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CPS Statement 2022 > 2022 > Flashcards

2022 Flashcards

1
Q

What adverse outcomes are PDAs associated with in preterm infants?

A
  • prolonged assisted ventilation
  • pulmonary hemorrhage
  • CLD
  • NEC
  • IVH
  • death
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2
Q

What prophylactic COX-1 drug can be used in ELBW/extreme prem infants to close the PDA?

A

Indomethacin IV
Note: there is insufficient evidence for ibuprofen or acetaminophen prophylaxis in this age/wt group.

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3
Q

What investigation should be done to confirm the presence of a PDA?

A

Echo

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4
Q

List examples of conservative management of a PDA.

A
  • diuretics
  • increase PEEP
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5
Q

What medication is preferred for the management of symptomatic PDAs in infants >26 weeks?

A

Ibuprofen
Note: can do high dose if the baby is >3-5 days old (Day 1: 15-20 mg/kg, Day 2-3: 7.5-10 mg/kg)

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6
Q

When should you consider procedural PDA closure (cath or surgery)?

A

If the infant has a persistent and symptomatic PDA with echo findings of a large shunt and pulmonary overcirculation after having 2 rounds of pharmacotherapy (or less if pharmacotherapy was contraindicated).

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7
Q

Should you refer an infant to cardiology if they have a persistent PDA at discharge?

A

Yes

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8
Q

By what age does infantile GER typically resolve?

A

1 yo

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9
Q

List the recommended non-pharmacological strategies to address infantile GERD.

A
  1. Thickened feeds
  2. Avoiding cow’s milk protein - should only be trialled if 2 weeks of thickened feeds failed to show symptom improvement.
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10
Q

Is infant re-positioning recommended as a non-pharmacological management of GERD?

A

No.
There is weak evidence to support any improvement in GERD symptoms. In addition, there is strong evidence that flat, back to sleep prevents SIDS in infants.

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11
Q

For what clinical symptoms is acid-suppression recommended as treatment for GERD?

A

Symptoms of Erosive Esophagitis
1. Hematemesis
2. Failure to feed
3. Failure to Thrive

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12
Q

Are prokinetics recommended in the management of infantile GERD?

A

No.
Limited evidence and significant negative side effects.

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13
Q

List 5 general risk factors for reduced bone mass.

A
  1. chronic inflammation
  2. reduced physical activity or low muscle mass
  3. pubertal delay
  4. poor nutritional status (either from inadequate intake or absorption)
  5. certain medications
  6. Obesity
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14
Q

Define pediatric osteoporosis

A

≥1 vertebral fracture in the absence of local disease or high-energy trauma
OR
≥2 long bone fractures by 10 yo OR ≥3 long bone fractures at any age until 19yo WITH a reduced BMD Z-score ≤2.0

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15
Q

What details will you ask a patient when obtaining an osteoporosis-specific history?

A
  • personal and family fracture history
  • back pain
  • diet (Ca sources)
  • physical activity
  • sun exposure, sunscreen use
  • onset of puberty
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16
Q

List examples of osteotoxic medications

A
  • steroids
  • traditional AEDs (phenytoin, PHB, carbamazepine, valproate)
  • GnRH agonists
  • medroxyprogesterone
  • calcineurin inhibitors
  • antiretrovirals
  • anticoagulants
  • loop diuretics
  • high dose methotrexate
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17
Q

What is the recommended dietary allowance (RDA) of Vitamin D in children ≥1yo?

A

600 IU

18
Q

What is the recommended dietary allowance (RDA) of Calcium in children aged 1-3yo, 4-8yo, and 9-18yo?

A

1-3yo: 700 mg
4-8yo: 1000 mg
9-18yo: 1300 mg

19
Q

List things to assess for on physical exam of a child being evaluated for osteoporosis.

A
  • growth charts, BMI
  • signs of nutritional deficiency (rachitic signs, widened metaphyses, limb pain, limb deformities)
  • vertebral fractures (palpate the spine for tenderness), - Tanner staging
  • signs of primary osteoporosis (blue sclera for osteogenesis imperfecta, joint laxity in collagen disorders)
20
Q

When is a DEXA scan indicated in pediatric osteoporosis?

A
  • used in patients with fragility fractures who are being considered for bisphosphonate therapy
  • can also be considered for patients with vertebral fractures
21
Q

What investigations should you consider for evaluating a patient with osteoporosis?

A
  • 25-OH-D if evaluating for rickets or low-trauma fracture
  • spine XR - for vertebral fractures
  • wrist XR - for rickets
  • DEXA scan - for fragility fractures who are being considered for bisphosphonate treatment. Can also be considered in vertebral fractures.
22
Q

List non-pharmacological suggestions you can give patients to improve their bone health.

A
  • adequate RDA of Calcium and Vitamin D (diet preferred over supplements)
  • encourage weight-bearing activities
23
Q

What is the most common presentation of COVID in children?

A

mild URTI or asymptomatic

24
Q

List risk factors for developing severe COVID

A
  • obesity
  • chronic neuro conditions
  • chronic lung disease (other than asthma)
  • chronic cardiac disease
  • immunodeficiency
  • multiple comorbidities
25
Q

What is the most common adverse effect of the COVID vaccine?

A

local pain/swelling

26
Q

What age group and demographic is most affected by post-COVID vaccine myocarditis/pericarditis?

A

Young, adult males
Typically within 1 week after the second dose

27
Q

Which brand of vaccine is preferable to prevent post-COVID vaccine myocarditis/pericarditis?

A

Pfizer
Allow 8 weeks between doses

28
Q

What investigations would you order for a child who presents with chest pain, SOB, or palpitations after the COVID vaccine?

A

ECG, troponins, CRP, ESR
Consult cardio and get an echo if the ECG or troponins are abnormal.

29
Q

What COVID immunization recommendations do you give to patients who are unimmunized or partially immunized for COVID, but have had a previous COVID infection?

A
  • If no previous vaccine or only 1 dose -> give vaccine 8 wks after symptom onset or COVID+ test result
  • If immunocompromised -> give vaccine 4-8 wks after symptom onset or COVID+ test result
  • If completed first series, but has not had booster series -> give vaccine 3mo after symptom onset or COVID+ test result; OR 6 mo after first series, whichever is longer
  • If had MIS-C -> give vaccine when recovered or 90 days from the onset of MIS-C, whichever is longer
30
Q

Is it recommended for patients with moderate-severe immunocompromise to receive a 2-dose or 3-dose COVID vaccine series?

A

3-dose

31
Q

Are COVID antibodies post-vaccine passed through the placenta and breastmilk?

A

Yes
- Covid protective antibodies can last in breastmilk for 6 weeks after vaccine administration
- Vaccine antibodies can also pass through the placenta

32
Q

In which circumstances are COVID immunizations contraindicated?

A
  1. Anaphylactic allergy to previous COVID vaccine
  2. If myocarditis occurred within 6 weeks of a previous COVID vaccine
  3. If pericarditis with abnormal ECG or echo findings occurred. In this circumstance, wait 3 months to vaccinate.
33
Q

Can COVID vaccination alter TB skin test and IGRA results?

A

Yes, mRNA vaccines temporarily diminish cellular immunity.
- If doing a TB skin test or IGRA, ensure this is done before COVID vaccine administration OR 4 weeks after vaccination

34
Q

What COVID vaccine brand and timing of series is recommended for children aged 5-11 yo?

A
  • Pfizer
  • 8 weeks between doses
35
Q

What COVID vaccine brand and timing of series is recommended for children aged >/ 12 yo?

A
  • Pfizer or Moderna
  • 8 weeks between doses
36
Q

Are booster COVID vaccine doses recommended for all children?

A

Yes. But specifically they are recommended for all children at higher risk for severe COVID. This includes:
- Immunocompromised, live in congregate settings, belong to communities disproportionately affected by COVID
- cancer on active treatment, CKD, CLD, uncontrolled asthma, CF, neuro conditions, diabetes, Down syndrome, CHD, chronic liver disease, obesity, pregnancy, sickle cell, thalassemia, substance use, medically fragile

37
Q

Should macrolide antibiotics be prescribed for their anti-inflammatory effect in common infections (PNA, AOM, etc)?

A

No
Macrolides are only indicated for atypical PNA or life-threating beta-lactum allergy.

38
Q

List the recommended first-line, second-line, and additional antibiotics for the treatment of Uncomplicated PNA? Include duration of antibiotic. I

A

Duration = 5 days
o 1st line Amoxicillin
o 2nd line Amox-Clav
o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin
o Non-life threatening amox allergy -> cefprozil or cefuroxime

39
Q

List the recommended first-line, second-line, and additional antibiotics for the treatment of AOM. Include duration of antibiotic.

A

Duration = 10 days if <2yo; 5 days if >/ 2yo
o 1st line Amoxicillin
o 2nd line Amox-Clav
o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin
o Non-life threatening amox allergy -> cefprozil or cefuroxime
o Other: Penicillin VK

40
Q

List the recommended first-line, second-line, and additional antibiotics for the treatment of GAS pharyngitis. Include duration of antibiotic.

A

GAS: treat for 10 days
o 1st line Penicillin VK or Amoxicillin
o Non-life threatening amox allergy -> Cephalexin
o Life-threatening amox allergy OR atypical PNA-> (1) clarithromycin, (2) azithromycin (5 days

41
Q

List the recommended antibiotics for the treatment of uncomplicated UTIs. Include duration of antibiotic.

A

uncomplicated and afebrile, treat for 3 days. Uncomplicated and febrile, treat for 7-10 days.
o Septra, Cefixime, Amox/Clav, Ciprofloxacin
o If choosing cephalexin, then always 7 days

CPS Statement 2022 (1 decks)

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