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*CPS Statements TD > Community + Thoracic+Digital > Flashcards

Community + Thoracic+Digital Flashcards

1
Q

Neonatal hearing loss - most is sensorineural or conductive?

A

Sensorineural

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2
Q

Risk factors for neonatal SNL?

A
  • FHx permanent hearing loss
  • Craniofacial abnormalities incl those involving external ear
  • Congenital infections (inc back meningitis, CMV, toxoplamosisi, rubella, herpes, syphilis)
  • Physical exam findings consistent w underlying syndrome assoc w hearing loss
  • NICU >2 days or any of the following (regardless of LOS):
  • -ECMO
  • -assisted ventilation
  • -ototoxic drug use
  • -hyperbilirubinemia req exchange transfusion
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3
Q

How to test hearing in newborn?

A

OAE in everyone

ABR if do not pass OAE or any risk factors

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4
Q

What is missed on newborn screening?

A

Less severe congenital hearing loss (<30 dB)

Progressive or late onset hearing impairment (ex CMV)

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5
Q

Criteria for Functional Constipation?

A

At least 1x/week for at least 2 months
Need 2 or more in a child with a developmental age of at least 4 years
1. Two or fewer defecations in the toilet per week.
2. At least one episode of fecal incontinence per week.
3. History of retentive posturing or excessive volitional stool retention. 4. History of painful or hard bowel movements.
5. Presence of a large fecal mass in the rectum.
6. History of large diameter stools that may obstruct the toilet.

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6
Q

What are the common times for children to develop functional constipation?

A

Transition periods - children are prone:
Toilet training
Start of school

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7
Q

Definition of constipation

A

large hard mass in the abdo or dilated vault filled w stool on rectal examination, often substantiated by a hx of overflow incontinence

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8
Q

Risk factors for positional plagiocephaly

A

Male sex
Firstborn
limited passive neck rotation at birth (congenital torticollis)
supine sleeping position
only bottle feeding
awake ‘tummy time’ fewer than three times per day
lower activity level with slower achievement of milestones
Sleeping with the head to the same side and positional preference when sleeping

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9
Q

Signs of craniosynysotisis?

A

Often have ridging of the affected suture
Ipsilateral occipitomastoid bossing with posterior displacement of the ear
PP: ipsilateral anterior displacement of the ear

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10
Q

Primary nocturnal eneuresis

  • how often
  • age
A

> 2x/week

>5yo

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11
Q

Military children - issues

A
  1. Mobility
  2. Separation
  3. Risk
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12
Q

Risk factors for coping difficulties in military family children

A

–Younger parent age
–Young children
–Family member with prior mental health issues
–Children with special needs
–Child with preexisting behavioral issues
–Spouse with English as second language

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13
Q

What are some issues with housing in Canada?

A

–Infestations
–Poor water and air quality
–Unsafe neighborhoods
–Unstable housing (> 3 moves in child’s life)
–Inaccessibility for those with disability

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14
Q

What are health impacts of housing needs?

A

More aggressive behaviour
Property offenses
Poorer school performance
More asthma symptoms
Lower overall health
Easier spread of infxn and more psychological distress in crowded housing
Food insecurity – as a result of high housing cost
Inaccessible housing (for special needs)
lowers self esteem & can lead to more accidental injuries
Exposure to environmental hazards
Infestations à allergic reactions and secondary infections, worsening asthma, anxiety
Unsafe or no water supply (First Nations)
Unsafe neighbourhoods
More anxiety, Less physical activity

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15
Q

Who is at greatest risk for housing needs?

A

Aboriginal families,
Recent immigrants,
single-parent families
those with developmental, mental health, or physical disabilities

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16
Q

How to assess about housing needs?

A

Harm (in need of repair?)
Occupancy (How many ppl)
Moves (How often move, use of shelter)
Enough/Income (Enough for house, food, utilities?)

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17
Q

Who to treat w prophylactic Abx for UTI?
What abs, dosing?
Length?
What if resistant?

A

Grade 4-5 VUR
Trimethoprim/sulfamethoxazole or nitrofurantoin
one-quarter to one-third of the daily total treatment dose
3-6 months

If resistant to TMP-SMP AND nitro, no abx at all because resistance

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18
Q

UTI

  • what to look for on U/A
  • Urine culture count
A

nitrite, Leuk esterase, microscopy WBC (>10/hpf)

UCx
Clean catch - >10^5 CFU/mL
I&O - >5*10^4 CFU/mL
SPA - any growth

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19
Q

Bugs for UTI?

A 
E. coli
Klebsiella pneumoniae
Enterobacter sp.
Citrobacter sp.
Serratiasp.
Staph saprophyticus (female teens only)
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20
Q

Treatment for UTI

Abx
Duration

A

PO = IV for UTI/Pyelonephritis
If < 3mo - Prefer initial IV

PO amox, clavulin, Cefixime

Gentamicin IV +/- Ampicillin
Cefotaxime or Ceftriaxone IV

UTI - Treat 7-10 days
Afebrile UTI (cytitis) - 2-4 day course PO Abx
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21
Q

Signs of complicated UTI

A 
Hemodynamically unstable
High serum Cr
Abdo mass
Poor urine flow
No clinical improvement 24h post Abx
Fever not coming down 48h post Abx
* Use IV antibiotics
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22
Q

Imaging in UTI

A

Renal U/S for children < 2 years with first febrile UTI
During or within 2 weeks of illness
Detects hydronephrosis

VCUG – best way to diagnose VUR
ONLY if RUS suggestive of issues
In children < 2 years with 2 documented UTIs
Perform after antibiotics completed
Use of prophylactic Abx before procedure is controversial

DMSA
Can diagnose acute Pyelonephritis and renal scarring (later)
Radiation and unlikely to alter management
Only do if Dx of UTI is in question

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23
Q

What drugs are contraindicated in breastfeeding?

A

Antimetabolites
Radioactive drugs
Drugs of abuse

24
Q

How long should infants breastfeed

A

2 years and beyond

exclusive breast-feeding for the first 6 months

25
Q

Most common chronic condition in children?

A

tooth decay

26
Q

Most common surgery in children

A

dental

27
Q

What is the most common bug in dental caries

A

Strep mutans

28
Q

Who is at higher risk of dental issues?

A

Low SES
aboriginal
new Canadians
complex care pts

29
Q

ADHD

  • prevalence
  • life issues
A

1/20

Reduced quality of life
Increased risk of injuries
Behaviour problems
Academic and social difficulties

30
Q

Considerations with starting ADHD meds

A

adherence
stigma
school storage of drugs
pharmacokinetic profiles

31
Q

What type of meds are recommended for ADHD

A

Extended release
more effective and equally efficacious as IR
less risk diversion

32
Q

Early vision screening helps prevent

A

decreases prevalence of amblyopia

33
Q

Amblyopia

A

= reduced vision in absence of ocular disease – brain doesn’t recognize input

Causes = strabismus, difference in refractive error

34
Q

Refractive error

A

= inability to eye to focus on image - correctible with lens

35
Q

Strabismus

A

= misalignment of eye

36
Q

Visual Development Landmarjs

A

Birth - 4 mo - face follow

3 months - visual follow

42 months (3.5 years) - visual acuity measurable

37
Q

What are screening tests for vision

A
  • Red reflex
  • Corneal light reflex – central position of light on each eye
  • Fundoscopy
  • Cover-uncover test = strabismus
38
Q

Screening vision by age?

A

Newborn to 3 months”

  • Complete exam of skin, external eye
  • Check red reflex

6 – 12 months:

  • Same exam
  • Ocular alignment test (cover-uncover test; corneal light reflex)
  • Fixation and following of a target

3 – 5 years

  • Same exam
  • Visual acuity

6 – 18 years
As above every routine visit + complaints

39
Q

two common causes of amblyopia

A

Strabismus

Difference in refractive error

40
Q

What does cover uncover test tell you

A

strabismus

41
Q

Contraindications to flying?

A
  • Contraindications for flight
  • Uncontrolled hypertension
  • Uncontrolled SVT
  • Eisenmenger’s syndrome
42
Q

What condition has there been some benefit with homeopathy

A

Diarrhea

43
Q

What are concerns with using homeopathy

A
  • reluctance on the part of those who practice homeopathy to support vaccinations
  • delays in seeking conventional medical therapies while waiting for results from homeopathic treatments may jeopardize the child’s health.
44
Q

Pacifiers:

Pros and Cons?

A 
Cons:
May be related to early wean from BF 
Risk factor for otitis media 
Issue w dentition past 2 years
Fomite - infection
Pros
May be protective against SIDS - but not enough ev to recommend
Analgesia
Good for Prems: 
Non-nutritive sucking, 
Comfort, 
Oromotor skills development, 
Better weight gain, 
Less NEC, 
Earlier discharge from hospital
45
Q

Signs of a child’s toilet learning readiness

A
  • Able to walk to the potty chair (or adapted toilet seat)
  • Stable while sitting on the potty (or adapted toilet seat)
  • Able to remain dry for several hours
  • Receptive language skills allow the child to follow simple (one- and two-step) commands
  • Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures
  • Desire to please based on positive relationship with caregivers
  • Desire for independence, and control of bladder and bowel function
46
Q

When do most children obtain continence

A

24-48 months

reflex sphincter control by 18mo

47
Q

Head lice
1st line
2nd line

A

Pyrethrins (R&C) & permethrin 1%

2nd line:
Isopropyl myrisate = Resultz; not for <4years
Dimeticone solution

48
Q

Higher incidence of flat foot

A

wearing shoes early in childhood,
overweight,
more flexible ligaments

49
Q

Sleep hygiene

A 
Stable bedtime and wake time
Dark quiet space
Avoid hunger (an excessive eating) before bed
Relaxation techniques before bed
Avoid caffeine, alcohol, nicotine
Avoid screen time before bed
50
Q

Risk factors for SIDS

A 
Male, premature, 
LBW babies, 
low SES  
Aboriginal babies
**Prone sleeping
**Maternal smoking during pregnancy

** Modifiable

51
Q

Risk reduction for SIDS

A
  • Place on back to sleep (supine)
  • Eliminate smoke exposure (Both during pregnancy and after)
  • Only sleep in crib/cradle/bassinet (No soft sleeping surfaces)
  • Avoid overheating
  • Do not leave to sleep in car seats, strollers, swings, etc.
  • Room sharing for first 6 months (NOT bed sharing)
  • Breastfeeding
  • Pacifier use while falling asleep
52
Q

when to screen for:
chlamydia/gonorrhea
HIV
Pap

A

chlamydia/gonorrhea: all sexually active
HIV: all sexually active > 15yo
Pap: >21yo

53
Q

How should children ride in car?

A

Rear-facing car seats: 0-1 year and/or weigh <10 kg (22 lb).

Forward-facing car seats: 10-18 kg (22-40 lb) and > 12 month

Belt-positioning booster seat and use the vehicle’s lap-shoulder seat belt: >18kg/40lb AND >4 yo

Vehicle seat belt system: > 145 cm (4’ 9”) tall or 9 years of age

Back seat until 13 yo

54
Q

Dx of asthma in preschooler

A 
Airway obstruction (doc. wheeze)
Reversibility (doc. improvement in airflow w SABA +/- steroid or course of ICS)
No clinical evidence of alternative dx
55
Q

Categories for PRAM score

A 
O2 sat
Suprasternal retraction
Scalene muscle contracton
Air entry
Wheezing
56
Q

Limits for screen time?

A

< 2yo: no screen time
2-5yo: <1 h/day
>5yo: <2h/day

57
Q

How to deal with screen use?

A

MANAGE screen time
Encourage MEANINGFUL screen use
MODEL Healthy screen use
MONITOR for signs of problematic screen use

*CPS Statements TD (17 decks)

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