Gen Peds Flashcards
When do you switch from rear seat to fwd seat to booster ?
Rear until
- 10 kg + 1 y.o. + walking
Fwd between 10-22kg
Booster until min. 36kg
Sit in back part of car until 13 y.o.
What is amelogenesis imperfecta?
Hereditary
Enamel defect of primary + permanent teeth
Yellow colour
Low susceptibility for caries
May need coverage of crown of tooth to protect dentin, and decrease sensitivity
18 mo. with dx of amelogenesis imperfect. What do you tell mom
a. due to exces fluoride
b. due to sleeping w/ bottle
c. associated w/ increased susceptibility to dental caries
d. associated w/ osteogenesis imperfect
e. hereditary w/ primary and permanent teeth affected
Hereditary w/ primary and permanent teeth affected.
List 4 recommendations to prevent dental caries.
- have fluoridated water and it not available use supplementation
- brush w/ fluoridated toothpaste once first tooth erupted (pea-size)
- sweetened drink only at meal and not in excess of 6 oz/day
- no bottle to bed
- First dental visit by 1 y.o.
Dark + Cavetated lesions on fissure of mandibular molars.
- associated w/ caries
- associated w/ osteogenesis imperfect
- hereditary w/ primary and permanent teeth affected
= CARIES
T or F: Mothers who BF are at increased risk of malignancy.
False.
There is a reduced risk of malignancies in mother and child.
Mother most at risk of stopping BF:
- unmarried
- less educated
- lower SES
What are benefit of BF:
Mother:
- improve wt loss
- cheaper
- delayed onset of menses
- decreased breast + ovarian CA, heart dx, RF
Child:
- decreased infection: meningitis, bacteremia, gastroenteritis, acute AOM, UTI
- less Type 1 and 2 DM
- less allergic dx including atopic dermatitis and asthma
- less IBD
- improved cognitive development
- decrease incidence of SIDS
- decreased obesity later in life
- less childhood malignancy including lymphoma and leukaemia
What is the casein-to-whey ratio?
BF is WAY better
Whey 60%; Casein 40%
T or F: CPS recommend exclusive BF for first 6 month of life.
True
Which should the first complementary foods be?
Iron rich!
- meat
- meat alternative
- Fe fortified pablum
When should soy based formula be used
Galactosemia
or cultural/ religious reasons
T or F: lumpy solid foods can be delayed till 12 mon.
False.
- should not delay past 9 mon.
Which food must you avoid < 1 y.o.
Honey
Reason: infantile botulism
What is a high risk infant for allergy prevention in the CPS statement?
Infant w/ first degree relative w/ an allergic condition.
What are CPS recommendations for allergy prevention for high risk infants?
- Do NOT restrict maternal diet in preg or BF
- do not delay specific solid intro
- *- some earlier introduction of solid secondary may be protective (4-6 mo.)
- *- regular ingestion of newly introduced food important to maintain tolerance
T or F: avoiding egg, milk, peanut in BF will help prevent allergy.
False.
Pacifier Pro and Con:
(-):
- dental occlusion if prolonged
BUT dental assoc. promote this over finger sucker
(+):
- prem: comfort, state regulation
- may offer some protection against SIDS
When do you do BMI versus wt for length
Wt for length: < 2
BMI > 2 y.o.
What are protective factors for childhood obesity
- siblings
- regular family meals
- adequate sleep
- parental limit setting + supervision
T or F: kids under 2 can have 30 min. of screen time.
False.
SHOULD HAVE NONE
How much screen time should kids 2-5 y.o. have?
Max 1 hour/day
T or F: you should avoid screen 1 hr before bed.
True
What should parents do to mitigate risk of screen time w/ kids?
- be present during screen time
- be aware of content
- teach self-regulation calming
What % of Canadians over 15 smoke?
15
Is smoking incidence decreasing or stabilized?
Stabilized. No longer decreasing.
What are the biggest factors leading to starting smoking?
- access to tobacco
- environment (parents smoking)
What are CPS recommendations for smoking prevention?
- ask about tobacco use and exposure
- 5 A’s= ask, advise, assess, assist, arrange
- counsel and Rx effective med re: cessation
- advocate for smoking prevention and cessation as part of medical education
T or F: sleeping on back decrease risk of SIDS.
True
T or F: room-sharing increases the risk of SIDS
False.
room sharing= decrease
T or F: risk of SIDS increased in infants who bed-share with mother’s who smoke
True
What environmental things increase risk of death for BB:
Soft bedding
Pillows
Covers
Bedshare w/ mom who smokes cig
Where is the safest place for BB to sleep in their 1st year of life?
Own crib
IN parents room
For first 6 mo.
When do most infants sleep through the night?
> 6 months
~ 7-9 months
T or F: Canada does have a harmonized national schedule.
False.
No harmonized schedule.
List 5 steps to engaging parents in decision making for vaccination.
- Motivational interviewing to understand specific vaccine concerns for parents.
- Stay on message. Clear benefits + risk.
- Inform about rigour of vaccine safety
- Address pain of immunization
- Do not dismiss from your parent if they refuse
Define nosodes
biologic prep used in homeopathic med to prevent dx
Is there is EBM to support nosodes?
No
What are traits of effective discipline?
- developmentally appropriate
- consequence must follow behaviour
- correct behaviour not person
- consistency key
- catch and praise good behaviour
T or F: spanking has no negative outcomes for the child.
False.
How do you define colic?
Paroxysm irritable, fussy, crying without cause
min. 3h/day
min. 3d/week
min. x 1 week
no FTT
When do teeth first erupt?
5-8 months
- lower central incisor
Most common bug for dental caries
Strep mutans
What are sequelae to chronic oral pain:
- poor growth
- poor sleep
- poor school performance
- behaviour problems
How does fluoride work to prevent caries?
- inhibit plaque
- inhibit bacteria
- inhibit demineralization by making teeth more resistant to acid
- enhance remineralization
What is the recommended amount of fluoride?
- 3 ppm.
- supp if not in water in kids > 6 mo.
What type of test is used in newborn hearing?
- Otoacoustic emission (OAE)
- if fail = Automated Auditory Brainstem Response (AABR)
T or F: universal hearing screen can miss less severe congenital loss.
True.
May miss progression like CMV infection.
What are the Rome 3 Criteria for Functional Constipation:
Min. 4 y.o. +
- max 2 stool/wk
- min. fecal incontinence 1x/week
- hx of retentive posturing
- hx of painful BM
- large fecal mass in rectum
- obstruct toilet
x min. 2 mo.
Scabies. What secondary conditions must you counsel?
- Bacterial Infection
- Depression
- Astigmatization
- Insomnia
What are Scabies RF
poverty
overcrowding
bed sharing
indigenous community
Burrows with red papule commonly btwn fingers, wrist flexures, genitals, with generalized pruritis (particularly at night).
Scabies
- Sarcoptes Scabiei
How do you dx scabies?
- typical hx
- skin scraping
- ink test (put ink and wipe and see burrow)
- dermatoscopy
How do you treat scabies?
Launder all bed linen + clothing via hot cycle wash + dry.
Treat symp + household member.
- 5% permethrin cream leave 24h and repeat in 7 d
- sulphur in petroleum jelly if infant
- daily x 3d
- 1% lindane cream linked with neurotoxicity
When can kids return to school after scabies tx?
Day after treatment
What is the most common potential benefit of circumcision?
Less risk of acquiring HPV.
- UTI reduction for all males has higher NNT than HPV.
List all potential risk of circumcision.
- meatal stenosis
- bleeding
- minor infection
- severe infection
- death from unrecognized bleeding
List all the potential benefit of circumcision:
- HPV reduction
- HSV reduction
- UTI reduction
- phimosis prevention
- HIV reduction
- less risk of cervical CA in F partner
- less risk of penile CA
Is there is any recommendation for routine circumcision?
NO
In which infants is rotavirus contraindicated?
Hx of intussusception or immunodeficiency.
What is that rotavirus immunization timing?
- 1st dose give after 6 wk of age
- Last dose before 8 mon of age
Why was Rotashield taken off the market?
Increased risk of intussusception. Taken off in 1998.
Is there still a risk of intussusception with Rotavirus vaccine?
Small increased risk of intussusception w/in 1-7d
Highest risk in > 8 months of age.
T or F: there can be genetic predisposition for ankyloglossia (tongue tie)
True
Typically isolated anomaly but may be genetic predisposition.
T or F: mostly ankyloglossia is an anatomical finding with minimal consequence.
True
How do you manage ankyloglossia?
Conservative
- parent edu
- lactation support
- reassurance
Frenotomy OR: if significant difficulty, other oral anomaly etc.
T or F: benzocaine is effective pain med for frenotomy?
False.
Ineffective compared to placebo.
Analgesia: acetaminophen, sucrose, lidocaine
What is recommended prophylaxis for preventing neonatal ophthalmia in neonate born with (+) N. gonorrhoea at time of delivery?
Ceftriaxone IV/ IM
What is neonatal opthalmia
Conjunctivitis within wk
What are complications of Ophthalmia Neonatorum
corneal perforation
perforation of globe
visual impairment
T or F: Erythromycin ointment is routinely recommended after birth.
False.
- close to 25% N. gonorr. resistance
- doesn’t tx Chlamyd.
T or F: chlamydia trachomatis is the leading cause of neonatal ophthalmia
True
When do you screen pregnant women for G&C?
1st prenatal visit
if (+) tx women + partner AND re-check in T3.
If not screen initially screen via rapid test at delivery.
If newborn born to F with N. gonorrhoea. Tx?
Conjunctival Cx
+ Ceftriax. IV/IM
If unwell- Blood, CSF, ID consult
If newborn born to F with C. Trachomatis. Tx?
No routine Cx or routine prophylaxis.
Watch for Symp (conjunctivitis, pneumonitis)
Tx if symptom
T or F: macrolide associated with pyloric stenosis.
True
Head lice- what environmental decontamination is recommended.
- seal in bag x 1 wk
- clothing in hot dryer
- wash in hot water
- none
None as lice do not survive long away from scalp.
How is head lice transmitted?
Direct head to head contact
Role of fomite controversial
How do you treat head lice?
- topical insecticide (and repeat 1 wk later)
Options…
> pyrethrin shampoo
> 1% permethrin
> isopropyl shampoo
T ro F: head lice kids should be excluded from school.
False.
T or F: Universal UTI Abx prophylaxis does not prevent renal scarring or long term sequelae
True
+ recurrent UTI does not cause chronic renal failure in kids w/out renal anomaly
List 3 strategies to prevent or manage recurrent UTI:
- Tx constipation
- Counsel on symp
- Abx if grade 3-4 VUR or significant urological anomaly (Trimethoprim/Sulfa or Nitrofurantoin)
Define sports drinks and its risk
Flavoured
Sugar
+ Lytes
RISK:
- obesity
- dental caries
- unnecessary
Define caffeinated surgery drinks and its risk
Flavoured
Sugar
+ Caffeine
Risk:
- Risk taking (when mixed with alcohol)
- Dependence
- arrhythmia
- anxiety
T or F: health Canada prohibit marketing caffeinated energy drink to kids < 13
True
What is the most appropriate replacement fluid for ROUTINE physical activity
Water
Croup. Given Oral dex 0.6 mg/kg and epi x 1. Better. What do you do now?
Observe 2-4 hour
Ensure no recurrence
D/C home
List 5 things on ddx for croup
- Bacterial Tracheitis
- Epiglottitis
- Abscess (retropharyngeal abscess, peritonsillar)
- FB/ aspiration
- Anaphylaxis
is EPO supplementation recommended in very prem infant to help minimize blood transfusion?
NO
b/c increased risk of ROP
How can you minimize blood loss in very prem?
- Delayed cord clamping (1/2 to 1.5 minute)
- Transfusion threshold (100 w/ resp support and 85 if not)
- Consider 20cc/kg if transfuse to avoid need later
- Iron supplement (to prevent later Fe-deficiency anemia)
- Non invasive monitoring or POCT BW
Teen with concussion. When do you consider CT head:
- LOC
- h/a
- focal neuro deficit
- vomiting after
Focal neuro deficit
7 y.o. with splenectomy due to hereditary spherocytosis. On Pen. Parents ask when to stop
Never.
- adults can have severe sepsis years post splenectomy
What is first line AOM Abx and if pen allergy?
- Amox 75-90 divided BID
- Cefuroxime or Ceftiraxone
non IgE= clarithro or azithro x 5 d
If you fail initial AOM Tx. what do you give?
Amox-Clav (7:1 formulation preferred)
List 5 RF for AOM:
First Nation or Inuit Orofacial (cleft) Shorter duration BF Bottle feeding supine FHX (+) AOM Household crowding Exposure to cig smoke
How do you dx AOM
Acute
+ Symp (otalgia, irritable)
+ Middle Ear Effusion
(immobile, otorrhea)
+ Inflammation
(bulging, discoloured)
AOM Thoughts…
6 mon.
acute symp.
MEE (immobile, otorrhea)
Inflamm (bulging, discoloured).
Tx?
Mod-Severe Ill or Fever 39 or > 48h
= ABX (10d if 2yr and 5d if > 2 yr)
Mild Ill w/ fever < 39 or < 48h
= Watchful wait 24-48h
AOM. Thoughts….
6 mo.
acute symp.
NO effusion (immobile, otorrhea) or immobile (MEE) but only light red (inflam)
Consider viral and R/A 24-48h
6 mo.
acute symp
perforated TM + purulent d/c.
Tx?
ABX x 10d
What are risk factor for S. pneumoniae resistance AOM?
< 2
daycare
frequent AOM (in last 3 mo.)
Failed initial Abx
= High dose amox!
AOM but unimmunized Abx choice?
Amox-Clav
Ear Tube Otorrhea
Cipradex (steroid + abx)
What are elements of authoritative parenting:
- give unreasonable demand and spend daily 1:1 time
- daily 1:1 time and say “good job” for desired behaviour
- teach child skills and involve child in choosing consequence ahead of time
- give clear rules and option of whether to follow them
Teach child skills and child involved with choosing consequence ahead of time
