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Royal College: Emergency Medicine flashcards
1
Q

Tic treatment

A

guanfacine
clonidine
non-pharm behaivoral therpay and counseling

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2
Q

is a comorbid tic disorder contraindication to treatment

A

no

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3
Q

how much does head circumference grow at age 3mo, 4-6 mo and after 6mo

A

2cm/mo for first 3mo
1cm/mo 4-6mo
0.5cm/mo after 6mo

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4
Q

factors that increase risk for deformational plagiocephaly

A

male
first born
prematurity
liited passive neck ROM (torticollis)
Dev delay
sleep position is suprine at birth and at 6 week
bottle feeding only
tumme time < 3 times per day
lower activity level
sleeping wtih head to same side, positional preference

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5
Q

which type of cranio is most similar to plagiocephaly

A

lamdoidal

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6
Q

what are features of plagiocephaly

A

normal round head shape at birth
paralleologram shaped head
ipsilateral ear anteriorly displaced
no palpable bony ridges or open fontanels

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7
Q

what is suggested amount of tummy time

A

10-15 minutes at least 3 times epr day

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8
Q

when and how long helmet therapy

A

started at 4-8 months of age and continued for 7-8 months

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9
Q

characterized by profuse, repetitive vomiting often accompnaied by pallor adn lethargy typically occurring 1-4h after ingestion of food

A

FPIES

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10
Q

lab findings in FPIES

A

can have leukocytsis, neutorphilia, thrombocytosis, methemoglobinemia, metabolci acidosis

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11
Q

common foods to trigger FPIES

A

milk, sy, grians, egg, meta/fish/vegetables, fruits peanuts/tree nuts

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12
Q

rate of resolutoin FPIES with age

A

35% by age 2, 70% by age 3, 85% by age 5

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13
Q

when to do an oral food challenge and how for FPIES

A

consider 12-18months after the most recentreaction, should be done in medical setting with access to IV fluids

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14
Q

what to eliminate for CMPA

A

milk/soy first
if that not working then egg and corn can be eliminated as well

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15
Q

when does CMPA usually resolve

A

1 year of age

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16
Q

most common chronic childhood disease

A

tooth decay

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17
Q

when should kids go to dentist

A

within 6 mo of their first tooth appearing and no later than one year of age

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18
Q

what is formal milk sharing screened for

A

Hep B. C, HIV, HTLV and syphilis

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19
Q

signs of cannabis withdrawal

A

2 of:
irritability, anger or aggression
nervousness, anxiety
sleep difficulty
decreased appetite/weight loss
restlessness
depressed mood
abdo discomfort, fever, chills, headache (1 of)

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20
Q

when do cannabis withdrawal symptoms start and for how long

A

start 24-72h after last use and persst for 1- weeks

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21
Q

age of consent for sexual activity in canada

A

16
12 to 13 can consent with partner 2 years older
14 or 15 can consent with partner 5 years older

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22
Q

do you need internal speculum exam or digital rectal exam post sexual abuse

A

very rarely

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23
Q

when to collect forensic kit

A

within 72h, highest yield 24h after

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24
Q

do you give prohpylaxis for STIs post sexual abuse

A

not for NG and CT especially if they can return for full STI testing in a follow-up clinic
HIV PEP if suspected offended is HIV positive, signfifcant exposure suc as oral, vaginal or anal penetration, should be started ASAP and within 72h
consider hep B immunization adn HBIG depending on immune status
? HPV in some places

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25
Q

testing post sexual abuse

A

NG and CT (can do NAAT)
HIV testing and fu at 6/12/24 weeks
Hep c and fy 12 and 24 weeks
Hep B

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26
Q

what has been associated with positive otucomes for SA victims

A

having a cergiver who believes and protects the child

27
Q

Main factors that impact childs well being after divorce

A

quality of parenting, quality of parent child interaction, conflict intensity

28
Q

red flags to investigate spinal dimple

A

midling tuft of hair, sacral dimple or sinus tract above gluteal cleft, hemangioma., dermal appendage and or subctuaneous lump

29
Q

imaging indicated for spinal dimple

A

subcutaneous las sor lipoma
hair patch
dermal sinus or cyst
atypical dimples (deep > 5mm or > 25mm from anal verge
vascular lesion ie. hemangioma or telangectasia
skin appendages or polypois lesions
sar like lesions

30
Q

STI screening for youths under 25y

A

NAAT for CT nad nG with frist catch urine, or swabs
anal swab is anal receptive intercourse
syphilis serology, HIV serology
consider hep B, A and C with uncertain vaccination history, oral/anal contact or IVDU

31
Q

characterisitics that increase change of quitting smoking

A

male, older, teen pregnancy/parenthood, scholastic success, team sport participation, peer and family support for cesssations, CYP 2A^ mslow emtabolizer

32
Q

Less likely to quit smoking

A

nicotine addiction, mental health conditions including ADHD, drug or alcohol use, chronic illness, family stress, peer and family tobacco use, overweight or weight preoccupation, developmental drie to experiement, fear of peer rejection, perceived lack of autonomy and privacy

33
Q

side effects of nicotin replacement

A

increased HR, higher BP
mouth adn skin irritation

34
Q

contraindications to bupropion

A

eating disorder
seizure

35
Q

Who should get RSV pophylaxis

A

< 30 week prems whoa re <6mo at onset of or during RSV season
<24mo with CLD on oxygen within 6mo preceding RSV
< 12mo with hemodynamically significant CHD
<36 and <6mo in inuit communities who would require air trnasport for hospital
May be considered in 30-32 weeks and age < 3mo whoa re high risk for exposure (sibs)
12-24mo awaiting heart transplant or received heart transplant
<24mo immunodeficiency

36
Q

what does rsv vaccination do

A

prevent 40-80% of hospitalizations, depending on age

37
Q

is egg allergy CI to flu vaccine

A

no

38
Q

who should not get live flu vaccine

A

immunocompromised
< 24 mo
on ASA
severe asthma (currently on oral or high dose steroids, or medically attended wheezing within 7 days of proposed vaccination)
pregnant people
can be given during bf

39
Q

vit D recommendations

A

400u daily for infantsand children under 2 who are partially or fully breastfed
800 units for inuit infants during winter breastfeed and 400 whoa re formula fed

40
Q

what vit D levels increase ricket chance

A

25 Oh Vit D < 30

41
Q

goal weight gain for preterm, term infants, 3-6mo and 6-12mo

A

15-20, 20-30, 15-25, 10

42
Q

when is weight loss surgery recommended

A

BMI > 35 and type 2 DM
pseudotumor cerebri
severe NASH
OSA
BMI > 40

43
Q

protein requirement for prem

A

4g/kg/day

44
Q

caloric needs for preterm infant

A

90-120kcal/kg/day

45
Q

What is human donor milk screened for

A

hep B, C HIV, HTLV and syphilis

46
Q

Cannabis withdrawal criteria

A

2 out of five psychological symptoms: irritability, anxiety, depressed mood, sleep, appetite changes and 1/6 physical symptoms: abdo pain, shaking, fever, chills, headache, diaphoresis

47
Q

Heavy cannabis use

A

daily or near daily for a few months

48
Q

Normal variant findings on GU exam

A

hymenal notches and bumps, intravaginal ridge, failure of midline fusion, partial dilatation of external anal sphincter

49
Q

Main factors that impact child’s well being during divorce

A

quality of parenting, quality of parent child interaction, conflict intensity

50
Q

red flags for investigating a sacral dimple

A

midline tuft of hair, sacral dimple or sinus tract above the gluteal cleft, hemangioma, dermal appendage and or subcutaneous lump

51
Q

IMaging indcated for sacral dimple with

A

subcutaenous mass or lipoma
tuft of hair
above gluteal cleft
> 2.5 cm from anal verge
> 5mm deep
vascular lesion
dermal sinus or cyst
scar like lesions

52
Q

condoms to use if latex allergy

A

polyurethan or polyisoprene condoms

53
Q

More likely to quite smoking factors

A

older teenager, male, teen pregnancy and parenthood, scholastic success, team sport participation, peer and family support for cessation, CYP2A6 slow metabolizer

54
Q

less likely to quit smoking

A

nicotine addiction, mental health conditions including ADHD, drug or alcohol use, chronic illness, family stress, peer and family tobacco use, overweight or weight preoccupation, developmental drive to experiment, fear of peer rejection, perceived lack of privacy and autonomy

55
Q

What is associated with adverse health impacts re: marijuana use

A

use before age 14 and at leas monthyl use

56
Q

Who qualifies for RSV proph

A

< 30 weeks of gestation who are < 6 months of age at onset of or during RSV season
- < 24months with chronic lung disease of prematurity who require ongoing oxygen therapy within the 6 months preceding or during the RSV seasons
- Infants < 12mo with hemodynamically significant CHD
Infants born < 36 weeks and < 6 months living in remote northern inuit communities who would require air transport for hospitalization

57
Q

dose rsv proph

A

15mg/kg by injection q monthly

58
Q

Management of sleep onset association disorder

A

establishment of a set sleep schedule and bedtime routine and implementation of a behavioral program

59
Q

low risk BRUE criteria

A

e > 60 days, gestational age > 32 weeks and corrected > 45 weeks, first BRUE (nor previous event), duration < 1 minute, no CPR required by medical provider, no red flags, no concerning physical exam findings

60
Q

principal side effect of vigabatrin

A

retinal toxicity

61
Q

West syndrome

A

Triad of spasms, arrest of psychomotor development and hypsarrhythmia

62
Q

Who should get HPV vaccine

A

all kids 9-13 years old

63
Q

who can get ondans

A

infants > 6mo

Royal College Studying (22 decks)

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