Community Flashcards
Tic treatment
guanfacine
clonidine
non-pharm behaivoral therpay and counseling
is a comorbid tic disorder contraindication to treatment
no
how much does head circumference grow at age 3mo, 4-6 mo and after 6mo
2cm/mo for first 3mo
1cm/mo 4-6mo
0.5cm/mo after 6mo
factors that increase risk for deformational plagiocephaly
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
which type of cranio is most similar to plagiocephaly
lamdoidal
what are features of plagiocephaly
normal round head shape at birth
paralleologram shaped head
ipsilateral ear anteriorly displaced
no palpable bony ridges or open fontanels
what is suggested amount of tummy time
10-15 minutes at least 3 times epr day
when and how long helmet therapy
started at 4-8 months of age and continued for 7-8 months
characterized by profuse, repetitive vomiting often accompnaied by pallor adn lethargy typically occurring 1-4h after ingestion of food
FPIES
lab findings in FPIES
can have leukocytsis, neutorphilia, thrombocytosis, methemoglobinemia, metabolci acidosis
common foods to trigger FPIES
milk, sy, grians, egg, meta/fish/vegetables, fruits peanuts/tree nuts
rate of resolutoin FPIES with age
35% by age 2, 70% by age 3, 85% by age 5
when to do an oral food challenge and how for FPIES
consider 12-18months after the most recentreaction, should be done in medical setting with access to IV fluids
what to eliminate for CMPA
milk/soy first
if that not working then egg and corn can be eliminated as well
when does CMPA usually resolve
1 year of age
most common chronic childhood disease
tooth decay
when should kids go to dentist
within 6 mo of their first tooth appearing and no later than one year of age
what is formal milk sharing screened for
Hep B. C, HIV, HTLV and syphilis
signs of cannabis withdrawal
2 of:
irritability, anger or aggression
nervousness, anxiety
sleep difficulty
decreased appetite/weight loss
restlessness
depressed mood
abdo discomfort, fever, chills, headache (1 of)
when do cannabis withdrawal symptoms start and for how long
start 24-72h after last use and persst for 1- weeks
age of consent for sexual activity in canada
16
12 to 13 can consent with partner 2 years older
14 or 15 can consent with partner 5 years older
do you need internal speculum exam or digital rectal exam post sexual abuse
very rarely
when to collect forensic kit
within 72h, highest yield 24h after
do you give prohpylaxis for STIs post sexual abuse
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
testing post sexual abuse
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
what has been associated with positive otucomes for SA victims
having a cergiver who believes and protects the child
Main factors that impact childs well being after divorce
quality of parenting, quality of parent child interaction, conflict intensity
red flags to investigate spinal dimple
midling tuft of hair, sacral dimple or sinus tract above gluteal cleft, hemangioma., dermal appendage and or subctuaneous lump
imaging indicated for spinal dimple
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
STI screening for youths under 25y
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
characterisitics that increase change of quitting smoking
male, older, teen pregnancy/parenthood, scholastic success, team sport participation, peer and family support for cesssations, CYP 2A^ mslow emtabolizer
Less likely to quit smoking
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
side effects of nicotin replacement
increased HR, higher BP
mouth adn skin irritation
contraindications to bupropion
eating disorder
seizure
Who should get RSV pophylaxis
< 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
what does rsv vaccination do
prevent 40-80% of hospitalizations, depending on age
is egg allergy CI to flu vaccine
no
who should not get live flu vaccine
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
vit D recommendations
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
what vit D levels increase ricket chance
25 Oh Vit D < 30
goal weight gain for preterm, term infants, 3-6mo and 6-12mo
15-20, 20-30, 15-25, 10
when is weight loss surgery recommended
BMI > 35 and type 2 DM
pseudotumor cerebri
severe NASH
OSA
BMI > 40
protein requirement for prem
4g/kg/day
caloric needs for preterm infant
90-120kcal/kg/day
What is human donor milk screened for
hep B, C HIV, HTLV and syphilis
Cannabis withdrawal criteria
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
Heavy cannabis use
daily or near daily for a few months
Normal variant findings on GU exam
hymenal notches and bumps, intravaginal ridge, failure of midline fusion, partial dilatation of external anal sphincter
Main factors that impact child’s well being during divorce
quality of parenting, quality of parent child interaction, conflict intensity
red flags for investigating a sacral dimple
midline tuft of hair, sacral dimple or sinus tract above the gluteal cleft, hemangioma, dermal appendage and or subcutaneous lump
IMaging indcated for sacral dimple with
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
condoms to use if latex allergy
polyurethan or polyisoprene condoms
More likely to quite smoking factors
older teenager, male, teen pregnancy and parenthood, scholastic success, team sport participation, peer and family support for cessation, CYP2A6 slow metabolizer
less likely to quit smoking
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
What is associated with adverse health impacts re: marijuana use
use before age 14 and at leas monthyl use
Who qualifies for RSV proph
< 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
dose rsv proph
15mg/kg by injection q monthly
Management of sleep onset association disorder
establishment of a set sleep schedule and bedtime routine and implementation of a behavioral program
low risk BRUE criteria
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
principal side effect of vigabatrin
retinal toxicity
West syndrome
Triad of spasms, arrest of psychomotor development and hypsarrhythmia
Who should get HPV vaccine
all kids 9-13 years old
who can get ondans
infants > 6mo
