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General Pediatrics > CPS general > Flashcards

CPS general Flashcards

1
Q

what are cardiac contraindications to air travel

A

uncontrolled HTN, uncontrolled SVT, eisenmenger syndrome

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2
Q

who are recommended for potential hypoxemia evaluation prior to air travel?

A 
hypoxemic
hypercarbic
known CLD or RLD
on home O2
history of difficulty on air travel
recent exacerbation CLD
other chronic conditions exacerbated by hypoxemia
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3
Q

who is at higher risk of thrombosis during air travel?

A

major surgery within 6 weeks
thrombophilia
previous VTE
malignancy

consider consult specialist for ASA/LMWH

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4
Q

what advice for AOM and air travel?

A

if possible, delay 2 weeks before air travel

topical nasal decongestant can be used before takeoff/landing

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5
Q

what do you do for air travel for medical devices?

A

Gas expansion can occur - ie NG, urinary cath can introduce air into hollow viscus. ALL should be capped during take off and landing

orthopedic casts - can expand during flight. bivalve to prevent pain and circulation problems
Proper elevation and analgesia

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6
Q

features associated with persistence of asthma into school age

A

up to 60% become asymptomatic by age 6

wheezing episodes
personal or FmhX atopy
age of onset
trajectory over time

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7
Q

Diagnostic criteria for asthma in preschool aged

A
  1. document airflow obstrucion
    (preferred health care > historical)
  2. documented airflow obstruction reversible
    (SABA +/- corticosteroids OR 3mo med ICS OR SABA parent)
  3. No alternative diagnosis
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8
Q

name 5 signs/symptoms that lead you to think other ddx to asthma

A
  1. stridor- infection (croup)/laryngomalacia/vascular ring
  2. 1st episode of wheeze < 1 yo - bronchiolitis
  3. acute onset during eat/play/recurrent same location - FB/aspiration
  4. persistent nasal discharge - allergic/infectious
  5. chronic wet cough, FTT, steatorrhea - CF
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9
Q

Name components PRAM score & interpret

A

O2 sat (0) >/=95% (2) < 92%
wheeze: absent, expiratory only, inspiratory, audible without steth (3)
Suprasternal: absent/present (0/2)
scalene: absent/present (0/2)
AE: normal, base, apex&base, minimal (3)

severe 8 - 12
mod 4 - 7
mild 0 - 3
reversibility = change in 3

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10
Q

name 3 options for Med dose ICS in child 1 - 5yo

A

beclomethasone (qvar) 200mc daily dose
ciclesonide (alvesco) 200mcg daily dose
fluticasone (flovent) 200-250mcg daily dose

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11
Q

reasons for referral for asthma specialist (5)

A 
diagnosis uncertain or comorbidity
repeat >/= 2 exacerbations needing PO, hospitalization OR freq symptoms (>/=8d/month) despite mod ICS
life threatening event or to ICU
need for allergy testing
other: social, education
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12
Q

definition of noctural enuresis

secondary?

A

regular bed wetting (>2/week) beyond 5 years old

- when incontintience occurs at least 6mo of continence

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13
Q

what is epidemiology of primary nocturnal enuresis?

A

more common boys
10% 5 years old
5% 10 years old
1-2% 15 years old

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14
Q

what are general behavioural rx advice for primary enuresis? (4)

A 
goal getting up at night to pee
assure access to toilet
avoid caffeine/excess H20 prior to bedtime
pee QHS
clean wet bed in non punitive manner
preserve child's self esteeem
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15
Q

what are 3 interventions for nocturnal enuresis?

what are s/e>

A
  1. alarms
    - disturbs whole family
    - cure rate only 50%
  2. desmopressin (ADH)
    - headache, water intox, abdo pain
  3. imipramine hydrochloride (TCA)
    - irritabilty, anxiety, headaches, overdose arrhythmias, sz
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16
Q

how does bed wetting alarms work?

A 
alarms when child starts to void
cure rate < 50%
most effective child >7yo and 
continue until 14 days DRY
THEN 7 nights in a row
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17
Q

Normal temps CPS def

AND recommended type for age

A

Oral 35.5 - 37.5
Ear 35.8 - 38
Axillary 36.5 - 37.5
Rectal 36.6 - 38

Birth - 5 yo: rectal&raquo_space; axillary
> 5: oral»axillary/tympanic

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18
Q

Functional constipation

Rome III criteria

A

developmental age 4
at least once/week x 2mo

Two or more:

  1. 2 or fewer BM in toilet/week
  2. 1 or more fecal incontience/week
  3. hx retention
  4. hx painful or hard BM
  5. large fecal mass rectum
  6. large diameter stools that obstruct
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19
Q

Functional constipation management

A
  1. education - BF infants can have stools qfeed or up to q7-10d
  2. fecal disimpactation
    -meds - trial min 6 months
    ie PEG 1g/kg/day
  3. behavioural - sit toilet, diet , CHO (ie prune juice), fiber
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20
Q

medications constipation

list 5 options

A 
lactulose, mineral oil (osmotic)
pEG 3350 (Cathartic)
phosphate enemas - not recommend< 2yo
Bisacodyl
senna - idiosyncratic heptitis
milk magnesium
docusate (softner)
duclolax (proknetic)
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21
Q

why are XR ADHD recommended as first line

A 
improve adherence
reduce stigma
reduce problems with storing/admin drugs @ school
pharmacokinetics
less likely to be diverted
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22
Q

ADHD cardiac screening

9

A 
SOB with exercise
poor exercise tolerance
Fainting/seizure with exercise/startle
palpations with exercise
FmHx unexplained death, SIDS
Long Qt syndrome
WPW
cardiomyopathy
PHTN
heart transplant
implanted defibrilator
HTN
organic murmur
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23
Q

def SIDS

A 
sudden death of child < 1yo
unexplained after case investigation, complete autopsy, exam death scene, review clinical history
 < 1 in 1000 risk
peak 2 - 4 months
90% before age 6mo
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24
Q

what are risk factors for SIDS

3 categories x3

A

maternal

  • < 20yo
  • mat smoking
  • lower SES
  • aborginal

fetal

  • prematurity
  • male
  • LBW
  • sibling sids

environmental

  • prone sleep
  • bed sharing
  • over heating
  • bed accessorys
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25
Q

what are preventions for SIDS (5)

A 
prenatal care - avoid smoking
supine sleep
firm sleep surface
room sharing - 1st 6mo
avoid overheating
no bed accessories
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26
Q

healthy active living guidelines for screen time

A

< 2 yo - NO Screen
2-4yo - 1hr
older children < 2 hrs

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27
Q

Physical activity recommendations

A

preschool 180min/day
older (~5+) 60min/day
vigorous exercise 3x/week

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28
Q

Physical activity considerations for Chronic diseases (4)

A 
1. asthma - NO scuba if sx/abnPFT
ventolin prior to exercise
2. JIA
-PA as tolerated
-neck xray if neck arthritis
3. hemophilia
-factor proph as indicated
-written strategies. protective equipment
4. CF
-avoid scuba
Nacl drinks to prevent hypoN dehydration
if enlarged spleen - avoid contact
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29
Q

top 3 errors of using car seats

A

not well to vehicle > 1” move
straps too loose - > 1finger
chest clip not at armpit level

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30
Q

car seat recommendations

A

rear facing - until 1 year and 10kg
fwd facing - at least 18kg (40lbs)
booster - at least 36kg and 145cm
then regular seat belt

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31
Q

DM1 in school

A

schools - train min 2 staff to recognize and rx hypoglycemia

  • not found liable if reasonable steps
  • provide safe for meds/dispose
  • supervised eating
  • accommodate if hypoglycemic during exam
  • DM ER kit at desk

Physician

  • written info for care
  • BID/TID care if limited support
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32
Q

Housing needs - types

A

inadequate housing - need of major repairs
unsuitable housing - crowded. fails meet national occupational standard
unaffordable - 30% or more household income

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33
Q

Screen housing need:

A

H -harm - housing in need major repair?
O - occupancy - how many people, # rooms
M - moves in lifetime
E - enough income - food security, utilities etc.

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34
Q

Hockey injuries

body checking

A

body checking - individual defensive tactic to legally separate puck carrier and puck

CPS recommend DELAY until age 13- 14 years old
prevention
4 stage skill development
fair play

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35
Q

concussion risk factors for longer recovery

A 
hx previous injuries
headaches
difficulty sleeping
LD
ADHD
mental health
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36
Q

def of concussion

A

complex pathophysiological process affecting brain, induced by biomechanical forces. results in rapid onset impairment that resolves spontaneously

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37
Q

acute concussion management

A

stop game immediately. remove and med exam ASAP
SCAT3 (sport concussion assessment tool) - brief neuropsych ax)
No imaging unless red flags
REST - no evidence for tylenol/advil
return to learn
return to play

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38
Q

Return to learn

A

1) cognitive rest - limit tasks & screen time. No school
2) increased - slowly increase at home 15-20min increments
3) modified school attned - 1/2 days, homework 15 - 20min blocks
4) inc attendance - gradually to fully days. tests limited 1/day
5) return to school fully

if worsen at any stage, decrease activity until improve

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39
Q

return to play

A

1) no activity - remain until sx free 7-10 days
2) light aerobic - walk/swim
3) sport-specific - drills
4) non contact training
5) full contact practice
6) return to play

min 24hrs each step. if symx, go back where asymptomatic for 24-48hrs

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40
Q

repetitive concussion injury

A

if cumulative, consider retiring from sport
concussion occurs with les force
results in more severe x
more likely due to pt’s playing style, position or sport
concomitant LD, cognitive disabilities

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41
Q

Boxing recommendation

A

Boxing - encourages and rewards deliberate blows to head. risk of neck, face, head injuries.
Concussion 33% > laceration > #

Chronic traumatic encephalopathy
-caused by cummulative effects of repeated blows. up to 20% professional boxers
-head guards not protective against concussions
OPPOSE boxing as sports for children

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42
Q

playground injuries

A

UE # most common
head injuries
backyard - 1-4 yo most often
fatality rare - but almost usually due to strangulation

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43
Q

playground prevention

A

anticipatory guidance
report playground injuries to authorities
municipal planning
new playground guidelines to reduce max height fall, risk of falling etc
parents to provide active supervision
remove helmet prior to play equipment

44
Q

foods to avoid in < 4 year old due to choking

A 
hard candies
gummy candies, chewable vitamins
peanuts
sunflower seeds
fish with bones
snacks on toothpicks/skewers
45
Q

FB aspiration/ingestion 4th leading cause injury hospitalizations - when peak?

A

in age group < 4years

peak 9-11mo

46
Q

choking - what common things and how to tell parents to test

A

food - commonly round and cylindrical (hot dog, grapes)
balloon - most common non food

if can fit through empty toilet paper roll - chocking hazard

47
Q

athlete back pain

main structural ddx

A

more likely due to structural injury
- r/o red flags for infection/malignancy, etc

spondylolysis (extension pain)
posterior element overuse (extension)
vertebral body apophyseal avulsion # (flexion pain)
disc herniation (flexion pain

48
Q

oral health recommendations

A

1st check up within 1 yo or first 6mo of first tooth eruption
fluoride supplementatio

49
Q

early childhood caries

A

prsence of one or more decayed, missing, or filled tooth surfaces in preschool children

vertical transmission streptococcus mutans
Associations
-chronic disease (ie asthma)
- LES, aboriginal, new immigrants
-LBW, prematurity, iron def
50
Q

positional phagiocephaly

Prevention & treatment

A

cranial asymmetry due to forces that deform shape in supine position (parallelogram)
max at 4 mo, decreases over 2 years
Prevention
prone position 10-15min x TID
Treatment
mild/mod - repositional thearpy and PT. Preferred if < 4mo

severe -
helmet (help rate, but not reverse)
23/hr/day, expensive, risk contact dermatitis, sores
max age to consider = 8 mo

51
Q

trampoline

A

warn dangers - most injuries 5 -14 yrs old. # most common. high rate admissions

Advise NOT to buy or allow to use home trampolines

52
Q

recommendations fever and exercise

A

IF sx confined to above beck (ie URTI) play as tolerated

if systemic symptoms - refrain 7-14days due to risk of dehydration, progression of illness

53
Q

EBV infection and return to exercise

A

spont splenic rupture 0.1-0.5% highest in first 3 weeks

-NO exercise min 3 weeks
If no symptoms, lab markers normal, and no spleen enlargement
RESUME light activity 50%
@ 4 weeks, can resume contact sports

54
Q

ankle sprain

Ottawa rules

A 
ankle xray
pain in malleolar zone AND one:
- bone tender @ lateral malleolus or
-bone tender @ medial malleolus or
- inability to weight bear immediately AND in ER
foot xray
pain in midfoot zone and one:
-bone tender at 5th metatarsal or
-navicular bone or
-inability to weight bear immediate AND in ER
55
Q

ankle sprain rx

A 
P - protect (bracing)
R - rest
I - ice - 15min TID x 36hrs, NSAIDS
C - compression
E - elevation

Return to play
- when ROM, strength, proprioception nromal and pain resolved.
usually 1- 6 weeks.

56
Q

most common ankle injury sprain

A

by inversio of plantar flexed foot
ATFL - anterior talofibular ligament

if increased severity, calcaneoufibular ligament and posterior-talofibular ligament an be injuried

57
Q

bronchiolitis higher risk group

A

prematurity < 35 weeks
age < 3 months
CHD
immunodeficiency

58
Q

bronchiolitis EBM

  • equivocal
  • not recommended
A

equivocal

  • HTS
  • epi nebs
  • nasal suction
  • combined epi and dex

not recommended

  • ventolin
  • steroids
  • antivirals
  • antibiotics
  • cool mist therapies
59
Q

bronchiolitis admission

A 
severe resp distress
o2 > 90%
cyanosis/apnea
dehydation
family social situation
high risk for severe disease
60
Q

bronchiolitis discharge

A

90% sats
wob improved
PO intake
education and f/u

61
Q

dental fluorsis

A

mainly in child < 7 year old, due to excessive fluoride in water, tootpaste, food/drinks
toxic effect 1 - only with dental exam
toxic effect 2 - florid mottling and pitting of teeth. snow capped cups

62
Q

supplemental fluoride when?

A

only if > 6mo
AND less than 0.3ppm natural sources
child not brush teeth at least BID
dentist recommends

63
Q

vision screening

tests

A 
red eye reflex
cornea light reflex
fundoscopy
cover/uncover 
Snellen vision testing >4yo
-letters or HOTV (4 letters or E)
64
Q

vision screening guidelines

A

newborn - 3mo - exam, red eye reflex. Refer if high risk (ieT21), FmHx

6 - 12 mo: occular alignment
- fix, follow target. Corneal reflex and cover/uncover

3 - 5 yr: visual acuity age appropriate

6 - 18 year: routine and PRN

65
Q

footwear

A

prewalking - not required
shoes - 1.25cm thumb space at top when stand up
flat foot - rarely needs special rx

66
Q

Time out discipline

A 
age 2 - primary years most effective
Duration = min x age . max 5mins
introduce by 24mo
Place - no distractions, no toys
Give warning
When time out - ignore
when over - don-t rediscuss, move on
67
Q

toilet training readiness

A

usually 6 months to attainment
BM and urine control usually 2 - 4 years old

Readiness:
ability to walk to toilet
stable when sitting on toilet
able to remain dry or several hrs
receptive/expressive language to communicate
desire to please parent
desire for independence
68
Q

toilet refusal

A

1 - 3 month break suggested

if repeated attempts unsuccessful, refer to GP or developmental peds

69
Q

advice to parents for toilet learning

A

decide on vocab to use
ensure toilet position, access
encourage child to tell parent when need void
praise upon success
avoid punishment/neg reinforcement
expect accidents
consistent approach - all caregivers involved
after repeat success, use panties/training pants

70
Q

swimming lessions

A

lessons < 4 years old - NOT effective drowning prevention strategy
s/e water intoxication, hypernatremia, seizures, hypothermia, external OM

personal flotation devices - all small children and those who cant swim
parental supervision + encourage first aid/CPR training
residental pools - fence all 4 sides.

71
Q

literacy promotion recommendations

A 
address @ birth and throughout 
ASK about literacy - book sharing, access etc
library card applications
singing, story telling, 
clinic waiting areas with literacy
72
Q

direct effects of low literacy on health

A

incorrect use medications
failure to comply with medical directions
errors in infant formula administration
safety risk in community

(other indirect)
unhealthy lifestyles
higher rates poverty
higher occupational injuries
higher stress
limit access/understand health services
73
Q

autism intervention

A

earlier is better
15 - 40hrs/week
Individualized learning plan
multidisciplinary team

74
Q

Asthma Risk factors ICU admission and death

A

previous life threatening events
admisisions to PICU
intubation
deterioration while on systemic steroids

75
Q

what are symptoms/signs of mild asthma exacerbation
severe asthma exacerbation
impeding resp failure

A 
mild:
normal speech, LOC, activity
mod wheeze, mild WOB
>94% room air
peak (personal) > 80%
Severe:
agitated, significant WOB
speak words
wheeze without steth
best spiro < 60%
impending resp failure
drowsy, unable to eat
unable to speak
chest silent
sat < 90%
76
Q

asthma exacerbation treatment

mod

A

keep sats >= 94%
ventolin q20min 1 - 3 doses
orsl asteroids
consider ipratropium x3dose 1hr

77
Q

asthma severe exacerbation treatment

A 
sats >/=94%
ventolin, ipratropium x3
oral steroids (possible IV)
NPO
consider cont ventolin neb
consider IV mgso4
78
Q

asthma impending resp failure treatment

A 
continuous ventolin and ipratropium x 3 doses
NPO, IV access
IV methylpred
blood work
consider IV mgSO4
consider SC
PICU
consider RSI/ETT
79
Q

asthma exacerbation admission criteria

A

O2
persistent increased WOB
B2 agonst more often Q4H after 4-8hr conventional rx
deteriorates while on PO steroids

80
Q

discharge asthma

A 
complete 3-5day steroids
venotlin 0.3puff/kg max 10puff Q4H until resolve
return to care if > Q4H
written asthma plan
review technqiue
f/u primary care
81
Q

GCS scale

A

E4
- spontaneous > to speech > to pain > none
M6
commands > localize > withdrawal > decorticate > decelebrate > none
V5
- oriented > confused > inappropriate words > sounds > none

82
Q

Pediatric risk factors for head trauma

A

larger head to body ratio
(large occiput)
thinner cranial bone
less myelinated tissue

83
Q

dangerous mechanism of injury for head

A

MVA
fall >/= 3 feet
down 5 stairs
fall bicycle without helmet

84
Q

classification Head trauma

A

severe < 8
mild 14 - 15
mod 9 - 13

85
Q

CATCH rule

CT head indication

A 
Children with MINOR head injury + one of following:
High risk
1. GCS < 15 after 2hrs 
2. suspect open or depressed skull #
3. worsening headaches
4. irritability on exam
Medium risk
1. basal skull # 
2. large boggy hematoma
3. dangerous mechanism
86
Q

other CT head absolute and relative indications

A

focal neurological deficit
GCS < 14 (mod/severe head trauma)
suspect open/depressed skull fracture

relative

  • persistent irritability < 2 ear old
  • seizures
  • known coagulation disorder
  • clinical deteriation over 4-6hr
87
Q

minor head trauma management

A

if asymptomatic –> d/c to reliable parents
written instructions
if headache, vomit, LOC after period of observation then ADMIT
- if persistent > 18-24hrs, likely CT head
if < 2 years, esp < 12 months –> CAUTION
consider skull xray < 2 years old

88
Q

risk factors post-traumatic seizures

A

majority within 24hrs
impact seizures - shortly after event. if N CT head/exam, low risk and can be d/c

younger age
severe head trauma < 8
cerebral edema
SDH
open or depressed skull #
89
Q

anaphylaxis diagnostic criteria

A
  1. skin + one system
    - resp - wheeze, stridor
    - BP or end organ
  2. likely allergen+ 2 systems
    - skin
    - cardio
    - resp
    - GI
  3. known allergy + hypotension (> 30% dec SBP or age specific)
90
Q

common anaphylaxis triggers

A

Food> hymenopetra (bee/wasp) > medications

food: peanuts, fish, milk, eggs, shellfish

91
Q

anaphylaxis treatment

A

IM 1:1000 epinephrine 0.01mg/kg q 5 - 15mins (max 0.5mg)
ABC, large bore IVs
Oxygen, monitors

H - histamine blocker (ranitidine, benadryl)
I - IV fluids
V - ventolin
E - epinephrine
S - steroids IV methylpred 1mg/kg

if still persistent hypotension,
IV epinephrine infusion 0.1mcg/kg/min
IV glucagon (on BB) - 20mcg/kg over 5 mins, then infusion 10mcg/min

biphasic reaction 1hr to 72hrs after

  • observe in ER 4- 6hrs. tell RTC
  • if repeated dose, severe symptoms, admit
  • high risk: peanut, asthma, use BB - admit
92
Q

status epilepticus

options pre-hospital management

A

lorazepam buccal/PR 0.1mg/kg (max 4mg)
midaz IN/buccal
diazepam DR 0.5mg/kg (max 20)

93
Q

status epilepticus

second line treatment

A 
IV fosphenytoin (20mg/kg)
IV phenytoin (20mg/kg)
IV phenobarb (20mg/kg)

if still seizing after 5mins med, use other class

94
Q

Status epilepticus. if no IV/IO, what 2nd line treatments?

A 
Fosphenytoin IM (20mg/kg)
phenytoin IO (20mg/kg)
--
paraldehyde PR (400mg/kg)
if still seizing after 5 mins use other class
95
Q

status epilepticus 3rd line

A

IV midazolam 0.15mg/kg bolus then 2mcg/kg/min
increase 2mcg/kg/min q5 mins
bolus 0.15mg/kg with each increase in infusion rate
max 24mcg/kg/min

if still seizing - thiopental/pentobarbital bolus and continuous
if no seizure - taper after 24-48hrs

96
Q

common etiologies of status epilpticus

A

acute CNS infection
metabolic derangement (Ca, glucose, HypNa, anoxic injury)
antiepileptic drug noncompliance/withdrawal
non AED overdose
prlonged febrile convulsions (30%)

cerebral migrational disorders (schizencephaly)
cerebral dysgnesis
Perinatal HIE
progressive neurocognitie disorders

97
Q

status epilepticus definition

refractory Status epilepticus definition

A

CSE = continuous GTC activity with LOC for > 30mins or 2 or more discrete seizure without return to baseline

convulsive status eplipticus unresponsive to 2 different antieplieptics ( ie benzo, pheno)

98
Q

SIADH risk

A 
CNS
pulmonary disorders
surgical interventions
medications (ie morphine)
stress, nausea, pain
99
Q

acute hyponatremia sx

A

decrease Na < 48hrs
acute cerebral edema, headache, lethargy seizure, brain herniation,
more likely if Na < 130
children higher risk due to higher brain/intracranial ratio

100
Q

MRSOPA

A 
M mask
R reposition
S suction
O oral airway
P pressure 
A alternative airway
101
Q

ETT size for PALS

A

uncuffed 4 + (age/4)

cuffed 3.5 + (age/4)

102
Q

post resuscitation targets O2, temp

A

O2 94-99%

temp consider 32-34 degrees

103
Q

pediatric office recommended equipment

A

airway

  • bag mask
  • o2 masks, O2 tank, tubing,

CVS

  • cardiac arrest backboard
  • BP cuffs
  • 16 gauge IO
  • IVfluids, tubing, N/S
Meds
IM epinephrine (1:1000)
neb epinephrine (croup)
neb ventolin  (+compressor for nebs)
(diazepam, glucose determination)
other
neck collar
dressing, splints, bandage
ER container box
latex-free gloves
104
Q

BRUE definition

A

infant < 1 year old with observe reports sudden brief, now resolved episode with one of following:

  1. cyanosis/pallor
  2. absent, decreased, irregular breathing
  3. change in tone
  4. altered LOC
105
Q

BRUE LOW RISK - criteria

A 
> 60 days old
GA >/= 32 and cGA > 45 weeks
only 1 BRUE (not clusters)
Duration < 1 min
no CPR by trained health care
normal physical exam
106
Q

BRUE low risk management

A

educate caregiver about BRUE
offer CPR training
MAY obtain pertussis/ ECG
brief monitor with o2 pulse

NOT extensive blood work, Bcx, LP
Not need U/A, neuroimaging

General Pediatrics (19 decks)

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