General Flashcards
What are hypoglycemia prevention measures that can be taken at school?
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
what is the leading cause of sport and recreational injury?
bicycling
20-40% of bike injuries are head injuries
what are potential barriers to safe mgnt of hypoglycemia in schools
no training of staffs
unscheduled activities
altered snack times
lack of rapid access to emergency kit
who should get IE prophylaxis?
- 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
when should Abx be given for IE prophylaxis?
30 min pre
and up to 2 hours post
what procedure should IE prophylaxis be given for?
manipulation of gingival tissue/periapical region of teeth
perforation or oral mucosa
what are the Abx options for IE prophylaxis?
amox
if allergic - cephalexin or clinda
can do IM if can’t do pills
what are the components of the vaccine safety program
- 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
What are the 3 categories of inhalants
- Aliphatic, aromatic, halogenated hydrocarbons
- Nitrous oxide
- Volatile alkyl nitrites
What are the effects of inhalants?
Stimulation Disinhibition Euphoria Hallucinations Depression- slurred speach, dizzy, drowsiness
What is the leading cause of death from inhalant?
Sudden sniffing death syndrome- arrhythmia and
Inhalants sensitize the heart to adrenaline. Sudden surge in adrenaline can cause fatal arrhythmia
What are some side effects of inhalants?
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
What are some side effects of inhalants?
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
What is CRAFFT screen
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
how to biologics work - 2 ways
- target the cytokine receptor or
- they are antibodies against proinflammatory cytokines
Biologics can increase the risk of ….
reactivation of TB, viral infection(EBV, HZV, Hep B) and fungal (histo, toxo)
increase incidents and severity of the same
if about to start patient n biologics, what should you do from an infection perspective?
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
what counselling do you give for someone on biologics?
- 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
what vaccine can temporarily suppress TST reactivity?
MMR
do TST 4-6 weeks post MMR vaccine
risk factors for positional plagiocephaly
male firstborn congenital torticollis supine sleeping bottle feeding low activity tummy time < 3 times per day
when does plagiocephaly resolve?
by 2 yrs
what are possible complications of helmet therapy for PP
contact dermatitis
pressure sores
local skin irritation
can only do if 8 mo or less
What is OCAP in relation to research involving first nations
Ownership
control
Access
Posession
what are the complications of chronic insomnia?
depression
learning disability
poor school performance
potential effect on the family
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
what is an appetite stimulant?
cyproheptadine-antihistamine
cannaboid derivatives
megestrol acetate
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
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
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
what is appropriate sun exposure to prevent Vit D def
3 X per week - 20 to 30 min of face and hands
vegetarian or vegan diets - what are the needs to ensure growth?
- need more proteins
- need more Iron
- babies > 7 mo to vegan mom will need fortification
- vegans need precursor od essential FA linolenic acid - flaxseed, canola, nut oils, soya
- VIt D supp
- should only have 0.5g/kg/day of fibre
- vegans need vit B 12 fortification
what intake/supplementation should a vegan pregnant mom take?
Vit B12 Vit D Iron Folic acids linolenic acid calcium
what are the most important risk factors for unhealthy weight control?
dissatisfaction with weight
obesity
low self esteem
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
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
what are environmental factors the correlate with dieting and unhealthy wgt mgnt behaviours
teasing
poor school involvement
peer group endorsement
wgt related sports
what is the most common acquired disorder of coagulation? vs most common inherited disorder?
- ITP
2. Von Willebrand- 1% of pop
if you suspect a drug-herb interaction,what should you do?
report to Pediatric Surveillance Program
How do you counsel a family who uses CAM
- Ask about use
- be nonjudjemental, watch your attitude
- Find out more about the CAM used
- evaluate the CAM
- Identify potential risks and harm
- provide the family with an array of therapeutic options
- educate the family on how to evaluate info
- avoid dismissal
- Offer to assist in closemonitoring
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
- 2 or less stools per week
- one episode of fecal incontinence per week
- Hx of retentive posture
- History of painful or hard stools
- large fecal mass in rectum
- Hx of large diameter stools that may obstruct toilet
What are possible complication of enemas
High PO4 Low Ca Abdo distention Vomiting Trauma
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
What is the dose f PEG
Clean out: 11.5g/kg/day for 3 days
Maintenance: 0.4 to 1 g/kg/day
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
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
how do platelet issues tend to present?
mucocutaneous bleed
how do factor deficiencies tend to present?
deep tissue bleed - joints, soft tissue, GI or GU bleeds
what are CF of hyponatremia?
HA nausea/vomiting irritability decreased level of consciousness seizures apnea
how much Na is in NS
154 mmol/L
and 154 of Cl
how much glucose is in D5
50g/L
what patients are particularly at risk of hyponatremia in hospital
from inappropriate secretion of ADH
- peri or post op
- resp infections
- neuro infections
if pt has Na that is 135 to 145, what should be their IV fluid?
D5W 0.45%NS
in what situation would a parent not be an appropriate decision maker? 4
- if lack decision making capacities
- if irresolvable differences between parents regarding care
- if parents relinquished responsability
- if legal guardian appointed
what is needed for someone to have decision making abilities?
- must understand the issues
- must understand the purpose of the intervention
- must understand the consequences of consent and refusal
- must understand the magnitude and probabilities of harm and benefits
What are the 5 criteria for effective discipline?
- given by adult with affective bond
- consistent and close to the behaviour
- perceived as fair by the child
- dev and temperamentally appropriate
- self-enhancing to lead to self-discipline
How do you counsel a parent about discipline?
- reinforce their competence
- help them find strategies
- suggest age appropriate techniques
- provide resources
what is the purpose of effective discipline?
help them organize themselves
internalize rules
acquire appropriate behaviour patterns
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
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
when should time outs start?
> 2
how do you manage a 3-5 year old who missbehaves
- Time out or
2. redirect or small consequences
how do you discipline a 6-12 yr old
withdrawal or delay of privileges
consequences
time outs
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
What are the 4 errors of car seat installment
- wrong size
- not attached to car
- moving more than one inch
- harness not snug enough and not in right location
- air bag
- wrong angle - need 45 de
- using recalled or
what makes car seat unsafe
- > 10 yrs
- beyond manufacterer date
- Car accident
Transition to a forward facing are appropriate
walking
> 10 kg
12 mo
child is 15kg and 15 month, what type of car seat should he get
forward facing
when can you use a booster
18 kg
when can you stop using a booster seat?
Must be:
> 8 yrs,
> 36 kg and
4’9 (145 cm)
lap belt syndrome
lumbar fracture
bowel bladder and
internal organ
when can they seat upfront
above 13
what is the most common inherited bleeding disorders - 3
hemophilia A - factor VIII
VWF
hemophilia B
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
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
what is the WU for bruising
CBC+diff blood smear INR/PTT/fibrinogen vWF blood group factor VIII and IX levels renal and LFTS
who is more likely to sue natural health products?
CF Eating disorder Homeless youth cancer arthritis/RF if had set back or relapse
what 3 factors increase the likelyhood of drug-herb interaction?
- Pt with most serious disease are the ones more likely to use alternative med
- use to complement treatment, not replace it
- tend to use more than one
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
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
who is not allowed to use cough and cold meds?
< 6 yrs
Caution for > 6yr
how is honey good during a cold
decreased cough frequency and severity
improved sleep quality
less bothersome
demulcent properties
antioxidant properties
inc cytokine release
how to protect yourself online
- Protect patient confidentiality
- preserve your privacy - high privacy setting, avoid friendship with pt
- maintain boundaries - keep business/personal websites separate
- behave professionally - provide clear, uptodate info from reputable sites, no advertising
Lyme disease testing
serology - ELISA
followed by
western blot
