General Flashcards
0
Q
What are hypoglycemia prevention measures that can be taken at school?
A
regular scheduled snacks adjust intake based on activity clean area for glucose checks spervising children to help they recognize lows access to emergency kits accommodations for tests
1
Q
what is the leading cause of sport and recreational injury?
A
bicycling
20-40% of bike injuries are head injuries
2
Q
what are potential barriers to safe mgnt of hypoglycemia in schools
A
no training of staffs
unscheduled activities
altered snack times
lack of rapid access to emergency kit
3
Q
who should get IE prophylaxis?
A
- prosthetic cardiac valves
- previous IE
- congenital hear disease
- unrepaired cyanotic heart disease - even if have shunt
- repaired CHD + prosthetic for 6 month
- partially repaired with residual defect and prosthetic - heart transplant who develop valvuloplasty
- rheumatic heart disease with prosthetic valve
4
Q
when should Abx be given for IE prophylaxis?
A
30 min pre
and up to 2 hours post
5
Q
what procedure should IE prophylaxis be given for?
A
manipulation of gingival tissue/periapical region of teeth
perforation or oral mucosa
6
Q
what are the Abx options for IE prophylaxis?
A
amox
if allergic - cephalexin or clinda
can do IM if can’t do pills
7
Q
what are the components of the vaccine safety program
A
- pre-licence reviews - stric and approval - gov regulators
- current magnufactoring practice- strict, global, regular checks
- test lot before release
- independent expert review of safety and efficacy data
- post-marketing surveillance of adverse effects
- rapid response - recall or non distr if safety concerns
- expert causality assessment if serious adverse event occurs
- International collaboration
8
Q
What are the 3 categories of inhalants
A
- Aliphatic, aromatic, halogenated hydrocarbons
- Nitrous oxide
- Volatile alkyl nitrites
9
Q
What are the effects of inhalants?
A
Stimulation Disinhibition Euphoria Hallucinations Depression- slurred speach, dizzy, drowsiness
10
Q
What is the leading cause of death from inhalant?
A
Sudden sniffing death syndrome- arrhythmia and
Inhalants sensitize the heart to adrenaline. Sudden surge in adrenaline can cause fatal arrhythmia
11
Q
What are some side effects of inhalants?
A
CnS: damage myelin, ataxia, tremor, nystagmus, slurred speach, decreased bison, deafness
CVS: cardiomyopathy, dyspnea, emphysema Renal: TA, Gi: hepatitis Women: PET, abortion Fetal solvent syndrome and withdrawal
12
Q
What are some side effects of inhalants?
A
CnS: damage myelin, ataxia, tremor, nystagmus, slurred speach, decreased bison, deafness
CVS: cardiomyopathy, dyspnea, emphysema Renal: TA, Gi: hepatitis Women: PET, abortion Fetal solvent syndrome and withdrawal
13
Q
What is CRAFFT screen
A
Car driven by someone under the influence Do you do drugs to Relax Do drugs Alone Do you Forget things when on drugs Do Friends/family worry Trouble because of drugs
14
Q
how to biologics work - 2 ways
A
- target the cytokine receptor or
- they are antibodies against proinflammatory cytokines
15
Q
Biologics can increase the risk of ….
A
reactivation of TB, viral infection(EBV, HZV, Hep B) and fungal (histo, toxo)
increase incidents and severity of the same
16
Q
if about to start patient n biologics, what should you do from an infection perspective?
A
Mantoux- + if >5mm
CXR
can do interferon gamma release assay as may be more sensitive in an immunocompromised py
if high suspicion - treat INH for 9 mo
start biologics one month post completion
17
Q
what counselling do you give for someone on biologics?
A
- avoid raw meat, soft cheeses, raw eggs
- stay away from kittents and litter
- away from reptiles
- stay away from construction site of caves
- avoid farms
18
Q
what vaccine can temporarily suppress TST reactivity?
A
MMR
do TST 4-6 weeks post MMR vaccine
19
Q
risk factors for positional plagiocephaly
A
male firstborn congenital torticollis supine sleeping bottle feeding low activity tummy time < 3 times per day
20
Q
when does plagiocephaly resolve?
A
by 2 yrs
21
Q
what are possible complications of helmet therapy for PP
A
contact dermatitis
pressure sores
local skin irritation
can only do if 8 mo or less
22
Q
What is OCAP in relation to research involving first nations
A
Ownership
control
Access
Posession
23
Q
what are the complications of chronic insomnia?
A
depression
learning disability
poor school performance
potential effect on the family
24
what are the 2 most common types of sleep disorders?
delayed phase type - sleep latency >30 min
| behavioural insomnia of childhood - behaviours to delay sleep
25
what is an appetite stimulant?
cyproheptadine-antihistamine
cannaboid derivatives
megestrol acetate
26
what are the suggested childcare ratios for ages
< 24 mo - 3:1
24-30 mo - 4:1
31-36 mo - 5:1
> 36 mo - 7:1
27
what are barriers for children in foster care to getting help?
lack of medical records
lack of consistency or FU BC moving
difficulty accessing services
28
what are Vitamin D recommendations by age
< 1 year - 400U
< 2 yrs and above 55 parallel - 800U from Oct to april
> 1 year 200 U
29
what is appropriate sun exposure to prevent Vit D def
3 X per week - 20 to 30 min of face and hands
30
vegetarian or vegan diets - what are the needs to ensure growth?
1. need more proteins
2. need more Iron
3. babies > 7 mo to vegan mom will need fortification
4. vegans need precursor od essential FA linolenic acid - flaxseed, canola, nut oils, soya
5. VIt D supp
6. should only have 0.5g/kg/day of fibre
7. vegans need vit B 12 fortification
31
what intake/supplementation should a vegan pregnant mom take?
```
Vit B12
Vit D
Iron
Folic acids
linolenic acid
calcium
```
32
what are the most important risk factors for unhealthy weight control?
dissatisfaction with weight
obesity
low self esteem
33
what are personal risk factors the correlate with dieting and unhealthy wgt mgnt behaviours
```
female
poor self esteem
overwgt
poor body image
low sense of control
depression/anxiety
vegetarian
early puberty
chronic illness - DM
already ahve risky behaviours
```
34
what are FAMILY factors the correlate with dieting and unhealthy wgt mgnt behaviour
```
lack of role model
parental dieting
parents wanting and supporting dieting for their kids
criticism of child's wgt
low connectedness
```
35
what are environmental factors the correlate with dieting and unhealthy wgt mgnt behaviours
teasing
poor school involvement
peer group endorsement
wgt related sports
36
what is the most common acquired disorder of coagulation? vs most common inherited disorder?
1. ITP
| 2. Von Willebrand- 1% of pop
37
if you suspect a drug-herb interaction,what should you do?
report to Pediatric Surveillance Program
38
How do you counsel a family who uses CAM
1. Ask about use
2. be nonjudjemental, watch your attitude
3. Find out more about the CAM used
4. evaluate the CAM
5. Identify potential risks and harm
6. provide the family with an array of therapeutic options
7. educate the family on how to evaluate info
8. avoid dismissal
9. Offer to assist in closemonitoring
39
what are the Rome criteria for functional constipation?
must fulfill criteria once per week for 2month
must be > 4 yrs
not meet criteria for IBS
need 2 or more
1. 2 or less stools per week
2. one episode of fecal incontinence per week
3. Hx of retentive posture
4. History of painful or hard stools
5. large fecal mass in rectum
6. Hx of large diameter stools that may obstruct toilet
40
What are possible complication of enemas
```
High PO4
Low Ca
Abdo distention
Vomiting
Trauma
```
41
Who should get enemas?
PEG 3 day clean out is better
Need to be > 2yr
if > 2, phosphate enema, 6ml/kg with Max off 135 ml
42
What is the dose f PEG
Clean out: 11.5g/kg/day for 3 days
Maintenance: 0.4 to 1 g/kg/day
43
discribe a bruise that is most likely accidental
```
small
oval with non distinct borders
near or above bony prominence
in front of body
usually - forehead, knees, shins
not in a pattern
```
44
what skin finding can be mistaken for a bruise?
```
stria
mongolian spot
hemangioma
nevi of Ito
erythema multiforme
eczema
incontinentia pigmenti
cultural-coining, cupping
dye
```
45
how do platelet issues tend to present?
mucocutaneous bleed
46
how do factor deficiencies tend to present?
deep tissue bleed - joints, soft tissue, GI or GU bleeds
47
what are CF of hyponatremia?
```
HA
nausea/vomiting
irritability
decreased level of consciousness
seizures
apnea
```
48
how much Na is in NS
154 mmol/L
| and 154 of Cl
49
how much glucose is in D5
50g/L
50
what patients are particularly at risk of hyponatremia in hospital
from inappropriate secretion of ADH
- peri or post op
- resp infections
- neuro infections
51
if pt has Na that is 135 to 145, what should be their IV fluid?
D5W 0.45%NS
52
in what situation would a parent not be an appropriate decision maker? 4
1. if lack decision making capacities
2. if irresolvable differences between parents regarding care
3. if parents relinquished responsability
4. if legal guardian appointed
53
what is needed for someone to have decision making abilities?
1. must understand the issues
2. must understand the purpose of the intervention
3. must understand the consequences of consent and refusal
4. must understand the magnitude and probabilities of harm and benefits
54
What are the 5 criteria for effective discipline?
1. given by adult with affective bond
2. consistent and close to the behaviour
3. perceived as fair by the child
4. dev and temperamentally appropriate
5. self-enhancing to lead to self-discipline
55
How do you counsel a parent about discipline?
1. reinforce their competence
2. help them find strategies
3. suggest age appropriate techniques
4. provide resources
56
what is the purpose of effective discipline?
help them organize themselves
internalize rules
acquire appropriate behaviour patterns
57
in what age group should a a child be allowed to develop some tolerance to frustration and learn to self soothe
B to 12 mo
58
how do you manage a temper tantrum of a 2.5 yrs old
```
avoid situation that might be the cause of tantrum
take the child away from area
allow them to regain control
give simple explanation and reassurance
redirect
```
59
when should time outs start?
>2
60
how do you manage a 3-5 year old who missbehaves
1. Time out or
| 2. redirect or small consequences
61
how do you discipline a 6-12 yr old
withdrawal or delay of privileges
consequences
time outs
62
colic definition
paroxysms of irritability, fussiness or crying that start and stop without obvious cause;
episodes lasting 3 h or more per day and occurring at least three days per week for at least one week; and
no failure to thrive.
starting at 3 weeks
63
What are the 4 errors of car seat installment
1. wrong size
2. not attached to car
3. moving more than one inch
4. harness not snug enough and not in right location
5. air bag
6. wrong angle - need 45 de
7. using recalled or
64
what makes car seat unsafe
1. > 10 yrs
2. beyond manufacterer date
3. Car accident
65
Transition to a forward facing are appropriate
walking
> 10 kg
12 mo
66
child is 15kg and 15 month, what type of car seat should he get
forward facing
67
when can you use a booster
18 kg
68
when can you stop using a booster seat?
Must be:
> 8 yrs,
> 36 kg and
4'9 (145 cm)
69
lap belt syndrome
lumbar fracture
bowel bladder and
internal organ
70
when can they seat upfront
above 13
71
what is the most common inherited bleeding disorders - 3
hemophilia A - factor VIII
VWF
hemophilia B
72
what are important Hx points to find out for an infant pt getting assessed for bruising?
```
post circumcision bleeds
cephalohematoma
bleeding at umbilicus
delayed stump separation
post venipuncture bleed
hematuria
petechia at clothing lines
or at sites of pressure - car seat
```
73
who should get WU for bruising
if testing will impact health
if will impact child's wellfare
if clinical suspicion
if unexplained bruising in a precruising baby
74
what is the WU for bruising
```
CBC+diff
blood smear
INR/PTT/fibrinogen
vWF
blood group
factor VIII and IX levels
renal and LFTS
```
75
who is more likely to sue natural health products?
```
CF
Eating disorder
Homeless youth
cancer
arthritis/RF
if had set back or relapse
```
76
what 3 factors increase the likelyhood of drug-herb interaction?
1. Pt with most serious disease are the ones more likely to use alternative med
2. use to complement treatment, not replace it
3. tend to use more than one
77
how do you counsel a family who is using complementary alt med.
- ask about use
- non-judgemental attitude
- seek info and share with family
- evaluate risk
- offer a range of therapeutic options
- avoid dismissing
- do not become defensive
- offer to assist and monitor
78
what factors are assocaited with fatalities from over the counter cough med
- < 2 yrs
- use med for sedation
- used in daycare setting
- combine 2 or more meds
- fail to use measure device properly
- product misidentification
- use adult products
79
who is not allowed to use cough and cold meds?
< 6 yrs
Caution for > 6yr
80
how is honey good during a cold
decreased cough frequency and severity
improved sleep quality
less bothersome
demulcent properties
antioxidant properties
inc cytokine release
81
how to protect yourself online
1. Protect patient confidentiality
2. preserve your privacy - high privacy setting, avoid friendship with pt
3. maintain boundaries - keep business/personal websites separate
4. behave professionally - provide clear, uptodate info from reputable sites, no advertising
82
Lyme disease testing
serology - ELISA
followed by
western blot
