sensitive
and specific for UTI.

(C) Fever in a child with UTI is suggestive of cystitis.

(D) A negative urine dipstick rules out a UTI.

(E) A urine culture with greater than 104 CFU/mL is considered positive for a midstream specimen.

8. You diagnose a 1-year-old well-appearing febrile female infant with UTI. The best management option
is to:

(A) Admit all infants with presumed pyelonephritis for parenteral therapy.

(B) Give one dose of ceftriaxone and send home on oral antibiotics.

(C) Send home on 10 days of oral antibiotics with close follow-up.

(D) Get an urgent ultrasound of the bladder and a voiding cysto-urethrogram (VCUG) prior to sending
home.

(E) Give intravenous hydration, obtain blood cultures, and start parenteral antibiotics.

9. You suspect rotavirus in a 1-year-old listless infant with moderate dehydration. You know:

(A) Rotavirus infections are responsible for approximately 90% of all diarrheal illness in infancy.

(B) Rotavirus infections are self-limited and cause little morbidity and mortality.

(C) Rotavirus infections can present with high fevers, copious diarrhoea, and vomiting.

(D) Patients with rotavirus always require hospitalization for moderate to severe dehydration.
10. You need to give approximately 1.5 times the maintenance intravenous fluids to a 15-kg child who
has received saline boluses for moderate dehydration. The correct rate is:

(A) 75 mL/h.

(B) 100 mL/h.

(C) 60 mL/h.

(D) 10 mL/kg/h.

(E) 4 mL/kg/h for the first 20 kg.

11. Given the following associations- name the causative agent of the diarrhoea:

Diarrhoeas associated with: Agents

Seizures
Guillan Barre Syndrome
Right lower quadrant pain
Clindamycin use
After a camping trip
Consumption of fried rice
Haemolytic Uremic syndrome
Explosive diarrhoea

The End