CPS Statements Flashcards
Most likely SE from ondansetron
Mild/self-limiting diarrhea
Dosing for ondansetron in mg/kg
0.15 mg/kg
Criteria for anaphylaxis
- Hypotension following known antigen.
- Acute onset of cutaneous +/or mucosal involvement with at least one of the following: (a) resp, (b) CVS
- Two or more of the following systems involved: (a) cutaneous/mucosal, (b) resp, (c) GI, (d) CVS
Biphasic anaphylaxic reaction: (a) when most occur and (b) total time frame when this can occur
A. 4-6 hours
B. 1-72 hours
EpiPen dosing
- 15mg for <25kg
0. 3mg for >25kg
In-hospital epi dosing for anaphylaxis
0.01 mg/kg of 1 mg/mL concentration
What age/gender most at risk for childhood UTI? x2 scenarios
- Boys: uncircumcised, <3 months
- Females: <1 year
Predictive rule for r/o UTI in girls <24 months of age (x5 risk factors)
- Age <12 months
- White race
- Temp >39
- Fever >2 days
- Absence of another source for infection
When to consider RBUS and VCUG for UTI?
- RBUS: First febrile UTI in <2 year old
- VCUG: Abnormality on RBUS and/or second febrile UTI in <2 year old
When to consider antibiotic UTI prophylaxis?
- VUR grade IV or V
- Significant urological abnormality
What do we call UTI without fever?
Cystitis
When to consider a complicated UTI?
- Hemodynamically unstable
- Not improving (with persistent fever, elevated inflam)
- Renal dysfunction (elevated Cr)
- Poor voiding/urine output
- Bladder or abdo mass
How does juvenile onset recurrent respiratory papillomatosis occur?
-Rare vertical transmission of HPV to infant
What x3 symptoms are classic for acute nicotine toxicity?
- Headache
- Tachycardia
- Abdo pain
Following a needle stick injury, what x2 infections have been reported and what x1 infection has not?
- HCV + HBV
- HIV
What is a rare but serious complication of vertical transmission of HPV?
Juvenile onset recurrent respiratory papillomatosis
Recommendations on hydration for sports
- If less than 1 hour = water
- If >1 hour and/or in hot environment = sports drink with 6% glucose with 20-30 mEq/L NaCl
What does lower SES and having a TV in your bedroom increase your risk for?
Overweight and obese through increased screen time
What are risk factors for being less active (x5)?
- Older
- Female
- Aboriginal
- “overscheduled”
- Not involved in or dislike sports/recreational activities
How much screen time is recommended for (a) <2 years old, (b) children 2-4 years old, and (c) children + youth?
(a) None
(b) <1 hours per day
(c) <2 hours per day
How much activity (of any intensity) should toddlers + preschoolers achieve each day?
-180 minutes per day
Important questions to ask for a neurologically impaired child in terms of feeding/nutrition?
- Duration of feeds
- Feeding aversion
- Safety: coughing/choking, recurrent PNA, chronic chest symptoms
- AEDs
What do AEDs do nutritionally to children with neurological impairment?
Micronutrient deficiency - folate, vit B12
When to consider supplemental fluoride + what preparations would you recommend?
-If >6 months of age
-Water supply contains <0.3 ppm
-At risk for caries
-No regular brushing
= mouthwash/lozenges
What x2 things should children avoid until resolution of their ITP?
- Avoid contact sports
- Avoid anti-platelet medications (e.g., NSAIDs)
How long to observe a patient with croup following their first epi neb?
2 hours
What processed food has the highest sodium content?
Bakery goods
What are risk factors in a patient with asthma that puts them at risk for ICU admission and death (x7)?
- Previous life-threatening events, admissions to an intensive care unit (ICU), intubation
- Hospitalizations or ED visits for asthma in the last year
- Deterioration while on, or recently after stopping, systemic steroids
- Using >1 canister of salbutamol per month
- Lack of an asthma action plan or poor adherence to treatment
- Comorbidities (e.g., food allergy, obesity)
- Low socioeconomic status, psychosocial concerns
25(OH)D level in nmol/L - (a) optimal, (b) deficient, and (c) toxic?
(a) 75-225
(b) <25
(c) >500
Most common dyslipidema in pediatrics?
Low HDL and high TG
What makes ceftazidine special?
Pseudomonas coverage
What genetic disorder -girl with microcephaly, seizures, absent speech, and ataxic gait?
Angelman Syndrome
What x4 genetic syndromes can be associated with self-injurious behaviour?
- Lesch Nyhan
- Cornelia de Lange
- Smith Magenis
- Prader Willi
3 week old with 2cm smooth, rubbery mass on left side of neck:
(a) Thyroglossal duct
(b) Brachial cleft cyst
(c) Congenital muscular torticollis
C
x2 most common bugs for acute otitis externa
- Pseudomonas
- S aureus
x7 deficiencies associated with a vegan diet
- Vitamin B12
- Iron
- Zinc
- Calcium
- Protein
- Vitamin D
- Omega 3 fatty acids
x8 adverse effects of septra
- Anaphylaxis
- Urticaria
- Photosensitivity
- Renal toxicity
- Hepatic toxicity
- Bone marrow suppression
- Hyperbilirubinemia (neonates)
- SJS/TEN
x3 most common pathogens to colonize CF airway
- S aureus
- Pseudomonas
- Burkholderia cepacia
x6 intestinal complications of CF
- Meconium plug/ileus
- DIOS
- Pancreatitis
- Rectal prolapse
- Malabsorption
- Biliary cirrhosis
x6 steps in management after identifying prolonged QT in a 15 year old F
- Referral to cardiology
- Restrict activity
- Consider B-blocker in consult with cardio
- Electrolytes
- Screen family members with ECG’s
- Avoid QT prolonging medications
What test should you do to screen for HIV in a neonate who may have been exposed?
HIV PCR within 48 hours if possible
HBV prophylaxis following needle stick injury
You got this! Look at CPS statement table
What to do after a possible HCV exposure from needle stick injury?
Monitor - no prophylaxis available
If high risk possible exposure to HIV following a needle stick injury, what to do?
- Baseline HIV PCR
- Start prophylaxis x28 days (within 72 hours - ideally within first 4 hours)
- Re-test 4-6 weeks later
When can children with chickenpox return to school?
If they have mild illness - as soon as they are well enough to participate (regardless of their rash status)
Most common location within a bone for acute OM?
Metaphysis
x2 different options for children <4 years of age with acute osteoarticular infections (and why)
- IV cefazolin (Kingella)
- IV cefuroxime (H. flu)
What age range is ideal for HPV vaccination?
9-13 years old
What is the HPV schedule? What about for immunocompromise?
x2 doses 6 months apart
x3 doses
What is the HPV vaccine best at protecting against?
Cervical disease
What is the current HPV vaccine?
Gardasil-9 or HPV-9
What x2 meningococcal vaccines do we routinely give and what is their timing in the immunization schedule?
MenC-C = at 4 months and 12 months MEN-ACWY = in grade 9
What are the x5 serogroups of meningococcal (N. meningitidis) that cause disease and the x2 that are the most prevalent?
ABCYW
B+C
Who is at greater risk for meningococcal disease?
- Asplenia (SCD)
- HIV
- Complement deficiency / B cell problem
- Travel to an endemic area
- Military, close contact, lab worker
What two vaccines should individuals be given if identification of condition that poses high risk for meningococcal infection or if travelling? How old must you be to give + how often to give boosters?
Men-ACYW and 4CMenB
- Need to be at least 2 months old
- Boosters q5 years
If a face is super edematous, what drug reaction to think about?
DRESS
Timeframe to use UTI prophylaxis?
3-6 months
When should you give the rotavirus vaccine to a preterm?
At or just after discharge from NICU - if staying in NICU for longer than 8 weeks of age then have to weigh +/-
What is one option of dosing for amoxicillin for AOM?
75-90 mg/kg/day divided BID
x5 complications of AOM
- Mastoiditis
- Facial nerve palsy or 6th CN palsy
- Labyrinthitis
- Venous sinus thrombosis
- Meningitis
What test to use for HSV swabs in neonate?
PCR (not serology)
If serum +/or CSF positive for HSV, how long would you treat the neonate for? Versus blood and CSF are both negative.
- Positive = 21 days
- Negative = 10-14 days
What are the x3 criteria for chemoprophylaxis of a family in setting of patient with Hib meninigits?
- If children <12 months
- If children <4 years old who are incompletely immunized
- Any immunocompromised children
What should you do in setting of C diff recurrence - (a) the first time or (b) the second time?
(a) use same tx as initial episode
(b) use vanco + tapering schedule
When should we give GAS chemoprophylaxis to close contacts? What Abx to give?
- If confirmed case of invasive GAS that is severe and close contact was there 7 days prior to onset of symptoms
- Keflex x10 days
What presentations would be considered invasive GAS?
- Meningitis
- Nec fasc or myositis
- TSS
- Pneumonia
In addition to Abx, what else can you give to patients with invasive GAS infections?
IVIG
What size of wheal is considered positive for a TB TST for a (a) immunocompromised, (b) close contact, and (c) 10 year old?
(a) 5mm
(b) 5mm
(c) 10mm
When to give TB prophylaxis to (a) <5 year old or (b) >5 year old?
(a) if TST <5mm = give –> repeat in 8-10 weeks
(b) if TST <5mm = do NOT give but also repeat
How many drugs do you use in TB window prophylaxis?
One
What type of Salmonella infection, do we need to check BCx for all, treat with Abx (and what Abx), and check stool for clearance?
- Typhoid
- CTX (admitted) vs azithro (outpatient)
When to consider zanimivir for influenza?
- If tamiflu (oseltamivir) not working
- Illness despite tamiflu
Who cannot receive tamiflu?
<1 year old
How long to wait to give live vaccines for (a) steroids, (b) chemo, and (c) biologic?
(a) 1 month
(b) 3 months
(c) 6 months
HPV - high risk types and low risk types
- High = 16 + 18
- Low = 6 + 11
Length of doxy of Lyme disease for (a) erythema migrans, (b) isolated facial palsy, (c) arthritis, (d) carditis?
(a) 10 days
(b) 14 days
(c) 28 days
(d) 14-21 days
x3 repellant/insectide products to consider for mosquitos and ticks
- DEET repellant
- Icaridin (considered first choice for repellants)
- Insecticide permethrin for protective clothing (considered best overall)
Infectious screening tests to consider for solid organ transplants
- Hep A, B, C
- HIV
- Syphilis
- VZV
- EBV
- CMV
- HSV
- TB
- Toxoplasmosis
- Measles
- Mumps
- Rubella
- Stronglyoides
What infection to think about for necrotizing funisitis?
Syphilis
What infection to think about with “barbershop pole” appearance of umbilicus?
Necrotizing funisitis = syphilis
What are the two steps of syphilis testing in Canada?
- Non-treponemal = RPR
- Treponemal = confirmatory
If maternal RPR fell by 4-fold, infant RPR non-reactive - what to do?
No further evaluation
-clinical and serologic follow-up to 18months
What bacteria is associated with dental caries?
Streptococcus mutans
What is the main difference between hearing screens?
- Otoacoustic emission (OAE): Identifies conductive and cochlear hearing loss from the level of the external ear to the level of the outer hair cells in the cochlea
- Automated auditory brainstem response (AABR): Identifies conductive, cochlear and neural hearing loss from the external ear to the level of the brainstem, including assessment of vestibular (8th) nerve function
x3 most common types of sleep disorders
- Behavioural insomnia of childhood = Sleep onset association disorder and Limit-setting type
- Delayed sleep phase type (>30 min sleep latency)
Dosing of melantonin for (a) children and (b) adolescents
-What age to trial melantonin
- No evidence for <2 years
(a) 2.5-3mg
(b) 5-10mg
Risk factors for positional plagiocephaly
- Male
- First born
- All bottle feeding
- Limited tummy time
- Sleeping supine
- Limited ROM of neck (torticollis)
- Lower activity level
Percentile differences between (a) risk for obesity, (b) overweight, and (c) obese?
(a) >85th%tile
(b) >97th%tile
(c) >99th%tile
What x5 conditions may benefit from high flow NC?
- Asthma
- Bronchiolitis
- OSA
- Heart failure
- PNA
What are the contraindications to the intranasal influenza vaccine?
<2yrs old - risk of wheezing seen 2-4wks after vaccination
Immunocompromised
Pregnant
Severe asthma - currently wheezing, currently on oral steroids, currently on high-dose inhaled steroids, wheezing in last 7 days
On ASA treatment - risk of Reye syndrome
>48h after antiviral for influenza completed
Significant nasal congestion
Who is most at risk from complications secondary to codeine - (a) fast or (b) slow metabolizer?
A
What is the max daily amount of caffeine for adolescents?
2.5 mg/kg/day
x5 positive impacts of probiotics
- prevent antibiotic-associated diarrhea.
- shorten the duration of acute infectious viral diarrhea.
- prevent necrotizing enterocolitis in preterm infants who are at risk of necrotizing enterocolitis.
- decrease the symptoms of colic.
- decrease some symptoms of irritable bowel syndrome.
Recommended intake of dietary fibre for (a) 1-3 yo, (b) 4-9 yo, (c) male adolescent, and (d) female adolescent?
(a) 19 g/d
(b) 25 g/d
(c) 38 g/d
(d) 25 g/d
what x3 other alternative measurements could be used instead of height for neurologically impaired children?
- Knee height
- Tibial length
- Ulnar length
How much iron to supplement in an infant weighing <2.5kg who is predominantly formula fed?
No supplementation as long as formula contains 10-12 mg/L of iron
How much iron supplementation for an infant who weighs (a) 2.0-2.5kg vs (b) <2.0kg and is predominantly fed with BM?
(a) 1-2 mg/kg/day for 6 months
(b) 2-3 mg/kg/day for the first year
What medication could be considered in a toddler not gaining weight to increase appetite?
Cyproheptadine
1st and 2nd tier of investigations for a child who has demonstrated growth failure
1) CBC, renal function, lytes + extended, ESR/CRP, LE’s, albumin, total protein, glucose, gas, immunoglobulins, celiac screen, UA, iron studies, TSH
2) vitamin levels, bone age, sweat chloride, fecal elastase
When is there typically a decrease in rate of growth and appetite in childhood?
2-5 years of age
What is a general rule to give to parents of how much of each food they should offer?
1tb of each food per year of the child’s age
How long should meals be limited to?
20 minutes
What is the dose for vitamin K IM for newborns?
0.5mg if <1500g or 1.0mg
Criteria for HIE
• GA >36 weeks
• <6 hours old
• Must meet either A or B PLUS C
○ A: cord pH <7.0 or base deficit >-16
○ B: pH 7.01-7.15 or base deficit -10 to -15.9
§ On cord or BG within 1h
§ AND:
□ History of acute perinatal event (e.g., cord prolapse, placental abruption, uterine rupture)
□ APGAR <5 at 10 minutes or >10 minutes of PPV
○ C: mod-sev encephalopathy = presence of seizures OR one sign in at least 3 categories
May be useful to have an EEG for at least 20 minutes to detect abnormal tracing
Draw out algorithm for management of early onset sepsis
You got this!
What is the syndrome called for neonates exposed to SSRI?
SSRI neonatal behavioural syndrome
Symptoms associated with SSRI neonatal behavioural syndrome
- Resp: tachypnea, elevated pulmonary pressures (delayed transition), cyanosis
- CNS: hypertonia, irritable, jitters, tremors, seizures (rare)
- FEN: poor feeding
Recommended protocol for premed for intubation for neonates (including doses)
- Atropine 20 ug/kg
- Fentanyl 3 ug/kg
- Succinylcholine 2 mg/kg
Threshold TSB for (a) severe and (b) critical hyperbili
(a) >340
(b) >425
Follow-up recommend for neonates with hyperbilirubinemia
- Neurodevelopmental monitoring
- Hearing screen
- CBC at 2 weeks (if Hb low at d/c) or 4 weeks (if Hb normal upon d/c)
What x2 things are included in a normal pulse oximetry screen as a newborn?
=/> 95% in right arm
<3% difference between right arm and leg
Gold standard in testing for penicillin allergy
Oral challenge
Risk factors for Autism
• Genetic/familial - male, specific genetic syndromes, first degree relative
• Prenatal - older parental age (>35 years old), maternal obesity/DM/HTN, in-utero exposure to VPA/pesticide/air pollution, maternal infection, close spacing of pregnancies
• Postnatal - low BM, extreme prematurity
ASD prodrome = delayed motor control (e.g., persistent head lag), feeding + sleeping difficulties, excessive reactivity or passivity
True or false: For genetic conditions that will not present until adulthood (susceptibility or predictive testing), testing should be deferred until the child is competent to decide. Same for carrier status.
True
Ddx for fractures - other than maltreatment
• Trauma: ○ Birth related ○ Accidental ○ Inflicted • Genetic bone disorder: ○ Osteogenesis imperfecta · Blue sclera, ligamentous laxity, osteopenia, wormian skull bones, dentinogenesis imperfect, family history, hearing loss · May an association with SDH ○ Menkes disease ○ Infantile cortical hyperostosis ○ Hypophosphatasia • Nutritional/metabolic disorder: ○ Vit D deficiency rickets ○ Osteopenia of prematurity ○ Copper deficiency ○ Chronic renal insufficiency ○ Scurvy • Infection: ○ Osteomyelitis ○ Congenital syphilis • Toxicity: ○ Hypervitaminosis A ○ Methotrexate toxicity • Neoplastic disorder: ○ Leukemia ○ Langerhans cell histiocytosis
Ddx for bruises - other than maltreatment
• Skin findings:
○ Slate-grey nevi - Mongolian spots
○ Hemangiomas
○ Skin staining from dyes
○ Eczema
○ Erythema multiforme
○ Cultural practices - cupping, coining
• Infections - meningococcemia
• Malignancy - leukemia, neuroblastoma
• Nutritional deficiencies - vitamin K or C
• Severe systemic illness - DIC
• CT disorders - Ehlers-Danlos syndrome, osteogenesis imperfecta
• Autoimmune or inflammatory disorders - ITP, HSP
• Vascular - AVM
• Bleeding disorders:
○ Coagulation disorders - hemophilia, von Willebrand disease, platelet abnormalities (ITP)
Defects of fibrinogen, fibrinolysis
