2019 Statements Flashcards
Who is considered vulnerable for lead toxicity?
(7 examples)
- HOME built before 1960 within the past 6 months, especially lead piping/paint
- SIBLING/MATE w hx of lead poisoning.
- PICA or have eaten paint chips, or mouthing
- EMIGRATED/ADOPTED from a country lead levels higher than Canada
- Above RFs+ known or ?neurodevelopmental disorder.
- POVERTY (living conditions)
- MINERAL DEFICIENCY (e.g., calcium/iron/zinc) - Shared absorptive pathways lead to more lead absorption
Work up for lead? What is gold standard for Dx?
· CBC
· Blood lead level *** << GOLD standard
· Ferritin
· Calcium, albumin
· Nutrition history
· Neurodevelopmental follow up
What blood lead level would require thorough investigation?
BLL > 5 mcg/dL (0.24 mcmol/L):
investigate thoroughly, if any identified exposure sources should be mitigated as soon as possible.
Lead toxicity: what are the components of the Pediatric Environmental Health History (PEHH)?
(5 components)
- Home/Chilcare/School: neighborhood, buidling, proximity to waste/construction, airfield
- Consumer products: Candles, jewelry, toys (improted), cosmetics
- Food: imported sugar/candy, prepared with containers w lead, wild game with lead bullets, Brassica family foods (accumulate lead)
- Occupation and hobby-related: battery, radiator repair/welding, renos
- Family Factors : mother/sibling exposed, adopted/immigr other country
How would you manage high lead levels in blood?
5-14 mcg/dL
15-44
>44
5-14:
- PEHHH to identify source, advice or educing exposures
- contact PH authority for guidance
- Re-test in 1-3 mo , then in 3mo if stable
- Nutritional counseling: calcium and iron. A fresh fruit with q meal because iron absorption quadruples when taken with vitamin C-containing foods. Encourage the consumption of iron-enriched foods (e.g., cereals, meats). Ensure iron sufficiency with adequate laboratory testing (CBC, ferritin, CRP) and treatment. Consider starting a multivitamin with iron.
- Complete full neurodev Ax and FU Over years.
15-44:
- As above
- Confirm BLL with repeat venous sample @ 1-4 wk
- PEHH, consider AXR and gut decontamination if ingested FB are visualized. Contact Poison Centre. Chelation is not recomm for asymptomatic.
>44:
- As above
- Repeat BLL in 48h
- Consider hospitalization and/or chelation therapy in consult w Poison Control.
- Mitigating lead exposures, identifying other sources, assessing the family’s social situation, and chronicity of the exposure will influence management.
What blood lead level would require hospitalization for investigation and management?
>44 mcg/DL
True or False: Confirmed Invasive group A strep is reportable to Public health
True
What is required for the diagnosis of Invasive GAS?
a. Clinical evidence of severe invasive disease
b. Bronchoalveolar lavage positive for GAS
c. Isolation of GAS from normally sterile site
d. Unvaccinated for varicella
c. Isolation of GAS from normally sterile site
(Varicella is a risk factor for IGAS)
Which of the following is NOT an example of severe invasive GAS?
a. Septic arthritis
b. Meningitis
c. Pneumonia
d. Necrotizing fasciitis
a. Septic arthritis
((1) TSS, (2) Nec Fasc/ necrosis, (3) meningitis, (4) pneumonia w/ sterile fluid positive for GAS, combination or any life-threatening disease = severe IGAS)
What is the first line treatment for confirmed GAS?
a. Cephalexin
b. Penicillin + clindamycin
c. IVIG
d. Clindamycin
b. Penicillin + clindamycin
- A 5 y/o M is admitted to hospital with pneumonia complicated by effusion. His pleural fluid culture is positive for GAS. Which of the following contacts do NOT require chemoprophylaxis?
a. His mother, who lives at home with him
b. His best friend, who he attended in-home child care with for 5 hours, 5 days prior to symptom onset
c. His father, who lives in a separate home, and kissed him on the mouth 6 days prior to symptom onset
d. His half-sister, whose house he visited for 3 hours, 8 days prior to symptom onset
d. His half-sister, whose house he visited for 3 hours, 8 days prior to symptom onset
Close contacts:
- Household contacts who, within previous 7 days, have spent at least 4 h / day on average or total of 20 h with index case
- Shared bed or sexual relations
- Direct contact with mucous membranes, open skin lesion or oral or nasal secretions
- IVDU
- Some Child care, hospital, long-term care contacts
Chemoprophylaxis should only be offered to close contacts of confirmed case of severe IGAS exposed 7 days before onset of symptoms to 24 h after initiating antimicrobial in index case
Which statement(s) are correct reagrding prevalence of autism spectrum disorder in Canada?
A. An estimated prevalence is 1 in 1,000 children
B. An estimated prevalence is 1-2 in 100 children
C. There is a higher prevalence in male than female approx 4:1
B and C
“The prevalence of ASD has increased, from an estimated 1 in 1,000 children in Nova Scotia, an example cited 30 years ago, to a current estimate of 1 in 66 Canadians aged 5 to 17 years (1 in 42 males, and 1 in 165 females)”
Which of the following features are early waring signs for autism spectrum disorder? (choose all)
A. 6 months old with limited eye contact
B. 9 month old with no pretend play
C. 12 months old repetitively spins objects
D. 15 months old with no single word
A, C, D
12-18 months: lack of pretend play
Which of the following statement(s) about screening for autism spectrum disorder are correct?
A. Open-ended questions to parents detect ASD earlier than screening tools
B. Universal screening for ASD would result in earlier diagnosis and treatment
C. All children should be monitored for early behavioural signs of ASD as part of general developmental surveillance
C
A. false - Compared with an open-ended question regarding parental concerns, some screening tools (e.g., M-CHAT and the Infant Toddler Checklist (ITC)) detected ASD earlier and more consistently.
B. false - universal screening for ASD would not result in earlier diagnosis and treatment under the Canadian health care system
C. correct
