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Canada Pediatriatics Question Bank (Comprehensive Exam Guide)
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Canada Pediatriatics Question Bank (Comprehensive Exam Guide) Complete with All Correct Answers
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Question 2An 8 -year - old child presents with dehydration. She has dry mucous membranes, tachycardia, and
decreased urine output. Her initial labs show a potassium of 5.0 mmol / L and normal glucose level.
Initial volume resuscitation was successfully administered. What is the most appropriate IV fluid to
infuse for maintenance hydration?
.
a 0.9% NaCI
b . 0.45 % NaCI with 5% Glucose
c. 0.2% NaCI with 5% Glucose + 20 KCI
d . 0.45 % NaCI with 5% Glucose + 20 KCI
e . 0.2% NaCI with 5% Glucose
,The correct answer is B .
Topic: Maintenance IV Therapy
Subject: Pediatrics
Explanation:
The recommended fluid to be infused as maintenance hydration is:
0.45% NaCI with 5% Glucose + 20 mmol KCI / Liter.
This is often written as D5 .45% NS + 20KCI
The D 5 refers to the glucose ( dextrose), NS refers to Normal saline which is 0.9% NaCI . 14 NS would
refer to 0.45% NaCI .
In this child the potassium is in the upper limit of normal, since normal range is 3, 5 - 5.0. So, do not
add potassium at this time. The maintenance treatment would be with 0.45 % NaCI with 5% Glucose
( choice B) . If giving a bolus, you would use 0.9% NaCI normal saline .
(0.2 NaCI with 5% glucose + 20KCI - in the first month of life).
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A father brings his 6 -year - old son to your office for evaluation of moderate pain in his left knee and
thigh . Over the past 3 days the father has noted reduced physical activity and a slight limp. There is
no known history of trauma and the child has otherwise been well . There is no fever, and a physical
examination is remarkable only for the presence of slight flexion, abduction, and external rotation of
the Jeft hip. The erythrocyte sedimentation rate is normal.
Which one of the following is the most likely diagnosis?
.
a Transient (toxic ) synovitis
b . Growing pains
.
c Benign osteoid osteoma
d . Septic arthritis
e. Legg-C a Ive- Perthes disease
, The correct answer is A,
Topic: Transient Synovitis
Explanation :
Transient (toxic) synovitis ( choice A) and septic arthritis of the hip present acutely with pain and
activity limitation. These conditions tend to affect younger children compared to osteomas, growing
pains, and Legg- CaJve- Perthes disease . The classic patient is a 6-year - old male who is otherwise
healthy with no trauma history. There may be a low -grade fever, but the erythrocyte sedimentation
rate is normal. On presentation there is limited pain and spasm .
—* Septic arthritis (choice D) has a more severe presentation, with the patient's temperature likely to
be > 38°C, the erythrocyte sedimentation rate > 20 mm / hr and severe tenderness present on
palpation,
— Growing pains (choice B) are idiopathic leg pains that affect children 3-12 years of age, with
symptoms including nocturnal leg pains and restlessness that may awaken the child from sleep.
Both Legg -Calve -Perthes disease ( choice E) and benign osteoid osteoma ( choice C } have more
protracted clinical presentations, with the pain developing more gradually. Pain is the prominent
symptom of osteoid osteoma, with nocturnal accentuation ,
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