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CPS Statements > Most recent CPS Statements > Flashcards

Most recent CPS Statements Flashcards

1
Q

What are the most common causes of pneumonia in children?

A
  1. Viral: Influenza, parainfluenza, RSV, HMPV 2. Bacterial: Strep pneumo, GAS, Chlamydia pneum, mycoplasma
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2
Q

What is the typical presentation of mycoplasma pneumonia?

A

Malaise and headache for seven to 10 days before the onset of fever and cough

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3
Q

What is the approach to antibiotic coverage in pneumonia?

A

Outpt: amoxicillin Inpt: ampicillin Respiratory failure or septic shock: Ceftriaxone or cefotaxime +/- vancomycin

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4
Q

What is the approach to treatment of mycoplasma pneumonia?

A

-Could potentially self-resolve -Treatment may hasten recovery -Macrolide (azithromycin) x 5 days -If resistance and >8: doxycycline

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5
Q

What is the standard length of therapy for uncomplicated pneumonia?

A

Seven to ten days

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6
Q

What is the approach to non-anaphylaxtic reactions to penicillin?

A

If a patient experienced a nonurticarial rash after previous use of a penicillin or amoxicillin, they can safely be started on ampicillin or amoxicillin therapy. X-reaction with cephalosporins is extremely low

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7
Q

Which terms should no longer be used regarding wheezing in preschoolers?

A

‘bronchospasm’ ‘reactive airway disease’ ‘wheezy bronchitis’ ‘happy wheezer’

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8
Q

Does recurrent preschool wheeze matter?

A

-can be associated with substantial morbidity and may impact long-term health

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9
Q

What are the new criteria for diagnosis of asthma between 1-5 years of age?

A
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10
Q

How does bronchiolitis present?

A

-The first episode of wheezing in a child <1 year of age.

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11
Q

In a child one to five years of age with recurrent (≥2) episodes of asthma-like symptoms and wheezing on presentation, what confirms the diagnosis of asthma?

A

Direct observation of improvement with inhaled bronchodilator (with or without oral corticosteroids) by a physician or trained health care practitioner confirms the diagnosis (preferred diagnostic method)

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12
Q

Children one to five years of age with recurrent (≥2) episodes of asthma-like symptoms, no wheezing on presentation, what confirms the diagnosis of asthma?

A
  • frequent symptoms or any moderate or severe exacerbation warrant a three-month therapeutic trial with a medium daily dose of ICS (with as-needed SABA)
  • Clear consistent improvement in the frequency and severity of symptoms and/or exacerbations confirms the diagnosis (alternative diagnostic method).
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13
Q

Children one to five years of age with recurrent (≥2) episodes of asthma-like symptoms, no wheezing on presentation, infrequent symptoms, and mild exacerbations, what confirms the diagnosis of asthma?

A

-Can be monitored and re-assessed by a health care practitioner when symptomatic. Alternatively, a therapeutic trial with as-needed SABA is suggested. Convincing parental report of a rapid and repeatedly observed response to SABA suggests the diagnosis (weaker alternative diagnostic method)

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14
Q

When is a referral to an asthma specialist suggested in children 1-5 years?

A
  • Diagnostic uncertainty
  • Suspicion of comorbidity
  • Poor symptom and exacerbation control despite ICS at daily doses of 200 µg to 250 µg
  • ife-threatening event (requiring intensive care admission and/or intubation)
  • for allergy testing to assess the possible role of environmental allergens
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15
Q

For children 1-3 years of age, what is the recommended delivery of puffers?

A

-a spacer with a correctly sized facemask is preferred.

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16
Q

For children 4-5 years, what delivery method is recommended for puffers?

A

-consideration to use a spacer with a mouthpiece is encouraged if the child can form a good seal around the mouthpiece and breathe in through the mouth as observed by a trained health care professional.

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17
Q

What is first line asthma therapy when the diagnosis is made?

A

-Daily ICS at the lowest effective dose

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18
Q

Who should receive influenza vaccination?

A

ALL children and youth ≥6 months of age

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19
Q

What groups should be given priority for influenza vaccination?

A

Cardiac or pulmonary disorders including bronchopulmonary dysplasia, cystic fibrosis, asthma or conditions associated with an increased risk for aspiration

Diabetes mellitus and other metabolic diseases

Renal disease

Anemia or hemoglobinopathy

Cancer or other immune-compromising conditions (due to disease or therapy)

Morbid obesity (body mass index ≥40 kg/m2)

Children and adolescents (six months to 18 years of age) with neurological or neurodevelopmental conditions (including seizure disorders, febrile seizures and isolated developmental delay)

Children and adolescents (six months to 18 years of age) with a chronic condition currently undergoing prolonged treatment with acetylsalicylic acid

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20
Q

What are the two types of influenza vaccines that are available in Canada?

A

inactivated influenza vaccines (IIV) for intramuscular injection and an intranasal, live attenuated influenza vaccine (LAIV).

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21
Q

Who can be given the LAIV for influenza vaccination?

A

It is authorized for use in individuals two to 59 years of age.[2] LAIV is not licensed for use in children <2 years of age because of a small, but significant, increased rate of wheezing two to four weeks following vaccination observed in this age group

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22
Q

In what group is the LAIV recommended?

A

children two to six years of age because of its greater efficacy

an expected higher acceptance of intranasal administration compared with injection

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23
Q

What are the contraindications for influenza vaccine?

A

An anaphylactic reaction to a previous dose of influenza vaccine or onset of Guillain-Barré syndrome within six weeks of influenza vaccination are contraindications

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24
Q

Is an EGG allergy a contraindication to the influenza vaccine?

A

No

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25
Q

What are the contraindications specifically for the LAIV?

A
  • Not recommended for egg allergy as no research
  • Immune-compromising conditions, severe asthma (defined as active wheezing, currently on oral or high-dose inhaled glucocortico-steriods or medically attended wheezing within the previous seven days) and during pregnancy
  • Children and adolescents, two to 17 years of age, receiving chronic acetylsalicylic acid-containing therapy because of the association of Reye’s syndrome with acetylsalicylic acid and influenza infection.
26
Q

What are the specifics of administration of the LAIV?

A
  • should not be administered until 48 h after antiviral agents active against influenza
  • If nasal congestion, should be deferred until the congestion has resolved or IIV should be given
  • it is recommended that contact with severely immunocompromised patients (such as recent transplant recipients) be avoided for two weeks following LAIV
27
Q

When are two doses of the influenza vaccine required?

A

The first year that a child <9 years of age receives influenza vaccine (either IIV or LAIV), two doses at least four weeks apart are required.

If a child <9 years of age has received at least one dose of any influenza vaccine in the past, only one dose is required this season.

28
Q

What percentage of Canadians live in substandard housing?

A

1/3

29
Q

List examples of things that contribute to a housing need? (5)

A

Infestations (eg, cockroaches, bed bugs, mice and other pests);

Poor water and air quality;

Unsafe neighbourhoods;

Unstable housing, leading to frequent moves (>3 in a child’s lifetime) or the use of temporary housing; and

Inaccessibility for family members with a disability.

30
Q

What are the risks of crowded unaffordable housing?

A

aggressive behaviours

property offences

diminished school performance

asthma symptoms

diminished overall health status

poor air quality and lead exposure

asthma

hunger

communicable diseases

31
Q

What are four questions a pediatrician can ask to assess a housing need?

A
32
Q

What is the cause of scabies? How is it transmitted?

A

A mite, Sarcoptes scabiei, that is transmitted by direct skin-to-skin contact

33
Q

What is the typical incubation period of scabies?

A

Up to 3 weeks to develop hypersensitivity reaction

34
Q

What is the typical presentation of scabies?

A

burrows, erythematous papules and generalized pruritus that is typically worse at night.

Burrows are usually located between the fingers, in the flexure of the wrist, elbows or armpits, or on the genitals or breasts; however, they can sometimes be difficult to find

35
Q

What are some of the complications of scabies?

A
  1. Secondary bacterial infection: impetigo, pyoderma with Staphylococcus aureus and group A streptococcus
  2. Complications from bacterial infections: poststrep GN, cardiac
  3. stigmatization, depression, insomnia, and significant direct and indirect financial costs
36
Q

How is a diagnosis of scabies made?

A
  1. based on a history of pruritic rash that is typically worse at night and present in characteristic locations, especially with similar symptoms occurring in other household members
  2. skin scraping
  3. Burrow ink test
  4. dermatoscopy
37
Q

What is the general treatment approach to scabies?

A

All household contacts, even those without symptoms, must be treated simultaneously to avoid reinfestation and transmission.

First-line treatment continues to be 5% permethrin cream or lotion, which is applied to the skin from neck to toes, usually for several hours – often overnight – then washed off

need to be reapplied after an interval of one to two weeks because they do not kill the mites’ eggs

38
Q

After treatment for scabies, what is or isn’t considered a sign of reinfection?

A

Hypersensitivity, itching may persist or even increase over several weeks despite killing the mites and is not by itself evidence of persistent infection.

However, the appearance of new lesions should be considered as a sign of persistent infection and a signal to retreat.

39
Q

What are the recommendations for clothing during the treatment of scabies?

A

All bed linen (sheets, pillowcases, blankets) and clothing worn next to the skin (underwear, T-shirts, socks, pants) should be laundered using a hot cycle wash and a hot drying cycle.

If hot water is not available, put all linen and clothing into sealed plastic bags and store them away from household members and close contacts for five to seven days. The mite cannot survive beyond four days without contact with human skin.

40
Q

When can children return to daycare after scabies treatment?

A

The day after completing their initial treatment series.

41
Q

When can a male retract the foreskin?

A

By six years of age, 50%

95% of boys have retractile foreskin by 17 years of age

42
Q

What are the potential benefits of circumcision?

A
  1. Treatment of phimosis
  2. UTI reduction (It has been estimated that 111 to 125 normal infant boys (for whom the risk of UTI is 1% to 2%) would need to be circumcised at birth to prevent one UTI.)
  3. Decreased STI
  4. Decreased cervical cancer in partners
43
Q

What are the potential risks of circumcision?

A
  1. Pain
  2. Bleeding
  3. Infection
  4. Most common late complication of circumcision is meatal stenosis (2% to 10%)
44
Q

Does the CPS recommend routine circumcision?

A

NO

45
Q

What are the indications for palivizumab for prems?

A

-In preterm infants without CLD born before 30 + 0 weeks’ GA who are <6 months of age at the start of RSV season “reasonable”

46
Q

What are the recommendatinons for syngeris in CLD/CHD?

A

Children with hemodynamically significant CHD or CLD (defined as a need for oxygen at 36 weeks’ GA) who require ongoing diuretics, bronchodilators, steroids or supplemental oxygen, should receive palivizumab if they are <12 months of age at the start of RSV seaso

47
Q

What are the recommendations for syngeris in remote patients?

A

Infants in remote communities who would require air transportation for hospitalization born before 36 + 0 weeks’ GA and <6 months of age at the start of RSV season should be offered palivizumab.

Consider term Inuit infants until they reach six months of age only if they live in communities with documented persistent high rates of RSV hospitalization.

48
Q

What are the other groups of children for whom you can consider syngeris?

A

Prophylaxis may be considered for children <24 months of age who are on home oxygen, have had a prolonged hospitalization for severe pulmonary disease or are severely immunocompromised.

49
Q

What do you do about breakthrough RSV on synergis?

A

Continuation of monthly palivizumab is not recommended for children hospitalized with breakthrough RSV infection.

50
Q

How many does of synergis is recommended?

A

Programs should administer a maximum of three to five doses, with four doses probably being sufficient in all risk groups if palivizumab is started only when there is RSV activity in the community, especially if doses 2, 3, and 4 are given 38 days apart

Standard dosing is 15 mg/kg administered intramuscularly every 30 days during RSV season for a maximum of five doses.

51
Q

What is Palivizumab?

A

humanized murine monoclonal immunoglobulin G-1 directed against an epitope on the F glycoprotein of RSV, is produced by recombinant DNA technology, and has 95% human and 5% murine amino acid sequences

52
Q

What is the efficacy of synergis?

A

Reduction in hospitalization: 80% in infants with prematurity but without chronic lung disease of prematurity (CLD), of 40% in infants with CLD, and of 45% in children with congenital heart disease (CHD)

53
Q

What are the SI risk factors?

A

Mental illness

Prior attempt (strongest predictor)

Impulsivisty

Precipitating factors

Lack of connection to psychosocial support

54
Q

What are the three components of the assessment for suicide?

A
  1. Ideation
  2. Intent
  3. Plan
55
Q

What is ankyloglossia?

A

Prevalence 4-10%

Typically an isolated congeital anomaly

Possibly a genetic predisposition

56
Q

What are the ancedotal reports of ankyloglossia and breastfeeding?

A

Ankyloglossia

Restriced tongue movement

Poor latch and suck

Low milk supply

Poor weight gain

57
Q

What are the options for pain contorl for frenotomy?

A

Analgesia: Acetaminophen, sucrose or lidcaine

58
Q

What are the main bugs in neonatal ophthalmia?

A

N gonorrhea

C trachomatis

Others: Staph, Strep, Haem, Gram neg

59
Q

What are the recommended management for bronchiolitis?

A

Oxygen

Hydration

60
Q

Breastfeeding advantages

A

Decreases SIDS
Improved cognitive development

Decreased Obesity later in life

Decrease ID: meningitis, bacteremia, gastroenteritis, acute OM, UTI

Decreased malginancies

Decrease DM t1/2

Decreased IBD

61
Q

When does a pneumonia become complicated?

A

Empyema

Abscess

Necrotic lung

62
Q
A

CPS Statements (18 decks)

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