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RC: Specialties Woo Hoo > Gen Peds > Flashcards

Gen Peds Flashcards

1
Q

When do you switch from rear seat to fwd seat to booster ?

A

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.

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2
Q

What is amelogenesis imperfecta?

A

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

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3
Q

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

A

Hereditary w/ primary and permanent teeth affected.

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4
Q

List 4 recommendations to prevent dental caries.

A
  1. have fluoridated water and it not available use supplementation
  2. brush w/ fluoridated toothpaste once first tooth erupted (pea-size)
  3. sweetened drink only at meal and not in excess of 6 oz/day
  4. no bottle to bed
  5. First dental visit by 1 y.o.
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5
Q

Dark + Cavetated lesions on fissure of mandibular molars.

  • associated w/ caries
  • associated w/ osteogenesis imperfect
  • hereditary w/ primary and permanent teeth affected
A

= CARIES

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6
Q

T or F: Mothers who BF are at increased risk of malignancy.

A

False.

There is a reduced risk of malignancies in mother and child.

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7
Q

Mother most at risk of stopping BF:

A
  • unmarried
  • less educated
  • lower SES
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8
Q

What are benefit of BF:

A

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
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9
Q

What is the casein-to-whey ratio?

A

BF is WAY better

Whey 60%; Casein 40%

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10
Q

T or F: CPS recommend exclusive BF for first 6 month of life.

A

True

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11
Q

Which should the first complementary foods be?

A

Iron rich!

  • meat
  • meat alternative
  • Fe fortified pablum
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12
Q

When should soy based formula be used

A

Galactosemia

or cultural/ religious reasons

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13
Q

T or F: lumpy solid foods can be delayed till 12 mon.

A

False.

  • should not delay past 9 mon.
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14
Q

Which food must you avoid < 1 y.o.

A

Honey

Reason: infantile botulism

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15
Q

What is a high risk infant for allergy prevention in the CPS statement?

A

Infant w/ first degree relative w/ an allergic condition.

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16
Q

What are CPS recommendations for allergy prevention for high risk infants?

A
  • 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
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17
Q

T or F: avoiding egg, milk, peanut in BF will help prevent allergy.

A

False.

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18
Q

Pacifier Pro and Con:

A

(-):
- dental occlusion if prolonged
BUT dental assoc. promote this over finger sucker

(+):

  • prem: comfort, state regulation
  • may offer some protection against SIDS
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19
Q

When do you do BMI versus wt for length

A

Wt for length: < 2

BMI > 2 y.o.

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20
Q

What are protective factors for childhood obesity

A
  • siblings
  • regular family meals
  • adequate sleep
  • parental limit setting + supervision
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21
Q

T or F: kids under 2 can have 30 min. of screen time.

A

False.

SHOULD HAVE NONE

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22
Q

How much screen time should kids 2-5 y.o. have?

A

Max 1 hour/day

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23
Q

T or F: you should avoid screen 1 hr before bed.

A

True

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24
Q

What should parents do to mitigate risk of screen time w/ kids?

A
  • be present during screen time
  • be aware of content
  • teach self-regulation calming
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25
Q

What % of Canadians over 15 smoke?

A

15

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26
Q

Is smoking incidence decreasing or stabilized?

A

Stabilized. No longer decreasing.

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27
Q

What are the biggest factors leading to starting smoking?

A
  • access to tobacco

- environment (parents smoking)

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28
Q

What are CPS recommendations for smoking prevention?

A
  • 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
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29
Q

T or F: sleeping on back decrease risk of SIDS.

A

True

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30
Q

T or F: room-sharing increases the risk of SIDS

A

False.

room sharing= decrease

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31
Q

T or F: risk of SIDS increased in infants who bed-share with mother’s who smoke

A

True

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32
Q

What environmental things increase risk of death for BB:

A

Soft bedding

Pillows

Covers

Bedshare w/ mom who smokes cig

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33
Q

Where is the safest place for BB to sleep in their 1st year of life?

A

Own crib
IN parents room
For first 6 mo.

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34
Q

When do most infants sleep through the night?

A

> 6 months

~ 7-9 months

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35
Q

T or F: Canada does have a harmonized national schedule.

A

False.

No harmonized schedule.

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36
Q

List 5 steps to engaging parents in decision making for vaccination.

A
  1. Motivational interviewing to understand specific vaccine concerns for parents.
  2. Stay on message. Clear benefits + risk.
  3. Inform about rigour of vaccine safety
  4. Address pain of immunization
  5. Do not dismiss from your parent if they refuse
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37
Q

Define nosodes

A

biologic prep used in homeopathic med to prevent dx

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38
Q

Is there is EBM to support nosodes?

A

No

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39
Q

What are traits of effective discipline?

A
  • developmentally appropriate
  • consequence must follow behaviour
  • correct behaviour not person
  • consistency key
  • catch and praise good behaviour
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40
Q

T or F: spanking has no negative outcomes for the child.

A

False.

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41
Q

How do you define colic?

A

Paroxysm irritable, fussy, crying without cause

min. 3h/day
min. 3d/week
min. x 1 week
no FTT

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42
Q

When do teeth first erupt?

A

5-8 months

  • lower central incisor
43
Q

Most common bug for dental caries

A

Strep mutans

44
Q

What are sequelae to chronic oral pain:

A
  • poor growth
  • poor sleep
  • poor school performance
  • behaviour problems
45
Q

How does fluoride work to prevent caries?

A
  • inhibit plaque
  • inhibit bacteria
  • inhibit demineralization by making teeth more resistant to acid
  • enhance remineralization
46
Q

What is the recommended amount of fluoride?

A
  1. 3 ppm.

- supp if not in water in kids > 6 mo.

47
Q

What type of test is used in newborn hearing?

A
  • Otoacoustic emission (OAE)

- if fail = Automated Auditory Brainstem Response (AABR)

48
Q

T or F: universal hearing screen can miss less severe congenital loss.

A

True.

May miss progression like CMV infection.

49
Q

What are the Rome 3 Criteria for Functional Constipation:

A

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.

50
Q

Scabies. What secondary conditions must you counsel?

A
  • Bacterial Infection
  • Depression
  • Astigmatization
  • Insomnia
51
Q

What are Scabies RF

A

poverty
overcrowding
bed sharing
indigenous community

52
Q

Burrows with red papule commonly btwn fingers, wrist flexures, genitals, with generalized pruritis (particularly at night).

A

Scabies

  • Sarcoptes Scabiei
53
Q

How do you dx scabies?

A
  • typical hx
  • skin scraping
  • ink test (put ink and wipe and see burrow)
  • dermatoscopy
54
Q

How do you treat scabies?

A

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
55
Q

When can kids return to school after scabies tx?

A

Day after treatment

56
Q

What is the most common potential benefit of circumcision?

A

Less risk of acquiring HPV.

  • UTI reduction for all males has higher NNT than HPV.
57
Q

List all potential risk of circumcision.

A
  • meatal stenosis
  • bleeding
  • minor infection
  • severe infection
  • death from unrecognized bleeding
58
Q

List all the potential benefit of circumcision:

A
  • HPV reduction
  • HSV reduction
  • UTI reduction
  • phimosis prevention
  • HIV reduction
  • less risk of cervical CA in F partner
  • less risk of penile CA
59
Q

Is there is any recommendation for routine circumcision?

A

NO

60
Q

In which infants is rotavirus contraindicated?

A

Hx of intussusception or immunodeficiency.

61
Q

What is that rotavirus immunization timing?

A
  • 1st dose give after 6 wk of age

- Last dose before 8 mon of age

62
Q

Why was Rotashield taken off the market?

A

Increased risk of intussusception. Taken off in 1998.

63
Q

Is there still a risk of intussusception with Rotavirus vaccine?

A

Small increased risk of intussusception w/in 1-7d

Highest risk in > 8 months of age.

64
Q

T or F: there can be genetic predisposition for ankyloglossia (tongue tie)

A

True

Typically isolated anomaly but may be genetic predisposition.

65
Q

T or F: mostly ankyloglossia is an anatomical finding with minimal consequence.

A

True

66
Q

How do you manage ankyloglossia?

A

Conservative

  • parent edu
  • lactation support
  • reassurance

Frenotomy OR: if significant difficulty, other oral anomaly etc.

67
Q

T or F: benzocaine is effective pain med for frenotomy?

A

False.

Ineffective compared to placebo.

Analgesia: acetaminophen, sucrose, lidocaine

68
Q

What is recommended prophylaxis for preventing neonatal ophthalmia in neonate born with (+) N. gonorrhoea at time of delivery?

A

Ceftriaxone IV/ IM

69
Q

What is neonatal opthalmia

A

Conjunctivitis within wk

70
Q

What are complications of Ophthalmia Neonatorum

A

corneal perforation
perforation of globe
visual impairment

71
Q

T or F: Erythromycin ointment is routinely recommended after birth.

A

False.

  • close to 25% N. gonorr. resistance
  • doesn’t tx Chlamyd.
72
Q

T or F: chlamydia trachomatis is the leading cause of neonatal ophthalmia

A

True

73
Q

When do you screen pregnant women for G&C?

A

1st prenatal visit

if (+) tx women + partner AND re-check in T3.

If not screen initially screen via rapid test at delivery.

74
Q

If newborn born to F with N. gonorrhoea. Tx?

A

Conjunctival Cx

+ Ceftriax. IV/IM

If unwell- Blood, CSF, ID consult

75
Q

If newborn born to F with C. Trachomatis. Tx?

A

No routine Cx or routine prophylaxis.

Watch for Symp (conjunctivitis, pneumonitis)

Tx if symptom

76
Q

T or F: macrolide associated with pyloric stenosis.

A

True

77
Q

Head lice- what environmental decontamination is recommended.

  • seal in bag x 1 wk
  • clothing in hot dryer
  • wash in hot water
  • none
A

None as lice do not survive long away from scalp.

78
Q

How is head lice transmitted?

A

Direct head to head contact

Role of fomite controversial

79
Q

How do you treat head lice?

A
  • topical insecticide (and repeat 1 wk later)

Options…
> pyrethrin shampoo
> 1% permethrin
> isopropyl shampoo

80
Q

T ro F: head lice kids should be excluded from school.

A

False.

81
Q

T or F: Universal UTI Abx prophylaxis does not prevent renal scarring or long term sequelae

A

True

+ recurrent UTI does not cause chronic renal failure in kids w/out renal anomaly

82
Q

List 3 strategies to prevent or manage recurrent UTI:

A
  1. Tx constipation
  2. Counsel on symp
  3. Abx if grade 3-4 VUR or significant urological anomaly (Trimethoprim/Sulfa or Nitrofurantoin)
83
Q

Define sports drinks and its risk

A

Flavoured
Sugar
+ Lytes

RISK:

  • obesity
  • dental caries
  • unnecessary
84
Q

Define caffeinated surgery drinks and its risk

A

Flavoured
Sugar
+ Caffeine

Risk:

  • Risk taking (when mixed with alcohol)
  • Dependence
  • arrhythmia
  • anxiety
85
Q

T or F: health Canada prohibit marketing caffeinated energy drink to kids < 13

A

True

86
Q

What is the most appropriate replacement fluid for ROUTINE physical activity

A

Water

87
Q

Croup. Given Oral dex 0.6 mg/kg and epi x 1. Better. What do you do now?

A

Observe 2-4 hour
Ensure no recurrence
D/C home

88
Q

List 5 things on ddx for croup

A
  1. Bacterial Tracheitis
  2. Epiglottitis
  3. Abscess (retropharyngeal abscess, peritonsillar)
  4. FB/ aspiration
  5. Anaphylaxis
89
Q

is EPO supplementation recommended in very prem infant to help minimize blood transfusion?

A

NO

b/c increased risk of ROP

90
Q

How can you minimize blood loss in very prem?

A
  1. Delayed cord clamping (1/2 to 1.5 minute)
  2. Transfusion threshold (100 w/ resp support and 85 if not)
  3. Consider 20cc/kg if transfuse to avoid need later
  4. Iron supplement (to prevent later Fe-deficiency anemia)
  5. Non invasive monitoring or POCT BW
91
Q

Teen with concussion. When do you consider CT head:

  • LOC
  • h/a
  • focal neuro deficit
  • vomiting after
A

Focal neuro deficit

92
Q

7 y.o. with splenectomy due to hereditary spherocytosis. On Pen. Parents ask when to stop

A

Never.

  • adults can have severe sepsis years post splenectomy
93
Q

What is first line AOM Abx and if pen allergy?

A
  1. Amox 75-90 divided BID
  2. Cefuroxime or Ceftiraxone

non IgE= clarithro or azithro x 5 d

94
Q

If you fail initial AOM Tx. what do you give?

A

Amox-Clav (7:1 formulation preferred)

95
Q

List 5 RF for AOM:

A 
First Nation or Inuit
Orofacial (cleft)
Shorter duration BF
Bottle feeding supine
FHX (+) AOM
Household crowding
Exposure to cig smoke
96
Q

How do you dx AOM

A

Acute
+ Symp (otalgia, irritable)

+ Middle Ear Effusion
(immobile, otorrhea)

+ Inflammation
(bulging, discoloured)

97
Q

AOM Thoughts…

6 mon.
acute symp.
MEE (immobile, otorrhea)
Inflamm (bulging, discoloured).

Tx?

A

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

98
Q

AOM. Thoughts….

6 mo.
acute symp.

NO effusion (immobile, otorrhea) or immobile (MEE) but only light red (inflam)

A

Consider viral and R/A 24-48h

99
Q

6 mo.
acute symp
perforated TM + purulent d/c.
Tx?

A

ABX x 10d

100
Q

What are risk factor for S. pneumoniae resistance AOM?

A

< 2
daycare
frequent AOM (in last 3 mo.)
Failed initial Abx

= High dose amox!

101
Q

AOM but unimmunized Abx choice?

A

Amox-Clav

102
Q

Ear Tube Otorrhea

A

Cipradex (steroid + abx)

103
Q

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
A

Teach child skills and child involved with choosing consequence ahead of time

RC: Specialties Woo Hoo (31 decks)

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