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RC Prep - Dev Peds > Ethics > Flashcards

Ethics Flashcards

1
Q

3 things to do if asked to provide evidence in court?

A

Contact CMPA for medical legal advice
Contact patient to get expressed consent to provide witness
Or need subpoena if no consent provided

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2
Q

Minimum age for power mobility?

A

18 - 24 months if no cognitive or sensory co-occurring disorders

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3
Q

4 ethical responsibilities of physicians

A

Autonomy
Beneficence
Non-maleficence
Justice

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4
Q

3 ophtho causes of blindness

A

Glaucoma
Retinopathy of prematurity
Cataracts

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5
Q

reasons while braille might be harder than using large letters

A

-parents may not know braille
-difficult to access teachers who are able to teach braille
-not enough time in school to teach braille in addition to other topics
-if associated motor impairments - potentially braille might be harder?
-or decreased sensory input from digits

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6
Q

Name 6 signs of burnout or substance use in colleges

A

Late to appointments; increased absences; unknown whereabouts
Unusual rounding times, either very early or very late
Increase in patient complaints
Increased secrecy
Decrease in quality of care; careless medical decisions
Incorrect charting or writing of prescriptions
Decrease in productivity or efficiency
Increased conflicts with colleagues
Increased irritability and aggression
Smell of alcohol; overt intoxication; needle marks
Erratic job history

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7
Q

4 predictors of poor outcomes after cochlear implants

A

CMV infection
Hypoplastic inner ear malformations
Cochlear nerve deficiency
Poor or absent e-ABRs in auditory neuropathy spectrum disorder

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8
Q

4 factors that predict better outcome after cochlear implants

A

Bilateral implantation for bilateral HL
Better preop hearing performance
Quality parent-child interactions
Favourable social determinants
Few comorbidities (ex. w/o DD)
Etiology (see right)
Implanting at earlier age
Post-lingually acquired deafness
Hearing hour percentage (i.e. % of day implant is active)
Post-operative auditory verbal habilitation

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9
Q

5 causes of abnormal hearing with normal hearing at birth?

A

Genetic
Syndromic versus non-syndromic
Bacterial meningitis
The most common cause of postnatally acquired (i.e. versus genetic) deafness in childhood
Ototoxic drugs
Chemotherapeutics
Aminoglycosides
Trauma
Temporal bone
Tumours
Vestibular schwannoma
Hyperbilirubinemia
Noise exposure
Congenital CMV (delayed onset)

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10
Q

3 indications for cochlear implants

A

bilateral > unilateral
Severe to profound
family readiness
> 12 months
No or limited benefit of other amplification
spoken language primary mode of communication

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11
Q

Risk of hearing loss in patients in long NICU stay

A

younger gestational age
Ototoxic medications
HIE
hyperbilirubinemia
meningitis
intracranial hemorrhage

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12
Q

Work up for SNHL

A

(history, development, family history, immune disorders)

Genetics
MRI
CMV serology (if in the first 3 weeks/neonatal period)
Vestibular assessment
Opthalmologic assessment
Urinalisys for microscopic hematuria (r/o Alport Syndrome)

Secondary level
- serology for congenital infections
- renal ultrasound
- metabolic screen
- hematologic biochemical studies

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13
Q

4 effects of visual disorder on develop

A

Social skills (shared attention, non-verbal, eye contact)

Gross motor delays
Fine motor delays

Speech and language delay - prolonged echolalia, delayed recognition of objects

Impacts on ADLs

Abnormal behaviors - visual inspection, stereotypic movements

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14
Q

define autonomy, justice, non-maleficence, beneficence

A

Beneficence: Doing what is good or what is in the best interest of the patient.
Justice: The equitable or fair distribution of health resources
Non-maleficence: The moral obligation to do no harm to the patient.
Autonomy: The right of competent patients to make decisions about their own medical care

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15
Q

name the patient safety outcome that medication safety and three steps of reconciliation

A

Non-maleficence

Review medication / medication history
Reconcile
Document changes to medications

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16
Q

Refusal of immigration. 3 advocacy steps

A

Connect with SW
Write an advocacy letter that demonstrates that the child does not have “excess medical needs” if able to do that
Connect with immigration lawyer

17
Q

3 risk for microarray or genetic testing

A

VUS outcome
Incidental finding
psychosocial risks
risk of non-paternity if testing parents

18
Q

4 steps in delivering bad news

A

SPIKES
Prepare the setting - right people and place
Perceptions - patients perspectives
invitation - to share and discuss topic
Knowledge - sharing
Emotions - empathize and acknowledge
Summary - summary and next steps

19
Q

SNHL test to identify

A

Auditory brain stem response (ABR)

vs Otoacoustic emissions - is for conductive

20
Q

name the diagnosis

A

1) normal L ear hearing
2) SNHL <15 dB difference between air and bone and below 15 dB loss
3) conductive hearing loss

> = bone
x = air conduction

21
Q

Long-term outcomes of severe untreated hearing loss

A

Academic under achievement
reduced employment
Higher emotional difficulties
social challenges or maladjustment
Delayed speech and language
Difficulty wiht complex motor skills

22
Q

3 most common syndromes associated with hearing impairment

A

Usher syndrome (AR)
Waardenburg syndrome (AD)
Pendred syndrome
DiGeorge

23
Q

5 clinic eye exam findings warrant opthal referral

A

misalignment beyond 4 months (or constant at any age)
absence of social smile or eye contact by 3 months
acuity <20/50, or 2 lines or greater between eyes
Aniscoria
Leukocoria or absent or asymmetric red reflex
horners (ptosis, smaller pupil) - r/o neuroblastoma

24
Q

Common visual conditions in children with disabilities (8)

A

Strabismus
Myopia, hyperopia
cortical visual impairment
cataracts
ROP
nystagmus
optic nerve hypoplasia
coloboma

25
Q

4 indications for artificial nutrition

A

Neurological impairment leading to an inability to feed orally and/or risk of aspiration
Malnutrition
Inadequate intake or increased caloric requirements
IEM, CHD
Malabsorption
Ex. SBS, IBD
To support management of chronic diseases
Cancer, CHD, IEM, diseases requiring management with special diets
Maintain hydration requirements
Ex. CKD

26
Q

risk of artificial nutrition

A

Infection (GT site, central line/IV for TPN)
Diarrhea (from hyperosmolar formula)
Electrolyte abnormalities (from TPN)
Dehydration or fluid overload
Blood clots (central line or PICC for TPN)
Liver failure or cholestasis

Psychosocial impacts

27
Q

Three components of informed choice

A

Disclosure by HCP of relevant information
Patient is competent to make decision
The decision is voluntary or non-coerced

28
Q

Two types of proxy for decision making

A

First category is legally appointed SDM (POA). These individuals are previously specified to be able to make decisions on behalf of the patient, are outlined within legal documents, and outrank family members
The second category is automatic SDM. These are the default SDM when no one has been previously, legally appointed
Spouse/partner
Adult child
Parent
Sibling
Other living relative
The difference is whether or not the SDM has been previously specified by the patient

29
Q

Parents refusing treatment in 15 year old severe depression
- 3 possible options

A

1) Assess pts capacity for informed consent and proceed without parental input under the mature minor doctrine
2) Provide parental education and discuss concerns and review treatment options (medication or psychotherapy)
3) Engage legal system through child protective services

30
Q

You studied 200 children. 100 received probiotics for 4 weeks and the other 100 did not. In that 4 week period, 40 of the children who received the probiotics had an aggressive outburst compared to 80 of the children who did not.

What is the absolute risk ratio (ARR), relative risk reduction (RRR), and number needed to treat (NNT)

A

ARR = likelihood of outcome - likelihood in control (C/C+D) - (A/A+B) = ARR
= -0.4 (reduced risk in intervention group)

RRR = 1-([C/C+D]/[A/A+B]) = 1-(0.4/0.8) = 0.5 = 50% reduction

NNT = 1/ARR = 2.5 ppl

31
Q

Heirarchy of data

  • systemic review
    -case-control/cohort
    -case series
  • RCT
A

1) Systemic review
2) RCT
3) Case control/cohort
4) Case series

32
Q

Benefits of advance care planning

A

Reduce unwanted interventions and associate harm/risk of those interventions (non-maleficence)

Allow for family and cultural believes to be respected and incorporated into treatment plans (autonomy)

improve adherence to pain control and relief of suffering strategies during acute illnes or end of life (beneficence)

33
Q

When should advance care planning occur?

A

Earlier, shortly after diagnosis or even prior to birth in specific cases, is preferred over discussion being prompted by critical care event. Signs the family is ready:
- asking about future/worry
- what if questions
- concerns about quality fo life or suffering

Periodically revisited - following significant changes in health status or life events.

CPS Goals of Care Conversations and Advance Care Planning

34
Q

Components of informed consent

A

1) Capacity
2) Risk, Benefits, Alternatives
3) No duress

35
Q

Sensitivity
Specificity
PPV
Likelihood ratio

A
36
Q

3 tests to determine cause of SNHL?

A

MRI
Genetic testing (GJB2, GJB6 = Connexin 26)
CMV testing

37
Q

our colleague’s wife just died. 6 evidence based warning signs that your colleague may be impaired.

A

taking short cuts,
o failing to follow established procedures,
o not answering patient questions,
o not discussing treatment options,
o making treatment or medication errors that cannot be attributed to a lack of knowledge
o poorer sense of teamwork

RC Prep - Dev Peds (12 decks)

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